Ear infections: treatment, symptoms and when to see a doctor

The NHS says treatment depends on what is causing the infection and which part of the ear is infected. A pharmacist or GP may give antibiotic tablets or eardrops, antifungal or steroid eardrops, or painkilling eardrops. If there is a spot or boil in the ear, a GP may pierce it with a needle to drain the pus. The NHS adds that eardrops may not work if they are not used correctly.

For middle ear infection in children, the NICE guideline on acute otitis media says it is a self-limiting infection that mainly affects children, that most children and young people get better within 3 days without antibiotics, and that complications such as mastoiditis are rare. It recommends offering regular paracetamol or ibuprofen for pain, using the right dose for age or weight, and considering eardrops containing an anaesthetic and an analgesic if an immediate antibiotic is not given and there is no perforation or discharge.

NICE says to consider no antibiotic prescription or a back-up antibiotic prescription for most children, because antibiotics make little difference to symptoms or to common complications. A back-up prescription is used if symptoms do not start to improve within 3 days or worsen rapidly. Children with discharge from the ear, or under 2 years with infection in both ears, may be more likely to benefit. An immediate antibiotic is offered to children who are systemically very unwell or at high risk of complications, and hospital referral is advised for severe systemic infection or complications such as mastoiditis, meningitis or facial nerve paralysis.

NICE and the NHS both say decongestants and antihistamines do not help ear infection symptoms.

The NHS lists things that help ease pain and discomfort while an ear infection runs its course.

• Use painkillers such as paracetamol or ibuprofen. Children under 16 should not take aspirin.

• Remove any discharge by wiping the ear with cotton wool.

• Do not put anything inside your ear to remove earwax, such as cotton buds or your finger.

• Do not let water or shampoo get in your ear, and do not go swimming while you have an ear infection.

• Do not use decongestants or antihistamines. The NHS says there is no evidence they help.

• If you or your child have a high temperature or do not feel well enough for normal activities, stay at home and avoid contact with other people until you feel better.

The NHS says symptoms of an ear infection usually start quickly and include pain inside the ear (earache), a high temperature, difficulty hearing, discharge running out of the ear, a feeling of pressure or fullness inside the ear, itching and irritation in and around the ear, and scaly skin in and around the ear.

Young children and babies may also rub or pull their ear, not react to some sounds, be irritable or restless, be off their food or keep losing their balance.

The NHS describes three types of ear infection, which differ in who they affect and what causes them.

The NHS says ear infections are particularly common in children, and middle ear infection usually affects children. A pharmacist can see children aged 1 to 17 with a suspected ear infection and can give the same treatments as a GP, or direct you to other medical help. See a GP if your child is under 12 months old and you think they have an ear infection. Ask for an urgent GP appointment or call NHS 111 if a child under 12 months has earache in both ears. Call 111 if you need advice for a child under 5.

The NHS suggests ways to reduce the chance of ear infections in children: making sure your child has had all their childhood vaccinations, keeping them away from smoky environments, and trying not to give a dummy after they are 6 months old. NICE says to assess and manage a child under 5 with fever as set out in its fever guideline.

The NHS says middle ear infections are caused by viruses like colds and flu. It advises that if you or your child have a high temperature or do not feel well enough to do normal activities, you should try to stay at home and avoid contact with other people until you feel better.

The NHS says the GP or pharmacist may use an otoscope, an instrument with a small light and magnifying glass, to look in your ear. Some otoscopes blow a small puff of air into the ear to check for blockages, which could be a sign of infection.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 now if you or your child have symptoms of an ear infection and: feel generally unwell, have a very high temperature or feel hot, cold or shivery, have swelling around the ear, have fluid coming out of the ear, have a change in hearing or new hearing loss, feel or are sick, feel dizzy or have a severe sore throat, have diabetes or a heart, lung, kidney or neurological condition, or have a weakened immune system, for example because of chemotherapy.

The NHS describes mastoiditis as a rare but serious infection of the bone behind the ear. Symptoms include pain, redness, tenderness or swelling behind the ear, which can make the ear stick out, discharge, high temperature and headache. It can lead to serious problems such as permanent hearing loss or meningitis if not treated quickly, and needs urgent help from a GP or NHS 111. Treatment is with antibiotics through a drip in hospital and sometimes drainage or surgery.

The NHS says you cannot always prevent ear infections, particularly those caused by colds and flu. It advises not sticking cotton buds or fingers in your ears, using earplugs or a swimming hat over your ears when you swim, and trying to avoid water or shampoo getting into your ears in the shower or bath, for example with cotton wool smeared with petroleum jelly. It also advises treating conditions that affect your ears, such as eczema or an allergy to hearing aids.

To use eardrops correctly, the NHS says to remove any discharge or earwax using cotton wool, lie on your side with the affected ear facing up, gently pull and push your ear to work the drops in, and stay lying down for 5 minutes so the drops do not come out.

Most ear infections are managed by a pharmacist or GP. For recurrent infections, discharge that persists, hearing loss or complications, referral to ear, nose and throat (ENT) services is usual. Private ENT and audiology appointments are available for people who want a quicker specialist review, with the same assessment and treatment principles, and findings should be shared with your GP.