Ear Infection Symptoms & Treatment: A Wimbledon GP Explains

Ear pain, itching, discharge or a blocked feeling in your ear can have several causes, including an outer ear infection or a middle ear infection. Knowing the possible causes, recognising warning signs and getting the right treatment can help prevent complications. In this article, I want to answer the questions I'm most commonly asked about ear infections, from how to spot the symptoms to when you should come in and see a GP in person.

I'm Dr Umer Malik, MBBS, BSc, MRCGP, MPH. I have seventeen years of postgraduate clinical experience, including nine years as a fully qualified GP, and I currently practise at Mayfield Clinic Wimbledon.

What are the symptoms of an ear infection?

Ear infection symptoms vary depending on which part of the ear is affected. Two conditions I see regularly are otitis externa, which affects the outer ear canal, and otitis media, which affects the middle ear behind the eardrum.

Symptoms of otitis externa (outer ear infection) may include ear pain or tenderness, particularly when touching or moving the outer ear, itching or irritation inside the ear canal, discharge from the ear, redness or swelling of the ear canal, a feeling of fullness or blockage, and temporary hearing difficulties if swelling or discharge obstructs the ear canal. Otitis externa can develop following exposure to water, irritation from cotton buds or scratching, or damage to the delicate skin lining the ear canal. Eczema and other skin conditions can also contribute.

Symptoms of otitis media (middle ear infection) may include earache, sometimes developing after a cold, a feeling of pressure or fullness in the ear, a raised temperature, temporary hearing difficulties, feeling generally unwell, and irritability, disturbed sleep or pulling at the ear in young children. Sometimes fluid or discharge comes through the eardrum if it perforates during a middle ear infection.

These symptoms can overlap with other conditions, including earwax build-up, glue ear and skin problems affecting the ear canal. Symptoms alone cannot always establish the diagnosis. If you have persistent or worsening ear pain, discharge or changes in hearing, a GP assessment can help identify the cause and determine the appropriate treatment.

Otitis externa versus otitis media: what's the difference?

Although both conditions can cause earache, otitis externa affects the outer ear canal, whereas otitis media affects the space behind the eardrum. Otitis externa often causes itching, discharge and tenderness when the outer ear is touched or moved. It may occur after swimming, repeated water exposure or irritation of the ear canal.

Otitis media commonly develops during or after a cold or other respiratory infection. It can cause deeper ear pain, pressure, fever and temporary hearing difficulties, and it is particularly common in children. A related condition is glue ear, in which fluid accumulates behind the eardrum without the acute infection and inflammation typically associated with acute otitis media. Glue ear can cause hearing difficulties, especially in children, but may not cause significant ear pain or fever.

Other conditions can also cause ear pain, so it is important not to assume that every episode of earache is an infection. During a consultation, I use an otoscope to examine the ear canal and eardrum, which helps distinguish between possible causes and guides decisions about treatment. The distinction matters because treatment varies. For example, otitis externa is commonly treated with appropriate ear drops, whereas many uncomplicated middle ear infections improve without antibiotics. The choice of treatment depends on the examination findings, symptoms and individual risk factors.

Do I need to see a GP in person for a suspected ear infection?

A face-to-face GP consultation is generally the most appropriate way to assess a suspected ear infection. A telephone or video consultation can help discuss symptoms and establish how urgently you need medical attention. However, it usually cannot provide the examination needed to distinguish reliably between otitis externa, otitis media, earwax build-up and other causes of ear pain.

During an in-person appointment, I can examine the ear canal and eardrum with an otoscope, assess inflammation or discharge and look for signs of other conditions. The examination also helps establish whether the eardrum is intact, which is important when deciding which ear drops are suitable. In some cases, the ear canal may be too swollen or obstructed for the eardrum to be seen clearly, and further assessment may be necessary.

At Mayfield Clinic Wimbledon, we offer face-to-face GP consultations for patients who need their ears examined. If you have earache, itching, discharge, a blocked sensation or other symptoms suggesting an ear infection, please arrange an in-person assessment rather than relying on a video consultation for diagnosis.

How are ear infections treated, and what can I do at home?

Treatment depends on the type of ear problem, the examination findings and how severe the symptoms are. For otitis externa, I may recommend ear drops containing medication to treat infection and reduce inflammation, depending on the suspected cause. If the ear canal is significantly swollen or blocked, professional cleaning or further assessment may be needed.

For acute otitis media, many uncomplicated cases improve within a few days without antibiotics. Depending on the patient's age, symptoms, duration of illness and risk of complications, a clinician may recommend pain relief, observation, a delayed antibiotic prescription or immediate antibiotics where appropriate. Antibiotics are not routinely needed for every ear infection, and the correct treatment depends on the diagnosis.

While symptoms settle, it helps to keep the affected ear dry and avoid swimming until symptoms have improved, avoid inserting cotton buds, fingers or other objects into the ear canal, and avoid attempting to remove earwax or discharge yourself. Don't put unprescribed drops, oils or other remedies into the ear, particularly if you do not know whether the eardrum is intact. Suitable pain relief can also help, following the packet instructions and any advice from your pharmacist or clinician.

If symptoms worsen, do not improve as expected or keep returning, arrange another medical assessment. Persistent or recurrent symptoms may require further investigation or referral to an ear, nose and throat specialist.

When should I seek medical help for an ear infection?

Arrange a GP assessment if you have persistent earache, discharge, itching that does not settle, swelling or changes in hearing. A face-to-face examination can help establish the cause and determine the appropriate treatment.

Some symptoms need more urgent assessment. Seek urgent medical advice if you have severe or worsening ear pain, a high temperature and feel significantly unwell, swelling or redness around or behind the ear, new or worsening hearing difficulties, significant dizziness or problems with balance, or repeated vomiting alongside ear symptoms.

People with diabetes or a weakened immune system should seek prompt medical assessment for suspected otitis externa, particularly if the pain is severe, persistent or worsening.

Seek emergency medical assessment immediately if ear symptoms occur alongside unusual drowsiness, confusion, a severe headache, or neck pain with stiffness, particularly if these symptoms are new or worsening. Call 999 if someone is difficult to wake, collapses or deteriorates rapidly.

Swelling and redness behind the ear, particularly if the ear begins to protrude, can indicate a serious complication such as mastoiditis and requires urgent assessment. Sudden hearing loss developing over three days or less should be assessed urgently, generally within 24 hours, if it is not explained by an obvious outer or middle ear cause. Do not assume sudden hearing loss is simply due to earwax or an ear infection.

If you are concerned about ear pain or a possible ear infection, a face-to-face GP assessment can help identify the cause and determine the most appropriate next steps.

This article provides general information and is not a substitute for individual medical advice. Ear pain and hearing symptoms can have several causes, and treatment should be based on appropriate clinical assessment.

At Mayfield Clinic Wimbledon, you can book an in-person GP consultation for assessment of earache, suspected otitis externa, middle ear infections and other common ear problems. You can find out more about our general practice services in Wimbledon or book a face-to-face private GP appointment directly.