A throbbing earache at 2 am, a child pulling at their ear after a cold, or sudden muffled hearing can make an ear infection feel urgent. Most are not dangerous, but the right next step depends on where the infection is, how severe the symptoms are and whether they are improving.
Ear infections are common in children, though adults get them too. A GP can assess your symptoms, advise whether treatment is needed and identify situations where an in-person ear examination is the safest option.
What is an ear infection?
The term ear infection covers inflammation or infection in different parts of the ear. The location matters because the cause and treatment can differ.
An outer ear infection, also called otitis externa, affects the ear canal between the outer ear and eardrum. It is often linked to water remaining in the ear after swimming, irritation from earbuds or hearing aids, eczema, or attempts to clean wax from the canal. It is sometimes called swimmer’s ear.
A middle ear infection, or otitis media, occurs behind the eardrum. It commonly follows a cold, flu or other upper respiratory infection. Swelling around the Eustachian tube can trap fluid in the middle ear, creating pressure and sometimes allowing bacteria or viruses to cause infection.
Fluid can also remain behind the eardrum after an infection has settled. This may create a blocked feeling or temporary hearing changes without causing severe pain or fever. It does not always need antibiotics, but ongoing symptoms should be checked.
Ear infection symptoms to look out for
Symptoms vary with age and the part of the ear involved. With a middle ear infection, people may notice ear pain, pressure, reduced hearing, a fever, irritability, poor sleep or fluid leaking from the ear. Pain can feel worse when lying down.
Babies and young children cannot always explain what hurts. They may cry more than usual, pull or rub an ear, refuse feeds, be unsettled at night or seem less responsive to sound. Ear pulling alone does not prove an infection, particularly in teething babies, but it is worth considering alongside other symptoms.
Outer ear infections often cause itchiness at first, followed by pain, tenderness and discharge. The ear may hurt when you gently move the outer ear or press the small flap of cartilage at the entrance to the ear canal. The canal can feel swollen or blocked.
A blocked ear after a flight, a cold or swimming is not automatically an infection. Wax build-up, changes in pressure and fluid behind the eardrum can cause similar sensations. That is one reason an assessment is more useful than choosing antibiotic drops or tablets without advice.
Why ear infections happen
Young children are especially prone to middle ear infections because their Eustachian tubes are smaller and sit more horizontally than those of adults. This makes drainage less effective. Colds picked up at childcare or school can add to the problem.
For adults, ear infections can follow a respiratory illness, allergies that cause nasal congestion, smoking or exposure to smoke, and changes in air pressure. Outer ear infections are more likely after swimming, humid weather, skin irritation or inserting cotton buds and other objects into the ear canal.
Cotton buds deserve a special mention. They can push wax deeper, scratch delicate skin and increase the risk of an outer ear infection. Ears usually clear wax naturally. If wax is causing hearing loss, pain or repeated blockage, a GP can advise the safest way to manage it.
What you can do for ear pain at home
Pain relief is often the most helpful first step while you arrange medical advice. Paracetamol or ibuprofen may help when taken as directed on the pack, if they are suitable for you or your child. Ask a pharmacist or GP if you are unsure about the right option, particularly for young children, pregnancy, kidney disease, stomach ulcers or other medicines.
Rest and fluids can help if an ear infection has developed alongside a cold. A warm compress held gently against the outside of the ear may be comforting. Keep an ear that is leaking dry unless a clinician gives different instructions. Avoid swimming until it has been assessed and settles.
Do not put oils, hydrogen peroxide, leftover ear drops or anything else into the ear unless a clinician has recommended it. This is particularly important if there is discharge, a known hole in the eardrum, grommets or previous ear surgery. Some products can irritate the ear or are unsuitable when the eardrum is not intact.
Decongestants and antihistamines do not reliably treat a middle ear infection, even when congestion is present. They can also cause side effects, and some are not appropriate for children. Targeted advice is better than trying several products at once.
Do antibiotics treat every ear infection?
No. Many middle ear infections are caused by viruses or improve without antibiotics. Antibiotics do not ease every earache, and using them when they are unlikely to help can cause side effects such as diarrhoea, rash or thrush. It also contributes to antibiotic resistance.
A GP may recommend monitoring symptoms and focusing on pain relief when the illness appears mild and the person is otherwise well. Antibiotics may be considered when symptoms are severe, persistent, worsening, associated with particular risk factors, or when examination suggests a bacterial infection that is likely to benefit.
Outer ear infections are managed differently. Prescription ear drops are often used, and the choice depends on what the GP sees, whether the ear canal is swollen and whether the eardrum can be safely treated with particular drops. Oral antibiotics are not routinely needed for uncomplicated outer ear infections.
If antibiotics are prescribed, take them exactly as directed and complete the course unless the prescriber tells you otherwise. Contact the clinic if you develop a rash, breathing difficulty, severe diarrhoea or another concerning reaction.
When to see a GP for an ear infection
It is sensible to speak with a GP if ear pain is significant, symptoms are not starting to improve within 48 hours, there is discharge from the ear, or hearing remains reduced. Babies under six months with suspected ear pain or fever should be assessed promptly. Children with repeated infections, speech or hearing concerns, or fluid that does not clear may need follow-up.
A phone or video consultation can be a convenient starting point for discussing symptoms, pain relief, medication safety and next steps. However, a GP may recommend an in-person examination because looking at the ear canal and eardrum is often necessary to confirm the cause. This is especially likely with discharge, marked hearing changes, severe pain or symptoms that keep returning.
For straightforward, non-emergency concerns, TeleDoc connects Australians with Australian-registered GPs by phone or video, without the wait for a clinic appointment. If an in-person review is needed, your GP can explain why and help you decide what to do next.
Get urgent help for these warning signs
Seek urgent medical care if there is swelling, redness or tenderness behind the ear, or if the ear is pushed forward. This can rarely indicate a more serious infection in the bone behind the ear.
Urgent assessment is also needed for severe headache, a stiff neck, confusion, extreme drowsiness, weakness in the face, persistent vomiting, severe dizziness, a very high fever or a child who appears seriously unwell. Call emergency services for symptoms that are severe or rapidly worsening.
People with diabetes, a weakened immune system or significant chronic illness should seek prompt advice for outer ear pain, discharge or swelling. In these circumstances, infections can sometimes progress more quickly.
Preventing repeat ear problems
You cannot prevent every ear infection, particularly those that follow ordinary colds. You can reduce the chance of outer ear irritation by drying the outside of the ears gently after swimming or showering, avoiding objects in the ear canal and using well-fitting ear protection only when it is appropriate for you.
For children, keeping vaccinations up to date, avoiding cigarette smoke and practising regular hand hygiene can help reduce respiratory infections that may lead to middle ear problems. If repeated infections are disrupting sleep, work, childcare or hearing, do not simply keep treating the pain at home. A GP review can provide a clearer plan and reassurance about what needs attention now.
Ear pain is unpleasant, but you do not have to guess your way through it. Start with safe pain relief, watch for warning signs and get professional advice when symptoms are severe, persistent or uncertain.
