Ear Infection
The location changes the treatment
General information from an emergency physician. It adds to your discharge papers and does not replace them or your own doctor. What this site is and isn’t
Key Takeaways:
- A middle-ear infection sits behind the eardrum. Swimmer’s ear affects the ear canal. They need different care.
- Middle-ear pain may not improve during the first 24 hours of antibiotics. Most outer-ear infections improve with prescribed drops.
- Return now for swelling behind the ear, the ear pushed forward, facial weakness, severe headache, neck stiffness, severe constant pain, or balance trouble.
About Ear Infections and the ED Workup
A middle-ear infection, or acute otitis media, forms behind the eardrum. It often follows a cold. Swelling blocks the small drainage tube from the middle ear, so fluid and pressure build behind the eardrum. Children get this more often because their drainage tubes are shorter and more level.
An outer-ear infection, or otitis externa, affects the skin of the ear canal. Water and small injuries from swabs or other objects can damage that skin and allow germs to grow. Pain when the outer ear or the small flap at its opening is moved points toward an outer-ear infection.
The location matters. Middle-ear infection may be treated with observation or antibiotics. Outer-ear infection is usually treated with ear drops.
First Steps and Evidence-Based Home Care
Follow the plan for the diagnosed location
Some children with a mild middle-ear infection can be watched without immediate antibiotics. This needs a backup prescription or a recheck if symptoms do not improve within 48 to 72 hours. If antibiotics were prescribed, use the exact plan provided.
Outer-ear infection is usually treated with drops. About 65% to 90% improve with topical treatment, and no single formula is clearly best for everyone. A hole in the eardrum or an ear tube changes which drops are safe, so do not use leftover drops. If swelling closes the canal, a wick may be needed to help drops reach the skin.
Protect the ear without injuring it
Keep the canal dry during treatment and for the short period your clinician recommends. Do not put cotton swabs or other objects into the canal. Wipe only the outside of the ear. Ear tubes do not always mean the ears must stay dry forever.
Timeline and Expected Recovery Course
For middle-ear infection, antibiotics do not improve pain during the first 24 hours. About 60% of children improve without them. The benefit becomes modest over the next several days, while about 1 in 14 treated children has a side effect.
If a watched middle-ear infection is not improving within 48 to 72 hours, use the backup or recheck plan. Outer-ear infection should begin improving with drops. Worsening pain or failure to improve needs reassessment.
Emergency Red Flags: Return Immediately
Return to the emergency department for any of these:
- Redness, swelling, or marked tenderness behind the ear, or the ear being pushed forward.
- New facial weakness, severe headache, neck stiffness, or dizziness.
- Severe constant or nighttime ear pain, especially with diabetes, older age, or a weakened immune system.
- Pain or redness spreading beyond the ear canal, or symptoms getting worse despite the prescribed drops.
- No clear improvement in a high-risk person with an outer-ear infection.
This list does not cover everything. If symptoms change rapidly or the person becomes very ill, return to the emergency department.
Reviewed September 3, 2026