Painful, common in children, and most clear without antibiotics.
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Middle ear infection — otitis media — is extremely common in children and causes earache, fever and irritability. It is painful, it is frightening for parents, and most of it resolves without antibiotics.
Around eight in ten children are substantially better within about three days whether or not they take an antibiotic. Antibiotics shorten the pain only slightly, and cause diarrhoea, rash and thrush in a meaningful number of children. Which means the treatment that matters most is proper pain relief, given regularly.
Three things worth knowing:
We should be straightforward about one limit: we cannot look inside the ear over video. That shapes what we can and cannot conclude.
Fluid sitting behind the drum after infection has settled. Not painful, and not an infection:
Different again — see otitis externa. Pain on pulling the earlobe or pressing the front of the ear, itch, and discharge, usually after swimming.
The Eustachian tube connects the middle ear to the back of the nose. A cold makes it swell and block, fluid collects behind the eardrum, and bacteria or viruses multiply in it.
In children the tube is shorter, narrower and more horizontal, which is precisely why ear infections are a childhood condition and become far less common with age.
Much less common, and worth a second thought. Recurrent or persistent middle ear problems in an adult raise nasal and sinus disease, allergy, reflux, or a structural problem.
One specific point: persistent fluid behind one eardrum in an adult — particularly with a blocked nose, nosebleeds or a neck lump — needs ENT examination of the back of the nose, because it can be the first sign of a nasopharyngeal tumour. Uncommon, more frequent in people of Chinese and South East Asian heritage, and easily missed because a blocked-feeling ear seems so trivial.
We cannot look inside the ear on a video call. An otoscope is what confirms whether the eardrum is inflamed, bulging, perforated or has fluid behind it — and that requires someone in the room.
What we can do is take a full history, judge how unwell a child is, give clear pain relief instructions, provide a back-up prescription where appropriate, and — importantly — tell you promptly when this needs looking at in person.
Glue ear is confirmed by hearing tests and tympanometry, not by looking alone. Where a child has had fluid or hearing concerns for weeks, formal audiology assessment is the right step — particularly if speech is affected.
Not routine. Reasonable for:
A back-up prescription — held and used only if things have not improved in three days or get worse — is often the best answer, and most families never need to use it.
Usually heals within a few weeks. Keep the ear dry — no swimming, and cotton wool with petroleum jelly for showers. Get hearing checked once it has settled, and have it looked at if discharge persists beyond a fortnight.
Three months of watchful waiting is the standard approach, because most cases resolve by themselves. Antibiotics, steroids, decongestants and antihistamines do not help and should not be used for it.
Where it persists with hearing loss affecting speech, learning or behaviour, referral for grommets or hearing aids is appropriate — and it is worth pursuing rather than accepting, since hearing matters most at exactly the age this happens.
Call 999 or go to A&E for:
Seek same-day medical advice for:
Book an appointment for:
No olive oil, no ear drops bought for wax, no cotton buds, no ear candles. If the eardrum has perforated — which you cannot tell without looking — anything poured in goes into the middle ear. Cotton buds push wax deeper and scratch the canal, which is how outer ear infections start.
Worth taking seriously rather than treating as behaviour. Glue ear causes hearing loss with no pain at all, and it is regularly mistaken for inattention or being difficult — sometimes for a year or more, at the age when hearing matters most for speech. If a child turns the TV up, does not respond when called, or their speech is unclear, ask for a hearing test.
Most ear infections in children settle without antibiotics, and pain relief is what actually helps. Regular paracetamol and ibuprofen, available over the counter for a few pounds, do more in the first 48 hours than an antibiotic does. Your NHS GP treats ear infections free, and many pharmacies now assess and treat earache in children through the Pharmacy First service without any appointment.
That pharmacy route is genuinely good and underused — same day, no appointment, free, and staffed by someone who can look in the ear. We would point you there before charging you.
The honest limitation of a remote consultation for ear infection is that we cannot look in the ear, and that is not a small caveat here — the eardrum is the diagnosis. We can assess the history, judge severity and safety-net properly, but where the examination is the deciding factor we will say so.
Where private care helps is out of hours and at speed — a child in pain at 8pm on a Sunday, where the alternative is a long wait, and where the useful output is a clear plan and a decision about whether this needs to be seen tonight.
Severe pain with swelling behind the ear, a child who is very unwell, facial weakness, or neck stiffness needs urgent in-person assessment.
NICE NG91, Otitis media (acute): antimicrobial prescribing, is the governing guideline. It recommends no antibiotic or a back-up prescription for most children, since the majority improve within three days without one, and reserves immediate antibiotics for children who are systemically unwell, under two with bilateral infection, or with otorrhoea.
NICE Clinical Knowledge Summary, Otitis media — acute, covers assessment, the central role of analgesia, and safety-netting advice.
NG91 is explicit that regular paracetamol or ibuprofen is the mainstay of symptom control, which is the basis for what this page says about pain relief mattering more than antibiotics in the first 48 hours.
NICE CKS and the NHS Pharmacy First clinical pathway for acute otitis media define the community pharmacy route for children aged 1 to 17, which is why this page directs there first.
Mastoiditis and intracranial complications are covered in NG91's referral criteria, underpinning the urgent features listed above.
Usually not. Around eight in ten children are substantially better within three days whether or not they take one, and antibiotics shorten the pain only marginally while causing diarrhoea, rash and thrush in a meaningful number. Regular pain relief at the correct dose is the treatment that matters. A back-up prescription — used only if things have not improved in three days — is often the best middle path.
No — nothing goes in the ear. You cannot tell without looking whether the eardrum has perforated, and if it has, anything poured in reaches the middle ear. Cotton buds are worse still: they push wax deeper and scratch the canal, which is how outer ear infections begin.
The eardrum has almost certainly perforated, and the pressure that was causing the pain has been released. It sounds alarming and is usually fine — most heal within a few weeks. Keep the ear completely dry, avoid swimming, and get it checked, particularly if discharge continues beyond a fortnight or hearing does not recover.
Swelling or redness behind the ear, or the ear being pushed forwards and outwards. That is mastoiditis — infection spreading into the bone — and it needs hospital assessment immediately. Facial drooping, neck stiffness or drowsiness are the same. Everything else on this page can wait for an appointment; those cannot.
Quite possibly. Glue ear is fluid behind the drum causing hearing loss with no pain at all, so there is nothing to complain about — and it is very commonly mistaken for a child not listening or being difficult. Ask for a hearing test. Most resolves within three months, but where it persists and affects speech or learning, grommets are worth pursuing.
Yes. Flying with an ear infection is uncomfortable but not dangerous, and it will not burst an eardrum. Swallowing during descent is what helps — a drink, a sweet, or feeding a baby. Give pain relief about an hour before the flight.
Mostly age and anatomy — the tube connecting ear to nose is short and horizontal in young children and improves as they grow. The most effective thing you can change is smoke exposure, which has a substantial effect. Also: feed babies upright rather than flat, stop dummies after six months, keep vaccinations current, and treat any allergic rhinitis.
Worth getting looked at rather than waiting. Adults do not usually get persistent middle ear fluid, and fluid behind one eardrum only — particularly with a blocked nose, nosebleeds or a neck lump — needs ENT examination of the back of the nose. Usually it is nothing, but it is one of those situations where a trivial-feeling symptom deserves a proper look.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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