Earache is one of the most common childhood complaints that sends parents to the GP. Acute otitis media — middle ear infection — affects the majority of children at least once before the age of ten, often causing significant pain, disturbed sleep, and parental anxiety.
For adults, earache can result from infections, referred pain from dental problems, or outer ear conditions such as otitis externa (swimmer's ear). Whatever the cause, getting timely advice has traditionally meant competing for GP appointments.
Under the NHS Pharmacy First service, community pharmacists can now assess earache in both children and adults, recommend appropriate treatment, and in certain cases supply prescription-only antibiotics without a GP referral.
Common Causes of Earache
| Condition | Typical features | Who it affects |
|---|---|---|
| Acute otitis media (middle ear infection) | Ear pain, fever, irritability, reduced hearing | Children (peak age 6–18 months), some adults |
| Otitis externa (outer ear infection) | Itching, discharge, pain when ear is touched | Swimmers, hearing aid users, adults |
| Glue ear (otitis media with effusion) | Muffled hearing, no pain usually | Children (often after repeated infections) |
| Referred pain | Ear pain without ear pathology | Adults (dental, TMJ, or throat causes) |
What the Pharmacist Can Do
For Children with Earache
When a parent brings a child with earache to the pharmacy, the pharmacist will:
- Ask about symptoms — duration, severity, whether the child has had a fever, and whether there is any discharge
- Consider the child's age — management differs for children under two and those over two
- Recommend pain management — paracetamol or ibuprofen at the correct dose for the child's age and weight is the first-line treatment for ear pain
- Apply a watch-and-wait approach — most ear infections in children over two resolve without antibiotics within three to seven days
If the child meets certain criteria — such as being under two years with bilateral infection, or having symptoms that are worsening after 48 hours of pain management — the pharmacist can supply antibiotics under the Pharmacy First pathway.
For Adults with Earache
Adults presenting with earache will be assessed for:
- Signs of middle ear infection (pain, reduced hearing, recent cold)
- Signs of outer ear infection (itchy or painful ear canal, discharge)
- Red flags that require referral (sudden hearing loss, vertigo, facial weakness)
For otitis externa, the pharmacist may recommend acetic acid ear drops (available over the counter) or supply antibiotic/steroid ear drops under Pharmacy First. For suspected middle ear infection, the same watch-and-wait principles apply, with antibiotics available if symptoms persist.
Treatment Options
| Treatment | When used | Notes |
|---|---|---|
| Paracetamol/ibuprofen | First-line for pain in all age groups | Dose by age/weight for children |
| Amoxicillin (oral) | Bacterial otitis media when antibiotics needed | 5–7 day course, first-line in children |
| Clarithromycin (oral) | Penicillin allergy | 5–7 day course |
| Acetic acid 2% ear drops | Otitis externa (mild) | Restores ear canal pH |
| Ciprofloxacin ear drops | Otitis externa with infection | Pharmacy First or GP prescription |
According to NICE guidance (NG91), most cases of acute otitis media in children can be managed with pain relief alone. Antibiotics reduce symptom duration by approximately one day but carry side effects — the pharmacist will weigh benefits against risks.
When to Go to the Pharmacy vs the GP
Go to the pharmacy if:
- A child over one year has earache with or without mild fever
- An adult has earache following a cold
- There is itching or mild discomfort in the outer ear
- You need advice on the right dose of pain relief for your child
See a GP or call 111 if:
- The child is under one year old with suspected ear infection
- There is discharge from the ear (may indicate a perforated eardrum — not dangerous but needs medical review)
- Symptoms have not improved after 48–72 hours of appropriate pain management
- The child or adult has recurrent ear infections (four or more per year)
- There is sudden hearing loss without obvious cause
Seek emergency care if:
- Severe pain with swelling behind the ear (possible mastoiditis)
- Facial drooping on the affected side
- High fever with neck stiffness
- Confusion or drowsiness (particularly in children)
Practical Tips for Parents
- Give pain relief regularly, not just when the child complains — maintaining pain-free intervals aids sleep and recovery
- Warm compresses held against the ear can provide additional comfort
- Prop the child up slightly during sleep — this can reduce pressure in the middle ear
- Do not insert anything into the ear — cotton buds, fingers, or home remedies can cause damage
- Complete any antibiotic course prescribed by the pharmacist, even if the child seems better after two days
Finding a Pharmacy Near You
Most of England's 13,000+ community pharmacies participate in Pharmacy First. Search for your nearest pharmacy on PharmSee, or use the location analysis tool to see pharmacy coverage in your area. If you are looking for pharmacy roles, the jobs page lists over 1,600 current vacancies.
Sources: NHS England Pharmacy First service specification; NICE guideline NG91 — Otitis media (acute): antimicrobial prescribing; NICE CKS — Ear pain; NHS.uk — Ear infections.