Ear infections explained: otitis media and swimmer's ear

The two main types

The ear has three parts, and knowing which is affected shapes the treatment. A middle ear infection (otitis media) occurs behind the eardrum, usually after a cold, when fluid and infection build up in the space that connects to the back of the nose. It is very common in babies and young children because of their anatomy, and causes earache, fever and, in little ones, tugging at the ear and irritability. An outer ear infection (otitis externa, or swimmer's ear) affects the ear canal — the passage leading to the eardrum. It is linked to water getting trapped, or to scratching and cotton-bud use, and causes an itchy, painful, sometimes weepy ear that hurts more when you tug the outer ear.

Middle ear infection (otitis media)

Most middle ear infections are caused by viruses and clear up by themselves within a few days without antibiotics. The mainstay is pain relief and time: paracetamol or ibuprofen can ease the earache and fever, and the illness usually settles as the cold does. Antibiotics are not routinely needed and are reserved for particular situations — for example, very young children, those who are more unwell, or infections that are not improving — where a clinician judges they will help. Sometimes the eardrum bursts, releasing pus and briefly relieving the pain; this usually heals on its own. After an ear infection some children have dulled hearing for a few weeks from fluid behind the eardrum (glue ear), which normally clears.

Outer ear infection (swimmer's ear)

Otitis externa is inflammation or infection of the ear canal, common in swimmers and in people who scratch or poke at their ears. The canal becomes red, swollen, itchy and painful, and there may be a discharge; moving or tugging the ear typically makes it worse. Treatment is usually with ear drops that contain an antibiotic, an antifungal, or a steroid to reduce swelling, prescribed after a clinician looks in the ear. Keeping the ear dry while it heals is important, and it helps to avoid swimming and to keep shampoo and water out of the ear. A key prevention message is to never poke cotton buds or other objects into the ear canal, as this damages the skin and invites infection.

Self-care and prevention

For most ear infections, comfort and patience are the main tools. Pain relief such as paracetamol or ibuprofen (used appropriately for age) helps, and a warm flannel held against the ear can soothe. There is no need to clean inside the ear — earwax is protective, and cotton buds do more harm than good. To prevent swimmer's ear, dry the ears gently after swimming or showering, keep water out during an episode, and avoid inserting anything into the canal; some regular swimmers use well-fitting earplugs. For recurrent middle ear infections in children, a GP may look for contributing factors. Most people recover fully, but ears that keep getting infected, or hearing that stays reduced, are worth a review.

When to seek help and red flags

See a GP or use NHS 111 if an ear infection is not improving after a few days, keeps recurring, if there is fluid or pus draining from the ear, if hearing is reduced and not recovering, or if a baby or young child is affected and unwell. Some features need more urgent attention: swelling, redness or tenderness of the bone behind the ear, the ear starting to stick out, a high fever with severe pain, dizziness or facial weakness, or a stiff neck — these can point to a spreading or serious infection. This is general education, not a diagnosis. If someone has a severe headache with a stiff neck, a rash that does not fade, confusion, or becomes very unwell, treat it as an emergency and call 999.