Ear Infections (Otitis Media and Otitis Externa)

Ear infections are common and can affect the outer ear canal, the eardrum or the space behind the eardrum. They often follow a cold, blocked nose or recent viral illness. Symptoms can include ear pain, pressure, temporary hearing reduction or discharge.
Most ear infections improve on their own, although some cases need GP review depending on symptoms and duration.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What an Ear Infection Is

Ear infections occur when the tissues in or around the ear become inflamed. This may affect:

The outer ear canal (often called otitis externa)
The middle ear behind the eardrum (often called otitis media)
The eardrum itself, which can become inflamed or pressured by fluid

These areas may become irritated by viruses, bacteria, water exposure, wax build-up or skin conditions affecting the ear.

Symptoms may include pain, itching, pressure, temporary hearing changes or discharge or flu-like illness, and most cases improve without treatment.

Bacterial Ear Infections

Most ear infections are linked to viral illnesses, congestion or irritation of the ear canal. A smaller number can be caused by bacteria, particularly when symptoms are more severe or fluid collects behind the eardrum.

Bacterial causes may include:

bacteria affecting the middle ear space
outer ear canal infections related to moisture or skin irritation

It is not possible to confirm a bacterial infection based on symptoms alone. A GP assesses factors such as:

previous episodes without antibiotics, even when bacterial organisms are present.
severity of ear pain
discharge
fever
appearance of the ear canal and eardrum
duration of symptoms

Some bacterial and viral organisms can be associated with ear symptoms. The table below lists a few examples that may be reported in clinical contexts. Symptoms alone cannot confirm the cause and results always need GP assessment.

Type	Organism	Notes
Bacterial	Streptococcus pneumoniae	A common organism associated with middle ear inflammation in some cases.
Bacterial	Haemophilus influenzae	Sometimes linked with ear symptoms following a respiratory infection.
Bacterial	Pseudomonas aeruginosa	More often associated with outer ear irritation, especially when the ear canal is frequently wet.
Viral	Rhinovirus, RSV	Common in upper respiratory infections that can be associated with ear pain or pressure.
Viral	Influenza, seasonal coronaviruses	May contribute to generalised cold or flu-like illness with ear discomfort.

Common Symptoms of an Ear Infection

You may experience:

Ear pain or discomfort
Feeling of pressure or blockage
Temporary hearing reduction
Discharge or fluid leaking from the ear
Itching or irritation in the outer ear canal
Fever (in some cases)
Irritability or disturbed sleep in children

Symptoms often follow a cold or nasal congestion.

Common Reasons to Have an Ear Infection Reviewed by a GP

Speak to a GP if you have:

Symptoms lasting more than 3 to 5 days
Worsening ear pain or pressure
Fluid or discharge from the ear
Hearing reduction that is not returning
Recurrent ear infections
Symptoms after recent swimming or water exposure
Ear symptoms associated with jaw pain or dental issues

A GP can examine the ear canal and eardrum, assess for inflammation and advise on next steps.

Severe Symptoms – Seek Urgent Help

Seek urgent medical care if you develop:

Severe ear pain
Dizziness, spinning sensations or balance problems
High fever or feeling very unwell
Swelling around or behind the ear
A drooping face or facial weakness
Sudden hearing loss
Stiff neck, confusion or drowsiness
Symptoms that rapidly get worse

These features may indicate a more serious condition requiring immediate assessment.

Understanding Typical Symptom Patterns

Symptoms suggesting simple ear inflammation (common)

Mild to moderate ear pain
Temporary hearing reduction
Discomfort after a cold
Itching of the outer ear canal

These symptoms usually improve gradually over time.

Symptoms that may need a GP review

Symptoms lasting more than a few days
Pain that is not improving with simple measures
Frequent or recurrent ear infections
Persistent crackling or popping sensations
Hearing not returning after the illness

A GP can guide you on treatment or further assessment if needed.

When Antibiotics May Be Considered

A GP may consider antibiotics in certain situations, usually based on:

severe or persistent symptoms
discharge from the ear canal
significantly inflamed eardrum on examination
symptoms lasting longer than expected
higher risk of complications
certain recurrent infection patterns

Most ear infections get better without antibiotics, and many are caused by viruses. A GP will advise if antibiotics are appropriate based on your symptoms and clinical findings.