Ear infections: symptoms, care, and when to see a doctor

TL;DR:

Most ear infections clear on their own within a few days.
Not all ear pain needs antibiotics. Pain control comes first.
Know the difference between middle ear infections, fluid, and swimmer’s ear.
See a doctor fast for fever, severe pain, swelling, or discharge.
Good ear care lowers the risk of hearing problems.

Ear infections, a simple guide for families worldwide

Ear infections are common, especially in children under 5. Most cases improve in 2 to 3 days with rest and pain relief. Antibiotics help in some cases, but not all. Knowing the type and the warning signs helps you choose the right care.

The three problems people mix up

Middle ear infection, acute otitis media (AOM). Infection behind the eardrum. Often follows a cold. Pain, fever, and sometimes drainage if the eardrum bursts.=

Otitis media with effusion (OME). Fluid behind the eardrum without active infection. No fever, no strong pain, but hearing can be muffled. It often clears over weeks.
Swimmer’s ear, otitis externa. Infection of the ear canal skin. Pain when the outer ear is pulled, possible swelling. Different treatment than AOM.

What you will notice

Common signs in children: ear pain, night pain, crying, ear pulling, fever, trouble hearing, balance issues, or drainage. Adults feel sharp ear pain, pressure, and muffled hearing. Symptoms can start fast.

First line care at home

Treat pain. Use paracetamol or ibuprofen at weight-based doses unless told otherwise.
Offer fluids and rest.
A warm cloth on the ear can soothe pain.
Keep the ear dry if fluid is leaking.
Do not place cotton buds, oils, or herbal drops in the ear unless a clinician tells you to.
Most uncomplicated cases ease in 48 to 72 hours.

Do you need antibiotics?

Not always. Many AOM cases are viral and settle without antibiotics. Doctors use watchful waiting for some children and adults when symptoms are mild. Antibiotics are used for severe illness, very young children with certain findings, or when symptoms do not improve after 2 to 3 days. Amoxicillin is a common first choice if antibiotics are needed. Your country’s guideline may vary.

How clinicians decide

Doctors consider age, both-ear versus one-ear infection, pain level, fever, eardrum appearance, and risks like immune problems. They may also give a delayed prescription to use only if symptoms persist.

Quick table: when to seek care

Situation	What to do
Severe ear pain, fever 39 C or higher, a child looks very unwell	Seek urgent care today.
Ear swelling, the ear sticks out, or severe tenderness of the outer ear	Seek urgent care. Could be swimmer’s ear or a spread of infection.
Pus or fluid draining from the ear	Contact a clinician within 24 hours. Keep ear dry.
Symptoms not better after 2–3 days of home care	Contact a clinician to review.
Babies under 6 months with suspected ear infection	See a clinician for assessment.
Repeated infections or hearing concerns	Ask about hearing checks and prevention.

What happens at the clinic

A clinician examines the ear with an otoscope. They look for a bulging eardrum, fluid level, or redness. They will ask about pain, fever, and recent colds. If AOM is diagnosed, they may advise watchful waiting with pain control, or start antibiotics based on age and severity. If OME is found, the plan is usually monitoring and hearing checks, not antibiotics.

Pain relief that helps

Pain control matters more than antibiotics in the first two days. Use paracetamol or ibuprofen as directed for age and weight. Ear drops with local anesthetic may help if the eardrum is intact, but this varies by country. Avoid aspirin in children.

Protecting hearing

Fluid behind the eardrum can reduce hearing for weeks. Most children recover, but keep an eye on speech, school, and behavior. Ask for a hearing check if fluid lasts more than 3 months, or sooner if you notice delays. Long-lasting fluid or frequent infections can affect learning. Early care protects hearing.

Prevention tips that work

Keep vaccines up to date, including flu and pneumococcal shots.
Breastfeed if possible.
Avoid cigarette smoke exposure.
Wash hands, manage allergies, and treat nose symptoms from colds.
Dry ears after swimming, and use well-fitting earplugs if prone to swimmer’s ear.
These steps lower risk but cannot prevent all infections.

For coastal and tropical settings

Swimmer’s ear is more common with warm, humid water. Rinse and dry the outer ear after swims. Do not use cotton buds. If you feel canal pain when you pull the ear, or if the canal swells, seek care for eardrops rather than oral antibiotics.

Red flags, do not wait

Stiff neck, severe headache, or swelling behind the ear.
New facial weakness.
A child under 3 months with fever.
Ear infection in people with immune problems or cochlear implants.
These signs are rare but need urgent care.

Why it matters

Ear infections are a top cause of doctor visits in childhood. Most clear fast, but some lead to hearing loss and school problems if not managed. Smart use of pain control and antibiotics helps each child now and protects antibiotics for the future.