Ear infections and earache — treatment
Reviewed by the My London Pharmacy clinical team, Trishla Shah, Pharmacist Independent Prescriber
·29 July 2026
·7 min read
Quick answer
Earache is common and often caused by an ear infection, a build-up of pressure or wax. Many cases, especially in children, settle within a few days with simple pain relief. When an outer ear infection is present, a clinician may consider medicated ear drops, and persistent or severe symptoms should be assessed.
What causes earache
Earache can come from several sources. The most common is an infection, which may affect the middle ear, the space behind the eardrum, or the outer ear canal, the passage leading to it. Middle ear infections often follow a cold, as congestion stops the ear draining properly, while outer ear infections can be linked to water exposure, irritation of the canal, or skin conditions.
Not all ear pain is an infection. A build-up of earwax, changes in pressure such as during a flight, jaw problems or a sore throat can all cause discomfort felt in the ear. Identifying the likely cause helps guide the right approach, which is why an examination is often useful when symptoms persist.
It also helps to know that the ear is closely connected to the nose and throat, which is why a cold, a blocked nose or a throat infection can lead to referred pain felt in the ear even when the ear itself is healthy. Dental problems and jaw joint strain can do the same. Because so many things can cause pain around the ear, the pattern of your symptoms, and whether you have other signs such as a cold or discharge, gives useful clues about what is going on.
Outer and middle ear infections
It helps to understand that ear infections are not all the same. An outer ear infection, sometimes called swimmer's ear, affects the canal leading to the eardrum. It is often linked to water getting trapped, to irritation from cotton buds or earphones, or to skin conditions such as eczema, and it typically causes itching, a feeling of fullness, and pain when the ear is touched or pulled. Discharge from the canal is common.
A middle ear infection affects the space behind the eardrum and frequently develops during or after a cold, when congestion stops the ear draining. It tends to cause deeper pain, muffled hearing and sometimes a fever, and is especially common in young children. The two types are managed differently: outer ear infections may benefit from medicated drops that treat the canal directly, while many middle ear infections settle on their own with time and pain relief. This is why identifying which type is present, usually by examining the ear, guides the most suitable treatment.
Recognising the symptoms
Depending on the cause, symptoms may include:
- Pain or a feeling of pressure in or around the ear
- Reduced or muffled hearing
- Itching, particularly with outer ear infections
- Fluid or discharge from the ear
- A high temperature or feeling generally unwell
In young children, who cannot always explain the problem, signs can include pulling or rubbing at the ear, irritability, disturbed sleep, reduced appetite or a raised temperature. Ear infections are especially common in children because of the way their ears are structured, and most settle without lasting problems.
Self-care and pain relief
Many ear infections, particularly middle ear infections in children, improve on their own within three to five days. In the meantime, comfort is the priority. Paracetamol or ibuprofen, used as directed and if suitable, can ease pain and reduce fever, and are usually the most helpful first step.
A warm flannel held against the ear may soothe discomfort. It is best to avoid inserting cotton buds or anything else into the ear, as this can cause damage or push wax further in. Keeping the ear dry while it settles is sensible, especially with an outer ear infection. Wax-related earache can often be eased with softening drops from a pharmacy, which loosen the wax so it can clear naturally.
Painkillers tend to be most helpful when taken regularly for the first day or two rather than waiting for pain to build, as long as the dose and timing on the packet are followed and they are suitable for you. If you wear hearing aids or have had ear surgery, it is worth checking with a pharmacist or clinician before using any drops. And while it is tempting to try to clear a blocked or uncomfortable ear yourself, poking or over-cleaning usually makes matters worse rather than better.
When ear drops or antibiotics are considered
For an outer ear infection, where the ear canal is inflamed, a clinician may consider medicated ear drops. Options such as Otomize, which combines an antibiotic with a steroid, or Cetraxal, an antibiotic drop, can treat infection and reduce swelling in the canal. For ear pain linked to a middle ear infection, anaesthetic drops such as Otigo may help ease discomfort where suitable.
Oral antibiotics are not needed for most middle ear infections, which are frequently viral or settle on their own, so they are used selectively. A clinician will examine the ear and choose the most appropriate treatment based on what they find, which is why an accurate diagnosis matters before starting any medicated drops.
Ear drops are used differently depending on the problem, and using the wrong type can be unhelpful, which is another reason a look inside the ear is valuable first. For example, if there is any chance the eardrum is perforated, some drops are avoided, so a clinician checks before recommending treatment. Where drops are appropriate, they are usually used for a set number of days, and it helps to finish the course and use them correctly to give the infection the best chance of settling.
Ear infections in children
Ear infections are very common in childhood, largely because of the way a child's ears and the tubes that drain them are shaped, which makes them more prone to becoming blocked after a cold. Most childhood ear infections are not serious and improve within a few days with comfort measures and appropriate pain relief, and antibiotics are often not needed. A young child may not be able to explain the problem, so signs to look out for include pulling or rubbing at the ear, irritability, disturbed sleep, reduced appetite and a raised temperature.
Keeping a child comfortable with the correct dose of paracetamol or ibuprofen for their age, offering plenty of fluids and allowing rest is usually the mainstay. It is sensible to seek advice if a child is very young, seems particularly unwell, has symptoms that last more than a few days, or has discharge from the ear. Repeated infections or lasting hearing difficulties, sometimes caused by fluid staying behind the eardrum, are worth reviewing, as occasionally further assessment or monitoring is helpful.
Reducing the risk of ear infections
A few simple habits can lower the chance of ear problems, particularly outer ear infections. Keeping the ears dry is one of the most effective, so it helps to dry them gently after swimming or bathing and to avoid getting water trapped in the canal. Some people who swim regularly find that keeping water out with suitable earplugs reduces recurrences.
It is best to avoid cleaning inside the ears with cotton buds, as this can scratch the delicate skin of the canal and push wax deeper, both of which can lead to problems. The ears are largely self-cleaning, so leaving them alone is usually the safest approach. Managing colds and allergies well can also reduce the congestion that contributes to middle ear infections.
Recurrent or ongoing ear problems
Some people experience repeated ear infections or ongoing symptoms such as reduced hearing or a blocked feeling. Frequent outer ear infections can be linked to skin conditions, water exposure from swimming, or habits that irritate the canal such as using cotton buds.
If ear problems keep returning, or hearing does not fully recover between episodes, it is worth seeking review so any underlying factors can be identified and managed. Persistent fluid behind the eardrum, sometimes called glue ear, is a common cause of reduced hearing in children and may need monitoring.
When to seek medical help
See a clinician if earache lasts more than about three days, keeps coming back, or comes with discharge, swelling behind the ear, or a high temperature that does not settle. Ear infections in very young children, or in anyone with a weakened immune system, should be reviewed sooner rather than waiting.
Seek urgent help for severe pain with swelling and redness behind the ear, dizziness with a spinning sensation, facial weakness, or a sudden loss of hearing, as these need prompt assessment. While such complications are uncommon, recognising them means the right help is sought quickly.
Frequently asked questions
Do ear infections need antibiotics?
Many middle ear infections are viral and clear on their own within a few days, so antibiotics are often not needed. A clinician examines the ear and decides whether treatment such as ear drops or antibiotics is appropriate.
How long should earache last?
Ear infections frequently improve within three to five days. If pain lasts longer than about three days, keeps returning, or comes with discharge or a high temperature, seek advice.
What can I do for earache at home?
Simple pain relief such as paracetamol or ibuprofen, if suitable, and a warm flannel against the ear can ease discomfort. Avoid inserting anything into the ear and try to keep it dry.
When are ear drops used?
Medicated ear drops are typically used for outer ear infections, where the ear canal is inflamed. A clinician can examine the ear and advise whether drops are the right treatment.
When is earache an emergency?
Get urgent help for severe pain with swelling and redness behind the ear, dizziness with spinning, facial weakness, or a sudden loss of hearing, as these need prompt assessment.