Patient information · ENT and urgent care
Earache and ear infection
why pain relief matters more than antibiotics
Ear infections are common, painful and usually short. Most are caused by viruses and settle within three days to a week without antibiotics. Treating the pain properly is the priority — it is what makes the difference to how the next few days feel.
Seek medical help urgently if there is
- swelling, redness or tenderness of the bone behind the ear, or the ear being pushed forwards
- a severe headache, stiff neck or dislike of bright light
- weakness of the face on the affected side, or a drooping mouth
- severe dizziness or vertigo, or new hearing loss
- confusion, drowsiness or a child who is very unwell or floppy
- earache in a baby under three months with a fever
Swelling behind the ear can indicate mastoiditis, an infection spreading into the bone, which needs hospital treatment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What to expect
Earache in children often follows a cold and is worse at night and when lying down. There may be a temperature, reduced hearing, irritability, or a child pulling at the ear. Hearing can stay dulled for a few weeks afterwards as fluid clears — that is normal and usually resolves on its own.
Treating the pain
- Paracetamol or ibuprofen at regular intervals, at the dose on the packet for age and weight. Give it before bedtime rather than waiting for the pain to wake them.
- Use one at a time; do not give both together. If the first has not helped after the recommended interval, you may try the other instead.
- A warm flannel held against the ear is soothing for many people.
- Sleeping propped up slightly can reduce night-time pain.
- Do not give aspirin to anyone under 16.
Do
- Keep the ear dry while it is infected
- Let discharge drain out and wipe it away gently from the outside
- Carry on with normal activities if you feel well enough
Do not
- Do not put cotton buds, fingers or anything else into the ear canal
- Do not use ear drops unless they have been prescribed for this problem
- Do not put olive oil or other oils in an actively infected or discharging ear
- Do not fly or dive while the ear is acutely infected if you can avoid it
If the eardrum bursts
A sudden discharge of fluid or pus from the ear, often with the pain easing dramatically at the same moment, usually means the eardrum has perforated. This is common, and it sounds far worse than it is. The hole normally heals by itself within a few weeks. Keep the ear dry — no swimming, and use a cotton wool ball smeared with Vaseline in the outer ear when showering — and arrange a review to check that it has healed.
When antibiotics are used
Antibiotics make little difference to most ear infections but are appropriate when a child is under two with infection in both ears, when there is discharge from the ear, when someone is systemically unwell or at higher risk, or when there has been no improvement after about three days.
Sometimes a delayed prescription is the right answer — you take it away and only use it if things have not improved in a couple of days. That approach avoids unnecessary antibiotics without leaving you stranded over a weekend.
Swimmer's ear (outer ear infection)
Pain when the outer ear is pulled or pressed, itching, and sometimes a watery discharge suggest infection of the ear canal rather than behind the eardrum. It is common after swimming or in people who use cotton buds or earphones a great deal.
- Keep the ear completely dry — no swimming until it has settled.
- Prescription ear drops are usually the treatment, not tablets.
- Do not clean inside the canal; the skin there is fragile and cleaning makes it worse.
- Use a hairdryer on a low, cool setting held at a distance to dry the ear after washing.
When to come back
- no improvement after three days, or symptoms worsening at any point
- discharge continuing for more than a week, or hearing not returning after several weeks
- repeated infections — three or more in six months is worth an ENT opinion
- any concern about a child's hearing, speech or balance
Book an appointment if you need the ear examined, ear drops prescribed, wax removed under direct vision, or a hearing assessment. Our ENT team and earwax removal service run seven days a week and no referral is needed.
Seen today, not next week
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.