Ear infection symptoms and treatment in adults and children

Two in the morning, and a three year old is awake, crying, and keeps batting at one ear with the flat of her hand. She had a cold last week that seemed to be clearing. Now she is hot, miserable, will not lie flat, and you are in a dark hallway wondering whether this can wait until the surgery opens.

Or you are the adult version: a deep throbbing behind one ear, everything sounding as though it comes through a duvet, and a jaw that aches when you chew. Earache feels far too big for how small the organ is, and at night it is worse.

Ear infections are extremely common, especially in young children, and most settle without antibiotics. Which part of the ear is involved makes a real difference to what helps.

Outer ear or middle ear

These two get lumped together as an ear infection. They are genuinely different problems, in different places, with different causes and treatments.

Otitis externa is an infection of the ear canal, the tube from the outside of your head to the eardrum. Otitis media is an infection behind the eardrum, in the air filled middle ear where the tiny hearing bones sit. You cannot see into either yourself, but they behave differently.

	Outer ear (canal)	Middle ear (behind the drum)
Typical trigger	Swimming, humid weather, cotton buds, earphones, eczema	A cold or blocked nose in the days beforehand
Pain on touching the ear	Yes, tugging the ear or pressing in front of it hurts	Usually not, the pain sits deeper inside
Discharge	Common, often watery or flaky	Only if the eardrum perforates
Who gets it	Any age, often adults	Very common in young children
Usual treatment	Keeping the ear dry, plus ear drops if judged appropriate	Pain relief and time, antibiotics only in certain cases

What you are likely to notice

• Pain in or around the ear, often sharp or throbbing, and reliably worse lying down
• Muffled hearing, as though that ear has been packed with cotton wool
• Pressure or fullness that will not clear when you swallow or yawn
• Fluid or pus coming out of the ear, sometimes with the pain easing suddenly at the same time
• Fever, and feeling generally unwell
• In a baby or toddler: pulling or rubbing the ear, waking repeatedly, refusing feeds, unusual irritability, and sometimes only a temperature

Why children get so many of them

Blame a small tube. The eustachian tube runs from the middle ear to the back of the nose, and its job is to keep the pressure equal and let fluid drain. In a child it is shorter, narrower and lies much flatter than in an adult, so it blocks easily and drains badly. Add a cold, which swells everything, and fluid gets trapped in a warm space where bacteria and viruses thrive.

Children also collect far more colds than adults, especially in their first nursery years, and enlarged adenoids can sit over the opening of that tube. Most children grow out of it as the tube lengthens and tilts. Knowing it is developmental rather than a sign you are doing something wrong takes some sting out of a third round in one winter.

How long it lasts and what to do meanwhile

Middle ear infections often improve substantially within two to three days, and most resolve without an antibiotic. That is why you may be advised to treat the pain and wait, which can feel like being fobbed off and is actually good medicine. Muffled hearing can hang around for a few weeks after the pain has gone, because fluid stays behind the eardrum long after the infection clears. That usually sorts itself out, though it needs checking if it does not.

Pain relief is the priority, so use a painkiller from the pharmacy suitable for you or your child, and ask the pharmacist if unsure. A warm flannel held against the ear soothes surprisingly well. Sleep with the sore ear uppermost, propped on an extra pillow. Keep water out while it is painful or discharging, so no swimming and care in the shower. Nothing goes into the canal: no cotton buds, no olive oil unless told to, no ear candles. If your face feels blocked and heavy too, the sinusitis page is worth a look.

Antibiotics have no effect on viruses, and a good share of ear infections are viral. Where a doctor does judge them clinically appropriate, for instance in a very young child, in someone significantly unwell, when both ears are involved, or when the ear is discharging, they can prescribe. Our page on ear infection treatment sets out what that assessment covers, and the point is that it is a judgement rather than something automatic.

When to get urgent help

Most earache is straightforward. These signs are not, and they need attention quickly:

• Swelling, redness or tenderness of the bone behind the ear, or an ear starting to stick out
• Weakness or drooping on one side of the face, or difficulty closing one eye
• A high fever in a baby, especially under three months, or a baby who is floppy, very drowsy or feeding poorly
• Severe pain along with discharge from the ear
• Hearing loss that does not come back after the infection has settled
• A severe headache, neck stiffness, confusion, or a rash
• Spinning dizziness that stops you standing, or new unsteadiness on your feet
• Earache in someone with diabetes or a weakened immune system

Call 999 for facial weakness, neck stiffness, confusion, a non fading rash, or a baby who is difficult to wake. Call 111 if you are worried, if pharmacy painkillers are not controlling the pain, or if you cannot tell how serious this is.

How an online consultation works for this

You book a time, describe the symptoms, and speak to a UK registered doctor by video. They will want the sequence of events, whether there was a cold first, whether touching the ear hurts, whether there is discharge, what the temperature has been, and how much pain relief is helping. A video call cannot include looking inside the ear with an otoscope, so if the doctor decides the eardrum needs examining they will say so plainly and can write a referral letter. Where a prescription is clinically appropriate, they can issue one.

See how consultations are set up, check the fees in pounds on the prices page, then choose an appointment time. Have the details ready: when it started, the highest temperature recorded, which ear, whether water was involved, and anything already given. For a child, how they are drinking and sleeping tells a doctor a great deal about how unwell they are.

When earache is not an infection

Plenty of ear pain comes from somewhere else. Jaw joint problems and teeth grinding refer pain straight into the ear while the ear itself is fine. A throat infection sends pain up to the ear on the same side through shared nerves, which is why a bad sore throat or tonsillitis so often comes with earache. Impacted wax causes fullness and muffled hearing without much pain, and flying can leave the ear blocked for days.

Then there is the inner ear, a separate system again. It controls balance as well as hearing, so inner ear problems produce spinning, nausea and unsteadiness rather than straightforward pain. If the dominant symptom is the room moving rather than your ear hurting, our article on getting dizziness assessed online is the better starting point.

If the pain is keeping you or your child awake and you would rather have a plan than another night of guessing, book a video call with a UK registered doctor, and get a clear answer on whether an antibiotic is needed or whether time and pain relief will do.