In short
Most ear infections clear within three days without antibiotics. Which part of the ear is infected changes the treatment completely, and swelling behind the ear is the sign that needs urgent care.
Emergency if: Swelling or tenderness of the bone behind the ear with the ear pushed forward, facial weakness, stiff neck, confusion, or a severely unwell infant.
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On this page
01
Three different problems, three different treatments
Middle ear infection sits behind the eardrum and typically follows a cold, when the tube linking the middle ear to the throat becomes blocked and fluid collects. It causes deep, throbbing pain and muffled hearing, and is most common in young children because that tube is shorter and more horizontal.
Outer ear infection affects the canal between the outside and the eardrum. It is often linked to water exposure or to something being pushed into the ear, and is distinguished by pain when the outer ear is pulled or pressed, and by itch and discharge. It is treated with eardrops rather than tablets, because the medicine can reach the surface directly. Glue ear is different again: painless fluid persisting behind the eardrum after infection has settled, causing dulled hearing.
02
How long it takes, and antibiotics
Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week. That natural course is why immediate antibiotics are usually not the first response for an otherwise well older child or adult with a middle ear infection. Treatment depends on what is causing it and which part of the ear is infected, and may include antibiotic tablets or eardrops.
Antibiotics are more readily given to babies and very young children, when both ears are affected, when there is discharge through a perforated eardrum, when someone is unwell or has a condition that weakens the immune system, or when symptoms are not improving after two to three days. A delayed prescription, to be used only if things have not improved, is a reasonable middle path.
03
Pain relief and what not to do
Regular paracetamol or ibuprofen at the correct dose for age and weight is the mainstay, and giving it on schedule for the first day or two controls pain far better than waiting for it to build. A warm cloth held against the ear is comforting. Sleeping slightly propped up can ease the pressure.
Do not put anything inside the ear to remove earwax, including cotton buds or a finger, and keep water and shampoo out of the ear while it is infected. Olive oil or other drops should not be used if there is any chance the eardrum has perforated. Unproven remedies poured into the ear risk real harm and should be avoided.
04
A perforated eardrum and discharge
Sometimes pressure builds until the eardrum tears, releasing fluid or pus into the ear canal. Paradoxically, the pain usually eases sharply at that moment, which can be mistaken for recovery. Discharge coming from the ear should always be assessed rather than assumed to be resolution.
Most perforations heal on their own over several weeks. While healing, the ear is kept dry — no swimming, and care in the shower. Hearing that has not returned to normal once the ear has settled, or discharge that continues, needs review, because persistent perforation and chronic infection need specific management.
05
Glue ear and repeated infections
After an infection settles, fluid can remain behind the eardrum for weeks or months without pain, dulling hearing. In children this matters because it happens during the years when speech and learning develop, and it is frequently mistaken for inattention. Most cases resolve on their own, so a period of watchful waiting with a hearing test is standard before anything is done.
When fluid persists and hearing is affected, small ventilation tubes may be offered. Repeated infections are reduced by keeping children away from tobacco smoke, by routine childhood immunisations, and by avoiding feeding a baby lying flat. Breastfeeding is associated with fewer episodes.
06
The signs that need urgent attention
Get urgent medical help for ear infection symptoms alongside swelling around or behind the ear, fluid coming out of the ear, a change in hearing or new hearing loss, feeling sick or vomiting, dizziness, a severe sore throat, being generally unwell or having a very high temperature, or having an underlying health condition that raises risk.
Swelling and tenderness of the bone behind the ear, with the ear pushed forward, suggests infection has spread into that bone and needs emergency assessment. So do a severe headache with a stiff neck, confusion, weakness of one side of the face, or a very unwell infant. These are uncommon, but they are the reason ear pain with those features is never left overnight.
When to act
Routine — see a doctor
Ear pain in an otherwise well older child or adult: regular pain relief and review after two to three days if it has not started improving.
Same-day — call promptly
Discharge from the ear, new hearing loss, a baby under 2 with both ears affected, a very high temperature, or a weakened immune system.
Emergency — act now
Swelling or tenderness of the bone behind the ear with the ear pushed forward, facial weakness, stiff neck, confusion, or a severely unwell infant.
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Sources
- Ear Infections — NHSnhs.uk
- Ear Infections — MedlinePlusmedlineplus.gov
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