Ear infections are common and most likely the result of a virus. You might feel unwell with a fever and a low appetite. Ear infections often affect the middle ear, which we term otitis media. The pain comes as infection and debris from our own inflammatory response build up behind the eardrum, pushing it. This gives a feeling of fullness, earache, and hearing may come and go. You may feel pain on the cheek side of the ear or under it, and it might be worse when eating. It's usually just one ear that is affected.
Sometimes infections affect the outer part of the ear. This may be the case if you have symptoms of wetness with white or yellow discharge, and the ear may feel itchy or sore just inside. This points more towards otitis externa, where the ear canal leading to the eardrum is infected.
Ear infections are most commonly caused by a virus, which can give you cold or flu-like symptoms – a runny nose, cough, sore throat, and fever alongside ear pain. Viral respiratory infections are contagious, so maintain good hand hygiene and consider keeping your distance from people while you're coughing and sneezing.
Bacteria can infect the ears, especially with otitis externa, and there is the possibility of passing it on to others if you have discharge, but it's fairly low.
It can be comforting to hold a cool, damp washcloth over the ear to relieve pain. You can remove any discharge from the outside of the ear – just the bit you can see – with a cotton ball pad soaked in boiled water and left to cool, so it's sterile.
There is a rule in medicine that nothing smaller than your elbow should be placed in the ear – it's self-cleaning, and you can potentially cause damage. So avoid anything to clean inside the ear, including water or cotton buds.
Most ear infections get better by themselves within 3 days with rest, plenty of fluids, and painkillers as necessary. In some cases, symptoms can last for up to a week. Viral infections don't respond to antibiotics, and it may only be in exceptional circumstances that your doctor would consider antibiotics for a suspected bacterial ear infection.
If your ear pain has not improved after 3 days, if the pain is severe and not responding to painkillers, you are finding it difficult to maintain fluids or to bring your fever down with medication, speak to your doctor urgently or call 911 outside of working hours. If your hearing has suddenly reduced, and this may be accompanied by discharge and paradoxically your pain improving, your eardrum may have burst (perforated): it's worth getting this checked with your doctor.
If you have severe pain on pressing the bony bit of the skull just behind your ear or there is swelling, seek urgent help.
If you are immunocompromised because of medication or a condition, or you have long-term medical conditions such as heart, lung, kidney, or neurological illnesses, speak to your doctor. If you have a sudden loss of hearing without pain or any other signs of an ear or respiratory infection, you should seek urgent help from your doctor.
You are fit for work if you have an ear infection unless you are feverish or feeling unwell – in which case it may be best to sign yourself off for a day or two and stay home and rest.
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