Infection of the middle or outer ear. Extremely common in children under 5. Causes significant pain and can affect hearing. Most resolve with or without antibiotics but need assessment.
Identify the location. Middle ear infection (otitis media) — pain felt deep inside the ear, often following a cold, with muffled hearing and sometimes fever. Outer ear infection (otitis externa, swimmer's ear) — pain in the ear canal, worsens when you pull the outer ear, often follows swimming or moisture in the ear.
For pain relief: paracetamol or ibuprofen taken regularly rather than waiting for pain to become severe.
Warm compress against the ear — a warm cloth or warm water bottle wrapped in cloth — provides significant pain relief.
Keep the ear dry. Do not allow water to enter the ear canal during bathing — cover with a cotton wool ball lightly coated in petroleum jelly.
Do not insert anything into the ear canal — no cotton buds, pins, or fingers. This pushes infection deeper and damages the delicate canal.
Most middle ear infections in children over 2 years resolve without antibiotics within 2 to 3 days. Pain management and monitoring is appropriate for mild cases.
Children under 2 with ear infection should see a doctor — they are at higher risk of complications.
If discharge is coming from the ear — the eardrum may have perforated. This is actually a sign the pressure has relieved and the pain usually improves. Keep the ear dry and see a doctor.
Swelling, redness, and tenderness behind the ear — mastoiditis, serious complication.
Facial weakness on the same side as the ear infection.
Severe dizziness or balance problems with ear pain.
Discharge from the ear in a child under 2.
High fever above 39°C with ear pain.
No improvement after 48 to 72 hours of pain management.
Never insert anything into the ear canal.
Do not use ear drops unless prescribed — some drops are harmful if the eardrum has perforated.
Recurrent ear infections in children cause cumulative hearing loss — get medical assessment.
Do not ignore ear infection in an infant — they cannot describe the pain and may just be unusually irritable.
✓ What Helps
· Paracetamol or ibuprofen for pain — ibuprofen is particularly effective for ear pain
· Warm compress for pain relief
· Olive oil drops — 2 to 3 drops of warm olive oil in the ear canal for pain relief in otitis externa
✗ What To Avoid
· Cotton buds in the ear canal
· Swimming or allowing water in the ear during infection
· Prescribed ear drops if the eardrum is perforated — check with a doctor first
→ Ask The Pharmacist For
· Amoxicillin if antibiotic is needed — standard first-line for middle ear infection
· Otomize or Sofradex ear drops for outer ear infection only — not if eardrum perforated
· Audiometry referral if recurrent infections affecting hearing
🏥 Get Professional Help
See a doctor for ear infection in a child under 2, any ear infection with fever above 39°C, swelling behind the ear, facial weakness, or no improvement after 3 days of pain management. All ear infections with discharge should be assessed.