What is the normal progression of an ear infection, and when should I seek help?

Doctor's Answers 3

Oh dear, I know exactly how awful it must be to have to suffer ear pain from an eardrum infection because I have experienced it myself before!

Eardrum infections commonly result from having had a bad cold or flu as the same "bug" that caused the flu, tracks up the pressure tubes (Eustachian tubes) which lead to your eardrums.

I wonder what antibiotic you have been prescribed? The "bugs" which cause ear infections may sometimes be resistant to simple penicillin/amoxicillin which is what many family practitioners usually prescribe. I hope you're on Augmentin or Klacid because they are the best antibiotics for eardrum infections.

If your ears are still painful and blocked, there might be infected fluid or pus trapped behind your eardrums which may need to be drained to relieve the pain and improve your hearing. Draining the trapped fluid behind the infected eardrum may be done safely in clinic after applying some "magic" cream inside the ear to numb it so that this minor procedure may be performed comfortably.

You should definitely see an ENT specialist instead of heading down to the A&E because the ENT specialist has a microscope and a fantastic repertoire of refined specialised instruments with which to examine your ear under high magnification and to perform the eardrum drainage procedure if necessary.

There really is no advantage to continue waiting any longer if your ears haven't improved after 3 days of antibiotics. Please go get your ears carefully checked out by your friendly ENT specialist!

Ear infections can be really painful as the middle ear cavity is really small, about only 1.5 cm3 volume. So when fluid and infection builds up behind the ear drum, the pressure and inflammation can be excruciating. In some cases, the ear drum bursts, which relieves the pressure, but to allow the perforation to heal, the infection would still have to be treated.

If it is a viral infection, antibiotics do not help. If your ear infection was associated with an upper respiratory tract infection (URTI) like a cough, cold or flu - medications to control the URTI would help resolve the middle ear infection faster too.

If it is a bacteria infection, then the antibiotic type and dose would need to be appropriate.

The blocked sensation would likely result in some reduction of hearing sensitivity. Usually, that improves over a week after the infection improves. However, it may take even 2 to 3 weeks if it is very viscous fluid in the middle ear.

Should there be a persistent blocked sensation, it is better that you see an ENT to get the ear drum and hearing checked. We need to get to the underlying cause of why things are not getting better. For example, there may be allergies, nose conditions or middle ear conditions that need to be evaluated and treated.

Kind regards,

Dr Lynne Lim

The duration of an ear infection depends on the severity of the infection and if it is an outer ear or middle ear infection.

If it is an outer ear infection (known as otits externa or swimmer's ear), you will lilely need the debris, pus and wax in your ear canal suctioned out (usually by an ENT Specialist). Together with antibiotic ear drops, this helps fasten the recovery of the ear infection (typically recovers within 1-2 weeks).

If it is a middle ear infection, it may take 1-2 weeks (if there is no fluid in the middle ear) or up to 2-3 months (if there is fluid in the middle ear) to clear up. If you have received treatment for 3 days without any improvement in symptom, you should see an ENT Specialist for an assessment.

Hope this helps and all the best!

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