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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. An ear infection is assessed by video from the symptom pattern and the tragus test on camera; antibiotics or ear drops are prescribed when criteria are met, and the doctor is honest about when the eardrum needs an in-person look.
- What it is: a middle ear infection (otitis media) is fluid and inflammation behind the eardrum after a cold, viral in most cases; an outer ear infection (otitis externa, swimmer's ear) is inflammation of the ear canal, usually bacterial or fungal after water or scratching.
- How long: most middle ear infections settle within 3 days, and muffled hearing can outlast the pain by 2 to 4 weeks while fluid drains; outer ear infections clear within 7 to 10 days of drops.
- Antibiotics: considered for a middle ear infection when symptoms are severe, there is discharge, both ears are infected in a child under 2, or there is no improvement after 3 days; ear drops, not tablets, treat the ear canal.
- Pain relief: regular paracetamol or ibuprofen taken on schedule is the first treatment for almost every ear infection, and it matters more than antibiotics in the first 48 hours.
- Emergency: call 112 for an ear infection with a stiff neck, confusion, a seizure, or a child who is floppy or hard to wake; swelling or redness behind the ear, an ear pushed outwards or new facial weakness need in-person care now.
Online care suits most straightforward ear infections. Get in-person care the same day for redness or swelling behind the ear, an ear that is starting to stick out, new facial weakness, severe headache with a stiff neck, confusion or unusual drowsiness, or a baby under six months with fever. A child who is getting sleepier, floppier or harder to wake needs to be examined, not booked online.
Can an online doctor treat an ear infection?
Often, yes. A structured history plus a look at the outer ear on camera can usually establish whether an ear infection is likely and whether it needs antibiotics or just pain relief; most middle ear infections clear within about three days.[1] A video call cannot see the eardrum, so uncertain or higher-risk cases are sent for in-person examination.
This page covers ear infection as a diagnosis, in both its common forms: middle ear infection (otitis media), which usually follows a cold, and outer ear canal infection (otitis externa), which usually follows water or cotton buds. If you have ear pain and do not yet know why, start with the guide to earache and ear pain, which walks through all the causes, including the ones that are not infections. If the problem is clearly the canal after swimming, the dedicated swimmer’s ear page covers drops and keep-dry care in full, so this page keeps only a summary.
Listen: Ear Infection Treatment Online
The audio version of this topic from the Mobi Doctor podcast. Open the episode.
How an online consultation helps with an ear infection
- Middle ear or ear canal: the two infections feel similar but are treated differently, one with pain relief and sometimes oral antibiotics, the other with ear drops. The symptom pattern separates them reliably in most cases.
- Antibiotics only when criteria are met: guideline criteria, not reflex prescribing. Most middle ear infections resolve on their own, so the doctor prescribes when defined markers are present and explains a backup plan when they are not.
- Your observations matter: fever pattern, ear pain, sleep, hearing changes and how the ear feels hour to hour are the raw material of the assessment. You leave knowing exactly which changes mean re-assessment.
- Honesty about the eardrum: no online service can perform otoscopy. When the diagnosis genuinely depends on seeing the eardrum, the doctor says so and directs you to an in-person examination instead of guessing.
📷 Photograph what is visible: the outer ear in daylight, the canal entrance, any discharge on a clean tissue, and any redness or swelling around or behind the ear. On the call the doctor looks at the outer ear on camera. No photo can show the eardrum itself, and the doctor never pretends otherwise.
What the doctor checks in an online ear infection consultation
The assessment is structured around three questions: which part of the ear, does it need antibiotics, and is anything dangerous developing. The doctor will typically assess:
- The story: pain after days of a cold points to the middle ear; itch turning to pain after swimming, humid weather or cotton-bud use points to the canal.
- The tragus test, guided on camera: pain when the small flap in front of the canal is pressed, or when the outer ear is pulled, is typical of canal infection rather than middle ear infection.[3]
- Fever and general state: in children especially, drinking, wet nappies, alertness and how they respond to you matter more than the thermometer reading alone.
- Discharge: sudden relief of pain followed by fluid from the ear suggests the eardrum has perforated, which changes both treatment and follow-up.
- Hearing change: muffled hearing is expected during a middle ear infection; the doctor checks it is recent, one-sided and explained by the infection.
- Risk factors that lower the antibiotic threshold: age under 2 with both ears affected, discharge, significant systemic illness, grommets, diabetes or a weakened immune system.[1]
- The red-flag screen, actively: swelling or redness behind the ear, an ear pushed outwards, facial weakness, stiff neck, drowsiness or confusion.
Is it a middle ear infection or an outer ear infection?
A middle ear infection sits behind the eardrum, usually follows a cold, and causes deep pain, muffled hearing and often fever, most commonly in children. An outer ear infection involves the ear canal itself, usually follows water exposure or scratching, and causes itch, tenderness when the ear is touched, and pain on chewing. The two are treated differently, so the distinction matters.
Otitis media: behind the eardrum
Cold viruses inflame the tube that ventilates the middle ear; trapped fluid becomes infected, pressure builds, and the ear hurts. It is one of the most common childhood infections and much rarer in adults, where a first episode still deserves proper assessment. Most cases settle within about three days with pain relief alone.[2] After the infection, fluid can linger for weeks and muffle hearing before it drains; persistent muffled hearing is covered on the hearing loss page.
Otitis externa: the ear canal
Water, humidity, eczema and cotton buds strip the canal’s protective wax and let bacteria in. The treatment is topical: antibiotic or antiseptic ear drops, not oral antibiotics, plus strict keep-dry care.[3] Because it is so strongly linked to swimming, it is covered in depth on the swimmer’s ear page, including the drops, the technique and the prevention routine that stops the next one.
Do I need antibiotics for an ear infection?
Usually not. Most middle ear infections resolve within about three days with pain relief alone, and antibiotics make little difference to pain for most people while adding side effects and resistance.[5] Doctors reserve them for defined groups: children under 2 with infection in both ears, ear discharge, significant systemic illness, or symptoms not settling.[1]
Antibiotics are only prescribed when there are genuine signs of bacterial infection meeting these criteria; they do nothing for the viral infections behind most ear trouble, and every unnecessary course makes resistance worse for everyone. Where the picture is borderline, the doctor can agree a backup prescription: one you activate only if things have not begun to improve after two to three days.[1] You stay covered without taking medicine you probably do not need. Ear canal infections are different again: the antibiotic goes in as drops, reaching the infection directly at far higher concentrations than tablets could.
How long does an ear infection last?
A typical middle ear infection hurts most in the first 24 to 48 hours and settles within about three days, occasionally up to a week.[2] Ear canal infections usually improve within a few days of starting drops, with a full course running 7–14 days. Muffled hearing can outlast the pain by several weeks while fluid drains.
Two timelines deserve respect. Pain worsening after three days despite proper pain relief needs re-assessment, because that is where treatment changes. And an ear still discharging, or hearing still muffled, beyond two to four weeks needs an in-person look at the eardrum to check for persistent perforation or trapped fluid, rather than another course of anything.[2]
Ear infections in children
Children get middle ear infections constantly, for anatomical reasons: their ventilation tubes are shorter and more horizontal, so cold viruses reach the middle ear easily, and nursery supplies the colds. The practical playbook for parents:
- Treat the pain properly: paracetamol or ibuprofen at the weight-appropriate dose on the packet, given regularly rather than only at crisis point, is the treatment that actually changes how the night goes.[1]
- Watch the child, not just the ear: a child who is drinking, playing between grumbles and consolable is reassuring; one who is listless, refusing fluids, or getting worse after day two or three needs review.
- Expect the hearing dip: days to weeks of mild muffling after an infection is common while fluid drains. Mention it at school if it lingers, and have it checked if it has not cleared in around a month.
- Count the episodes: frequent repeat infections, or persistent fluid with hearing difficulty ("glue ear"), are a reason for referral to ear specialists to discuss options such as grommets, because long-running hearing loss can affect speech and learning.[4]
Most childhood ear infections need assessment, pain treatment and safety-netting rather than a procedure, but that assessment happens in person: Mobi Doctor does not see children at the moment. The exceptions are always in-person: babies under six months, children who look seriously unwell, and any red-flag sign go to in-person care immediately.
Which ear infection treatment might the doctor recommend?
Treatment follows the site of infection and the risk group. This is the decision framework the doctors use, aligned with the cited guidance:[1]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Ear pain during or after a cold, no discharge, otherwise well | Regular paracetamol or ibuprofen; most settle within about three days without antibiotics | Usually yes | Not improving after 2–3 days, worsening pain, or any red-flag sign |
| Child under 2 with both ears affected, ear discharge, or marked systemic illness | Antibiotics often indicated after assessment, alongside pain relief | Often yes | Baby under 6 months, dehydration, or a child who looks seriously unwell |
| Itchy, tender ear canal after swimming or cotton buds, pain on pulling the ear | Antibiotic or antiseptic ear drops plus strict keep-dry care | Usually yes | Spreading redness or swelling, severe pain, diabetes or a weakened immune system |
| Discharge after sudden relief of pain (likely perforated eardrum) | Assessment first; some ear drops are unsuitable with a perforation | Case-dependent | Discharge beyond 1–2 weeks, or hearing not recovering: the eardrum needs to be seen |
| Swelling or redness behind the ear, ear pushed forward, facial weakness or stiff neck | Emergency in-person assessment the same day | No | Always; these are signs of a spreading complication |
Not sure which row is your ear? A doctor can tell you in one consultation.
See available times →Treatment options for ear infections
What you can do yourself
Regular paracetamol or ibuprofen is the evidence-backed first treatment for ear infection pain in adults and children; give it on schedule for the first day or two rather than chasing the pain.[1] A warm flannel against the ear soothes, sleeping with the sore ear upwards helps some people, and swallowing or yawning eases pressure. What not to do matters as much: nothing goes into the ear canal, no cotton buds, no warmed oil for a painful infected ear, and no old leftover drops, which may be the wrong treatment entirely or unsafe if the eardrum has perforated. Decongestants and antihistamines do not speed recovery of middle ear infections and are not recommended for them.[2]
Prescription treatment
A prescription is never issued without a consultation. After assessment, a middle ear infection meeting antibiotic criteria is usually treated with a course of amoxicillin, with alternatives for penicillin allergy; where the case is borderline, a backup prescription to start only if symptoms have not improved in 2–3 days is often the smarter route.[1] Ear canal infections are treated with antibiotic, antiseptic or combination ear drops rather than tablets.[3] In pregnancy, ear infections are treated on the same principles with pregnancy-compatible choices, so mention pregnancy or breastfeeding at the start of the consultation.
Flying, swimming and other practical questions
Flying with a middle ear infection is usually possible but can be painful, because a blocked ventilation tube struggles to equalise pressure on descent; swallowing, yawning or gently blowing against a pinched nose helps, and adults can time pain relief for the landing. Diving is different: do not dive with any active ear infection, since the pressure change risks real eardrum damage. Swimming should wait until an ear canal infection has fully settled, and after a perforation the ear must stay dry until the drum has been confirmed healed.
When an ear infection is treated online, and when you need in-person care
Treated online: typical middle ear infections in adults, with a proper pain plan, antibiotic assessment against guideline criteria and clear safety-netting; ear canal infections suitable for drops; backup prescriptions for borderline cases; and reviews when an ear is not following the expected timeline.
In-person care: babies under six months with fever; any sign of mastoiditis or spreading infection; new facial weakness; suspected perforation that is not healing or discharge beyond two weeks; frequent recurrent infections or glue ear needing an ear, nose and throat opinion; persistent one-sided smelly discharge with hearing loss, which needs specialist examination; and any case where the diagnosis genuinely requires seeing the eardrum. In those cases the consultation buys you a clear, fast route to the right examination, not a guess.
When to get in-person care
Go to urgent in-person care for swelling, redness or tenderness behind the ear, an ear starting to protrude, discharge with high fever in someone who looks very unwell, or ear infection symptoms with severe headache and vomiting. If there is facial drooping, a stiff neck with a rash or light sensitivity, confusion, a seizure, or a child who is floppy or hard to wake, call 112 immediately.
Treating an ear infection at home: what helps and what does not
Many ear infections settle by themselves within two or three days, and home care carries you through them: simple pain relief on a regular schedule, a warm compress against the ear, and staying upright when you can. Antibiotics often add nothing to a mild early ear infection in adults.
What home care cannot do: you cannot see your own eardrum. Pain that is worsening after two to three days, discharge from the ear, hearing that drops, dizziness, or an ear infection on top of a weakened immune system needs an examination and sometimes treatment. Repeated ear infections in an adult are also worth investigating properly rather than treating one at a time.
The strongest at-home treatment is still a doctor. A video consultation brings one to your sofa: you can see a doctor over video, usually within 15 minutes, for an honest assessment. If treatment is right, the doctor may prescribe it, to use at a pharmacy near you. Book a video consultation: the exact price is shown before you pay.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about ear infections: a private video call from anywhere in Europe, with photos uploaded beforehand if there is anything visible around the ear.
- Leave with your plan: everything agreed before you hang up: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
No sign-up needed
Not sure it’s an ear infection? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Earache and Ear Pain can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about ear infections
What causes an ear infection?
Most middle ear infections start with a cold: the tube that drains the middle ear swells shut, fluid collects behind the eardrum, and viruses or bacteria multiply in it, which is why they are commonest in winter and in young children with narrow tubes. Outer ear infections are caused by bacteria or fungi getting into a canal softened by water, scratched by cotton buds or irritated by eczema or hearing aids.
What are the symptoms of an ear infection in adults?
A middle ear infection in an adult causes a deep earache that often peaks at night, a feeling of fullness, muffled hearing, sometimes fever and a burst of discharge if the eardrum perforates, which relieves the pain. An outer ear infection itches first, then hurts when the ear is touched or pulled, with a swollen canal, discharge and tenderness in front of the ear.
Is it a middle ear infection or an outer ear infection?
The ear infection is in the canal (swimmer's ear) if it followed swimming or scratching, itched before it hurt, and is tender when you press the flap in front of the ear or pull the earlobe. It is in the middle ear if it followed a cold, the ear feels full and muffled, and pressing the outside does not change the pain. Drops treat the canal; pain relief and sometimes tablets treat the middle ear.
Do I need antibiotics for an ear infection?
Usually not. Most middle ear infections are viral and settle within about three days with regular paracetamol or ibuprofen. Antibiotics are considered when symptoms are severe, there is discharge, both ears are infected in a child under 2, you are immunocompromised, or there is no improvement after three days. Outer ear infections are treated with antibiotic or antifungal ear drops rather than tablets.
Can an online doctor prescribe antibiotics for an ear infection in Europe?
Yes, after a consultation. A prescription is never issued without one: the doctor assesses your ear infection by video first and prescribes antibiotics or ear drops only when guideline criteria are met, because most ear infections clear without them. If the doctor prescribes, the prescription goes to a pharmacy near you with a plan for what to do if you are not improving.
Can a doctor really assess an ear infection without looking inside the ear?
Often, yes, honestly: the pattern of symptoms, the tragus test guided on camera, fever, discharge and hearing changes give a reliable working diagnosis of an ear infection in most straightforward cases. What a video call cannot do is see the eardrum, so when the picture is unclear, the pain is one-sided and persistent, or there are warning signs, the doctor sends you for an in-person examination.
How long does an ear infection last?
A middle ear infection usually hurts for two to three days and settles within a week; muffled hearing can persist for two to four weeks while the fluid behind the eardrum drains, and a perforated eardrum heals within a few weeks. An outer ear infection improves within two to three days of starting drops and clears in seven to ten days. Pain beyond three days or hearing still muffled after a month needs review.
Is an ear infection contagious?
The ear infection itself is not contagious, but the cold viruses that lead to a middle ear infection are, so hand washing and covering coughs protect others from the cold, not the ear infection. Outer ear infections are not passed between people, though sharing earbuds or towels can transfer the bacteria that cause them.
How do I treat an ear infection at home?
Treat an ear infection at home with paracetamol or ibuprofen taken regularly rather than at crisis point, a warm compress against the ear, sleeping with the sore ear uppermost, fluids and rest. Keep the ear dry if there is discharge or a canal infection, and do not put cotton buds or home remedies into the canal. Most middle ear infections settle within three days this way.
Does my child need antibiotics for an ear infection?
Usually not: most childhood middle ear infections settle within about three days with regular paracetamol or ibuprofen. Antibiotics are considered when defined criteria are met, such as an ear infection in both ears under age 2, discharge from the ear, marked general illness or no improvement after three days. Children are seen in person; this service is for adults.
Can I fly or swim with an ear infection?
Flying with a middle ear infection is usually possible but expect pressure pain on descent because the infected ear equalises poorly; swallowing, yawning, drinking during landing and timed pain relief help, and do not fly with a fresh perforation if you can avoid it. Do not swim or dive with any active ear infection, and keep water out of an infected canal for a week after the drops end.
How can I prevent ear infections?
Prevent middle ear infections by treating colds and allergies promptly, not smoking and avoiding smoke, and keeping flu and pneumococcal vaccines up to date. Prevent outer ear infections by drying the ears after swimming, tilting and towelling rather than using cotton buds, using earplugs or a swim cap, treating ear eczema, and keeping hearing aids and earbuds clean.
Is an ear infection different in pregnancy or with diabetes?
In pregnancy, an ear infection is treated with paracetamol first and antibiotics safe in pregnancy only when criteria are met; ibuprofen is avoided in the third trimester. With diabetes or a weakened immune system, an outer ear infection that is severe, spreading or very painful needs prompt in-person care, because the infection can spread to the bone around the ear.
- Otitis media (acute): antimicrobial prescribing (NG91), NICE, National Institute for Health and Care Excellence, 2018 (updated 2022).
- Otitis media - acute: Clinical Knowledge Summary, NICE Clinical Knowledge Summaries, revised 2024.
- Otitis externa: Clinical Knowledge Summary, NICE Clinical Knowledge Summaries, revised 2024.
- Deafness and hearing loss: fact sheet, WHO, World Health Organization, 2025.
- Antibiotics for acute middle ear infection (acute otitis media) in children (Cochrane Review), Cochrane, Cochrane Collaboration, accessed August 2026.
- Ear infections, NHS, National Health Service (UK), accessed October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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Read article →Speak to a doctor about ear infections over video, usually within 15 minutes
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