RFSymptoms: Safety netting advice
AdultsMiddle ear infection
DATE LAST REVIEWED: 05/11/2026
When to seek further review
- Ear infection symptoms usually start improving within 3 days, although they can last a week. Contact the GP if there is no improvement after 3 days.
- Get urgent advice sooner for worsening pain, high fever, fluid leaking from the ear, hearing changes, dizziness or feeling generally unwell.
- Get urgent assessment for swelling or redness behind the ear, particularly if the ear starts to stick out.
- If given a back-up prescription, follow the specific starting instructions from the clinician rather than starting it automatically.
- For mild symptoms without any of the urgent or emergency warning signs listed here, a community pharmacist can advise on self-care and suitable medicines. Tell them the patient’s age, other medicines and any pregnancy or breastfeeding. They can direct you to another service if needed.
- Pharmacy First can assess earache and possible middle ear infection in children and young people aged 1 to 17 years. Contact the pharmacy first to check that it offers the service. Assessment does not always mean an antibiotic or other prescription is needed.
- Do not wait for the suggested review time if symptoms become worse, new symptoms appear, or you are worried.
- If you need medical advice and are unsure which service can help, call NHS 111. This includes when your GP is closed or you cannot get the help you need. NHS 111 can direct you to an appropriate local service. You can call even if you are not sure whether symptoms are serious.
When to get emergency help
(Immediately dial 999 or go to your nearest Emergency Department)
- Swelling behind the ear with severe illness or rapid deterioration.
- New facial weakness or drooping.
- A severe headache with a stiff neck, discomfort in bright light, or a rash that does not fade when pressed with a clear glass. Do not wait for a rash to appear.
- A seizure or becoming very difficult to wake.
- Severe difficulty breathing, such as gasping or being unable to speak normally.
- New confusion or not making sense when speaking.
- Being very difficult to wake.
- Collapse or loss of consciousness.
- Blue, grey, unusually pale or blotchy skin or lips, especially when feeling very unwell.
How to spot sepsis
Sepsis is a life-threatening reaction to an infection. It can get worse quickly. If someone is seriously unwell and may have sepsis, call 999 or go to your nearest Emergency Department. Do not wait for every sign, a high temperature or a rash.
An unwell child under 5 who has not had a pee or wet nappy for 12 hours needs emergency assessment. If you are unsure and there are no emergency signs, call NHS 111 for advice.
Sources
- NHS - Otitis mediahttps://www.nhs.uk/conditions/ear-infections/
- NHS - How pharmacies can helphttps://www.nhs.uk/nhs-services/pharmacies/how-pharmacies-can-help/
- NICE NG91 - Acute middle ear infectionhttps://www.nice.org.uk/guidance/ng91/chapter/Recommendations
- NHS - Sepsishttps://www.nhs.uk/conditions/sepsis/
- NHS - When to use NHS 111https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-use-111/