If you have an ear infection, your first steps are managing the pain at home and deciding whether you need to see a doctor right away or can safely wait a couple of days. Most ear infections cause significant discomfort but resolve on their own or with a short course of treatment. What you should do depends on the type of infection, how severe your symptoms are, and your age.
Figure Out What Type You Have
Ear infections fall into two main categories, and the treatment differs for each. A middle ear infection happens behind the eardrum, often following a cold or upper respiratory illness. It causes deep ear pain, sometimes fever, difficulty sleeping, and a feeling of fullness or muffled hearing. In young children, look for fussiness, tugging at the ear, or trouble settling down.
An outer ear infection, commonly called swimmer’s ear, affects the ear canal itself. It typically starts with itching, then progresses to pain that worsens when you tug on your earlobe or press near the ear opening. The canal may feel swollen, and you might notice discharge. Outer ear infections are usually triggered by water that stays trapped in the ear canal, creating a breeding ground for bacteria.
Start With Pain Relief
Regardless of the type, pain management is the most important thing you can do right away. Over-the-counter pain relievers are effective. Ibuprofen works well because it reduces both pain and inflammation. Take it with food to prevent stomach upset, every six to eight hours as needed, up to four times in 24 hours. Acetaminophen is an alternative you can take every four to six hours, up to five times daily. For children, dose by weight rather than age, and avoid ibuprofen in infants under six months and acetaminophen in infants under eight weeks.
A warm compress held against the ear can also ease the ache. Try alternating between a warm and cool compress every 30 minutes. When using heat, test it on the inside of your wrist first to make sure it won’t burn the skin. These simple measures can make the difference between a miserable night and a manageable one while you wait to see if the infection clears or you get in to see a doctor.
Know When You Can Wait
Not every middle ear infection needs antibiotics. The American Academy of Pediatrics recommends a “watchful waiting” approach for children over six months old whose symptoms are mild: pain that’s been present for less than 48 hours, no fever above 102°F (39°C), and no pus draining from the ear. Under these guidelines, you monitor symptoms for two to three days before starting antibiotics, because many infections clear on their own during that window.
This approach is standard in medical guidelines across the U.S., Europe, Australia, and Asia. The logic is straightforward: unnecessary antibiotics contribute to resistance without speeding recovery in mild cases. During the waiting period, keep managing pain with the methods above. If symptoms worsen or don’t improve after 48 to 72 hours, that’s when antibiotics become appropriate.
For adults with mild symptoms, the same general principle applies. A day or two of watchful waiting with pain relief is reasonable. But if you have a high fever, severe pain, or notice fluid draining from your ear, skip the waiting period and get evaluated promptly.
What Happens at the Doctor
Your doctor will look inside the ear with an otoscope to check the eardrum. A red, bulging eardrum with fluid behind it confirms a middle ear infection. If the infection is severe or has lasted beyond the observation window, you’ll likely get a prescription for antibiotics. For children two and older with non-severe infections, a five to seven day course is typically sufficient, shorter than the traditional ten-day regimen.
Outer ear infections are treated differently. The standard approach is prescription antibiotic ear drops, sometimes combined with a steroid to reduce swelling. To apply them correctly, lie down with the affected ear facing up, squeeze in the prescribed number of drops, and stay in that position for three to five minutes so the medication reaches the full length of the canal. If your ear canal is too swollen for drops to penetrate, your doctor may place a small wick (a tiny piece of compressed material) into the canal to help draw the medication deeper. The wick typically falls out on its own as swelling goes down.
What to Avoid
Don’t put anything inside your ear canal unless your doctor has specifically told you to. Cotton swabs can push debris deeper and worsen an outer ear infection. Ear candles have no proven benefit and carry a real risk of burns. Avoid getting water in an infected ear while it’s healing. When showering, a cotton ball lightly coated with petroleum jelly placed at the ear opening works as a simple barrier.
If you have fluid draining from your ear, don’t use over-the-counter ear drops without medical guidance. Drainage can signal a ruptured eardrum, and certain drop formulations can damage the inner ear if they pass through a perforation. Your doctor will prescribe a type that’s safe to use in that situation.
Symptoms That Need Immediate Attention
Most ear infections are uncomfortable but not dangerous. A small number can spread beyond the ear if left untreated. The bone behind your ear, called the mastoid, is particularly vulnerable. Mastoiditis develops when a middle ear infection migrates into this bone, and it can lead to serious complications including hearing loss, facial paralysis, and in rare cases, meningitis or sepsis.
Get medical care right away if you notice pus or bloody discharge from the ear, sudden hearing loss, swelling or redness behind the ear, a fever that spikes above 102°F, severe pain that suddenly stops (which can indicate a ruptured eardrum), dizziness or balance problems, or facial drooping on the affected side. These symptoms suggest the infection has moved beyond where the body can handle it alone.
Dealing With Recurring Infections
Some people, especially young children, get ear infections repeatedly. If a child has three or more infections in six months, or four or more within a year with at least one in the most recent six months, ear tubes become an option. These tiny tubes are placed through the eardrum during a brief procedure and allow fluid to drain from the middle ear rather than building up. They also make it possible to treat future infections with ear drops instead of oral antibiotics.
Tubes are also recommended when fluid persists behind the eardrum for three months or longer and is affecting hearing, balance, school performance, or quality of life. Most tubes stay in place for six to eighteen months before falling out naturally as the eardrum heals.
Flying With an Ear Infection
Pressure changes during takeoff and landing can make ear infection pain significantly worse. If you have a severe infection, rescheduling your flight is the safest option. When that’s not possible, take a decongestant about an hour before takeoff. During ascent and descent, swallow frequently, yawn, or drink water to help equalize the pressure in your middle ear. Avoid caffeinated drinks, which can contribute to dehydration and make congestion worse. For children, encourage sipping water or using a pacifier during pressure changes, and check with their pediatrician beforehand for specific guidance.