Ear Infections: Outer vs Middle, and What Actually Helps

Earache sends more people to the pharmacy counter than almost anything else — and most of what we're asked reduces to three questions: which kind of infection is it, does it need antibiotics, and when is it serious? Here are the answers as the NHS and NICE guidance actually gives them.

By the Hyde Park Pharmacy pharmacist team · Hyde Park Pharmacy, 22–24 Woodsley Road, Leeds LS3 1DT · Last updated 24 August 2026

First: which ear infection is it?

The treatment depends on where the infection sits — in the canal (outer ear) or behind the eardrum (middle ear). They feel different, behave differently and are treated differently, which is why the single most useful step is having someone look in the ear.

The 3-day rule

The guidance both routes rest on is simple: most ear infections clear up within about 3 days, sometimes up to a week. For middle-ear infections, NICE treats “no antibiotic” or a back-up (delayed) prescription as the norm — antibiotics make little difference to how long symptoms last for most people, and serious complications are rare with or without them. Immediate antibiotics are reserved for people who are very unwell, have discharge from the ear, or are at higher risk.

What helps at home — and what makes it worse

• Do: take paracetamol or ibuprofen for the pain; wipe discharge from the outer ear with cotton wool; keep water and shampoo out of the ear; use ear plugs or a cap when swimming once healed.
• Don’t: put anything inside the canal — cotton buds, fingers, tissues. It damages the canal skin and drives infection.
• Don’t bother with: decongestants or antihistamines — NHS guidance is blunt that there’s no evidence they help ear infections.
• Swimmers: stay out of the water for at least 7–10 days during treatment for an outer-ear infection, then protect the ears — recurrent wetting is the classic driver.

Where treatment comes in

Outer-ear infections that need more than self-care are treated with drops or sprays into the canal — usually an antibiotic, often combined with a steroid to settle inflammation, for 7–14 days. Because some drops can harm hearing if the eardrum isn’t intact, the ear should be examined first — that’s why our ear service is an in-person examination with an otoscope, not an online form.

Middle-ear infections that genuinely need an antibiotic get a 5–7 day course — typically amoxicillin, with alternatives for penicillin allergy. The point of the examination is deciding whether that minority case applies to you.

The NHS route and the pharmacy route in Leeds

• Children and young people aged 1–17 with suspected middle-ear infection: free assessment under NHS Pharmacy First — walk in, no GP referral needed. (Babies under 1 with a suspected ear infection should see a GP.)
• Adults aren’t covered by the NHS earache pathway — our private ear examination fills that gap: the pharmacist examines the ear and can supply appropriate treatment on the spot, or refer you if it needs a prescriber.
• Blocked with wax rather than infected? Ear wax feels similar — ask us; softening drops are available over the counter.

Common questions

How long does an ear infection last?

Usually about 3 days, sometimes up to a week. Not improving after 3 days, or getting rapidly worse, means it’s time to be seen.

Do ear infections need antibiotics?

Usually not. Middle-ear infections mostly settle alone; outer-ear infections are usually treated with drops into the canal rather than tablets.

Why does my ear hurt when I pull on it?

Pain on touching or pulling the ear points to the outer canal (otitis externa) rather than the middle ear — worth having looked at if it isn’t settling.

Can I fly with an ear infection?

You can, but expect the pain to be worse with pressure changes, and avoid swimming if there’s any chance the eardrum is perforated. Ask the pharmacist before you travel.

My child keeps getting ear infections — what counts as “recurrent”?

Three or more episodes in six months, or four or more in a year — that pattern deserves a GP review rather than treating each episode in isolation.