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Health condition · Clinically reviewed

Ear infections, from swimmer\'s ear to serious ENT emergencies.

Most settle with simple measures. A small minority need urgent specialist care - knowing which is which matters.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG91, CKS and peer-reviewed ENT sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on delayed prescribing, topical drops and specialist ENT referral.

Key facts

Ear infections at a glance.

The essentials, in plain English - the common types, who they affect and how UK clinicians treat them today.

  • What it is

    A family of infections affecting the outer or middle ear, ranging from swimmer's ear to acute otitis media and rarer complications.

  • Common types

    Otitis externa, acute otitis media, otitis media with effusion (glue ear), chronic suppurative otitis media and mastoiditis.

  • Who gets them

    Otitis media peaks between six months and two years; otitis externa is more common in swimmers and hearing-aid users.

  • First-line care

    Analgesia, aural toilet and topical drops for otitis externa; watchful waiting or delayed antibiotics for most acute otitis media.

  • When to escalate

    Severe pain out of proportion, facial nerve weakness, post-auricular swelling or persistent discharge need urgent ENT.

  • Prevention

    Avoiding cotton buds, drying ears after swimming, vaccinations and reducing tobacco smoke exposure in children.

Why this guide matters

A calm plan, not a panic.

Ear infections are common, mostly self-limiting - and occasionally serious. The three points below shape everything else on this page.

  • Most acute otitis media self-resolves

    Around 60% of cases settle within 72 hours without antibiotics - a delayed prescription is often the right first step.

  • Otitis externa needs the canal cleared

    Aural toilet or microsuction is often more important than the drops themselves - drops need to reach the skin to work.

  • Some presentations are true emergencies

    Facial palsy, mastoid swelling and unrelenting pain in diabetes need same-day ENT - don't wait.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP or ENT specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and symptom pattern

    Pain, hearing loss, discharge, itch, fever and duration - and any prior grommets, perforations or hearing-aid use.

  2. 02

    Assessing

    Otoscopy

    A bulging red drum points to acute otitis media; a swollen debris-filled canal points to otitis externa.

  3. 03

    Assessing

    Tuning fork and tragal tests

    Tragal tenderness supports otitis externa; conductive hearing loss suggests middle-ear involvement.

  4. 04

    Confirming

    Ear swab if discharge

    Culture and sensitivity for persistent, treatment-resistant or post-surgical discharge - especially with suspected Pseudomonas.

  5. 05

    Confirming

    Audiometry and tympanometry

    For suspected effusion, glue ear or recurrent infections - documents hearing loss and middle-ear pressure.

  6. 06

    Escalating

    CT temporal bone if concerning

    For necrotising otitis externa, suspected mastoiditis, facial nerve palsy or suspected cholesteatoma.

  7. 07

    Escalating

    ENT referral

    For chronic disease, recurrent infections, red-flag features or when specialist procedures like grommets are needed.

Typical timeline: most infections settle in a week; recurrent or complicated cases move to ENT.

Symptoms

What ear infections actually feel like.

The classic mix of pain, discharge, muffled hearing and itch - and the features that mean it\'s time to escalate.

  • Ear pain (otalgia)

    A deep aching pain in acute otitis media - or a sharper, tender pain in otitis externa, worse on pulling the pinna.

  • Discharge (otorrhoea)

    Watery, purulent or blood-stained discharge - a hallmark of otitis externa and perforated acute otitis media.

  • Hearing loss and fullness

    A muffled or blocked-ear feeling from swelling, wax or middle-ear fluid.

  • Itching in the canal

    Classic for otitis externa - often the first symptom and easily worsened by cotton buds.

  • Fever and irritability

    More common in acute otitis media, especially in babies and toddlers who may tug at the affected ear.

  • Pop then relief

    Sudden discharge after severe pain suggests the eardrum has perforated - pain typically eases immediately after.

  • Post-auricular swelling

    Tenderness and swelling behind the ear that pushes the pinna forward - a warning sign for mastoiditis.

  • Red flag - severe unremitting pain

    Deep, unrelenting pain in an older or diabetic patient can signal necrotising otitis externa - a same-day ENT emergency.

Treatment

How ear infections are treated in the UK.

Analgesia and aural toilet first, topical drops for the canal, targeted antibiotics for the middle ear - and ENT for the difficult few.

  • Aural toilet and microsuction

    Careful cleaning of the canal - the single most useful step in otitis externa and often needed before drops can work.

  • Topical antibiotic drops

    Ciprofloxacin, Otomize, Sofradex or Locorten-Vioform for otitis externa - chosen with attention to any perforation.

  • Acetic acid drops

    Mild otitis externa or as prevention in swimmers - lowers canal pH and is available over the counter.

  • Antifungal drops

    Clotrimazole for otomycosis - typical after prolonged antibiotic drop use or in humid climates.

  • Analgesia and delayed prescribing

    Paracetamol and ibuprofen with a delayed antibiotic script - most acute otitis media resolves within 72 hours.

  • Immediate oral antibiotics

    Amoxicillin or clarithromycin for severe, bilateral, discharging or systemically unwell cases - typically five to seven days.

  • Grommets and adenoidectomy

    For recurrent acute otitis media or persistent glue ear affecting hearing and development.

  • IV antibiotics and surgery

    Necrotising otitis externa, mastoiditis and chronic suppurative disease need admission, IV therapy and specialist ENT input.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your ears and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Otitis media (acute): antimicrobial prescribing (NG91).

  • NICE Clinical Knowledge Summaries. Otitis externa; Otitis media - acute; Otitis media with effusion.

  • ENT UK. Position papers on chronic suppurative otitis media and mastoiditis.

  • MHRA and BNF. Prescribing guidance for topical and systemic antibiotics.

Red flags

When ear infections need urgent attention.

Most ear infections are manageable in primary care. These are the situations that aren\'t - and where specialist ENT is needed.

  • Necrotising otitis externa

    Severe, unrelenting pain, visible granulation in the canal or facial nerve weakness in a diabetic or immunocompromised patient - a same-day ENT emergency.

  • Mastoiditis

    Fever with post-auricular redness, swelling, tenderness or a protruding pinna - needs urgent ENT and IV antibiotics.

  • Facial nerve palsy

    A new facial weakness alongside ear infection points to a serious complication - refer immediately.

  • Meningism or altered consciousness

    Neck stiffness, photophobia, drowsiness or seizures suggest intracranial spread - call 999.

  • Persistent discharge over six weeks

    Chronic suppurative otitis media or cholesteatoma need ENT review and often specialist surgery.

  • Sudden severe vertigo or deafness

    Suggests labyrinthitis or inner-ear involvement and needs urgent assessment.

  • Immunocompromise or diabetes

    Lowers the threshold for imaging, admission and IV antibiotics in any significant ear infection.

  • Recurrent infections in a child

    Four or more episodes in a year, or three in six months, warrants ENT review and consideration of grommets.

  • Suspected cholesteatoma

    Foul-smelling discharge, hearing loss and a retraction pocket on otoscopy - needs specialist ENT and imaging.

Living with it

A treatable condition, with a clear ladder.

Four habits that make the biggest difference - keeping ears dry, treating pain early, being patient with acute otitis media in children and knowing when to return.

A quiet reminder

Nothing smaller than an elbow in your ear.

Cotton buds are the single most common cause of recurrent otitis externa - the canal cleans itself.

  1. 01 Prevention

    Keep ears dry and untouched

    Dry gently after swimming, avoid cotton buds, and consider acetic acid drops after regular water exposure.

  2. 02 Pain

    Treat pain properly, early

    Paracetamol and ibuprofen at regular doses beat waiting until the pain is severe.

  3. 03 Children

    Watch, don't rush to antibiotics

    Most childhood acute otitis media settles in 72 hours - a delayed script is often the safest plan.

  4. 04 Escalate

    Know when to come back

    Return sooner for facial weakness, worsening pain, swelling behind the ear or symptoms lasting beyond a week.

Frequently asked

Everything we get asked about ear infections.

Quick answers on antibiotics, swimmer\'s ear, grommets and when to worry.

  • What is an ear infection?

    An umbrella term for infections of the outer ear canal (otitis externa) or the middle ear (acute otitis media, otitis media with effusion and chronic suppurative otitis media). Each behaves differently and needs a slightly different plan.

  • Do all ear infections need antibiotics?

    No. Most cases of acute otitis media in otherwise well children settle within 72 hours without antibiotics. NICE NG91 supports watchful waiting or a delayed prescription for most patients, reserving immediate antibiotics for severe, bilateral, discharging or systemically unwell cases.

  • How is swimmer's ear treated?

    Aural toilet or microsuction to clear debris, followed by topical antibiotic or antifungal drops for a week. Simple acetic acid drops help milder cases, and analgesia is important. If swelling closes the canal, a specialist may insert a small wick to deliver the drops.

  • When should I worry about severe ear pain?

    Deep unrelenting pain out of proportion to signs on examination - especially in a diabetic or immunocompromised patient - can signal necrotising otitis externa. This needs same-day ENT assessment. Any new facial weakness or swelling behind the ear also warrants urgent review.

  • What are grommets and who needs them?

    Grommets are tiny ventilation tubes placed through the eardrum to drain middle-ear fluid and equalise pressure. They are offered for recurrent acute otitis media (four or more episodes a year) or persistent glue ear affecting hearing and speech development. See our guide on grommets insertion for details.

  • Can adults get ear infections too?

    Yes. Otitis externa is common in adult swimmers, hearing-aid users and people with eczema. Adult acute otitis media is less frequent than in children but still occurs, and chronic suppurative otitis media, cholesteatoma and necrotising otitis externa are largely adult problems needing specialist ENT care.

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