1 Min In Conditions
Follow this topic
Bookmark
Record learning outcomes
Our hard-working ears function around the clock – even while we’re asleep – to process a whole spectrum of sounds, from the quietest of whispers to the loudest of noises. They also play an important role in terms of balance, thanks to the vestibular system within the inner ear, which sends signals to the brain.
However, their delicate structure means that they can also be sensitive when things go wrong. Ear infections are common in children – with around 80 per cent experiencing at least one during their early years – but can also occur in adults, while RNID (the Royal National Institute for Deaf People) says that more than 18 million people in the UK are affected by deafness, hearing loss or tinnitus.
Inside and out
“The external ear is the part on the outside we can see and the ear canal down to the eardrum,” says Mr Peter Monksfield, consultant ENT surgeon and president of the British Society of Otology, who works for University Hospitals Birmingham.
“The middle ear is the area that amplifies sound through the eardrum and ossicles or small bones of hearing. The inner ear is the cochlea (where sound is converted to a signal which runs through the hearing nerve to the brain) and the balance organ, which is the semicircular canals and vestibule.”
With the introduction of Pharmacy First in 2024, pharmacies are well equipped to support customers with their ear health. This feature will cover some of the conditions you might encounter, together with treatment options and self care tips. As with any medicines, always check for any contraindications to help the patient find the right product for them.
“More than 18 million people in the UK are affected by deafness, hearing loss or tinnitus”
Ear infections
Signs of this can include earache, fever, hearing problems, a discharge, redness or swelling, while parents might notice that young children have lost their appetite, seem miserable, or have been pulling on their ear. In many cases, a mild ear infection will usually resolve itself in 72 hours or so, but the NHS website says that patients should seek medical advice if their earache doesn’t start to feel better in three days, or if they experience a lot of infections.
There are several different types of ear infection:
- An inner ear infection such as labyrinthitis can affect balance, causing patients to feel dizzy or sick. Symptoms may come on suddenly, then start to ease after a few days, though it can take weeks for balance to return to normal.
There are a number of self care steps that people can try: these include lying in a dark, quiet room, getting plenty of rest, and staying hydrated by sipping water (and avoiding alcohol). Patients shouldn’t drive or operate machinery if they feel dizzy. If symptoms persist or worsen, they should see their GP
- A middle ear infection, also known as otitis media, is an infection behind the eardrum, which can lead to pain, fever, dulled hearing, inflammation and a build-up of fluid. Acute otitis media (AOM) symptoms typically develop quickly, often triggered by a respiratory illness such as a cold, and usually clear up within a few days. A suitable painkiller, such as paracetamol or ibuprofen, can help to ease discomfort in the short term if needed
AOM is also one of the seven common conditions covered by the Pharmacy First scheme in England, providing that patients are within the specified age range (which is between one and 17 for AOM; other exclusion criteria also apply). If patients are eligible for this service, a participating pharmacist can assess them, and if necessary, supply a restricted set of prescription only medicine. Ineligible patients can be supported with OTC care and advice
- In some cases, patients may have otitis media with effusion – also known as ‘glue ear’ – where the middle ear fills with a sticky fluid. This can cause symptoms such as earache, tinnitus or temporary hearing loss. In this situation, the Pharmacy First option wouldn’t apply, and they should be referred to their GP. Glue ear often resolves itself within three months, but in some cases the patient may require further treatment, such as grommets (small tubes placed into the eardrum to help drain fluid from the middle ear)
- An outer ear infection or otitis externa affects the ear canal (the part between the eardrum and outer ear). Also known as ‘swimmer’s ear’, it’s often triggered by trapped water. It typically worsens gradually, and can cause itching, redness, discomfort, muffled hearing and discharge. It usually, though not always, occurs in one ear.
Where appropriate, acetic acid eardrops may help to tackle a mild infection, and alongside a suitable pain relief. For more severe cases, patients should see their GP, who may prescribe treatment containing an antibiotic. Pharmacy teams can also share tips to help prevent otitis externa, such as wearing a cap when swimming, and not poking fingers or cotton buds into the ears.
Signs that a child may be struggling with ear pain include tugging, rubbing, pulling at the ear, restlessness and becoming irritable.
The wax factor
Earwax is meant to act as a protective barrier, but too much build up can cause problems. However, you may find that there’s a lot of confusion among patients about the best way to deal with it.
“There is an old saying that nothing smaller than your elbow should be put in your ear, which is true,” says Mr Peter Monksfield, consultant ENT surgeon and president of the British Society of Otology, who works for University Hospitals Birmingham.
“Most people do not need any care for their ears other than usual bathing or showering. Wax will come out naturally by itself for most who have not had previous ear disease or surgery. However, ears can block up if people have got very narrow or hairy ears, for example.”
According to RNID, more than two million people in England and 95,000 in Wales need professional earwax removal every year. RNID is calling on the Government to address the postcode lottery of NHS removal services, which it says is forcing thousands to go private or resort to risky self-management at home.
A 2025 survey by the charity found that the situation was leading to a widespread use of dangerous DIY removal methods, with one in 20 of those polled admitting to using items such as tweezers or hair pins. The advice from RNID is to never insert objects into the ear, including cotton buds or hair clips, as these can push wax deeper and cause damage to the ear.
Ear drops can be purchased from the pharmacy to help aid wax removal, but there are some circumstances where these wouldn’t be suitable, such as if the patient has a suspected perforated eardrum or infection. In this case – or if symptoms persist after five days or the patient is unable to hear – they should contact their GP.
Useful resources:
- ENT UK: entuk.org
- Ménière’s Society: menieres.org.uk
- Royal National Institute for Deaf People: rnid.org.uk.
“Patients with sudden hearing loss in one or both ears should be seen by the emergency service”
Eustachian Tube Dysfunction (ETD)
We have two eustachian tubes – one for each side – that connect the middle ear with the back of the nose, helping to regulate air pressure and allowing fluid/mucus to drain away.
However, sometimes these tubes don’t function as they should – for example, if they become blocked because of a cold – causing symptoms such as a plugged or popping sensation, muffled hearing, tinnitus or pain.
“ETD can be due to abnormal blockage of the tube which causes hearing loss and pressure in the ear, or abnormally open tubes called Patulous Eustachian Tube,” says Mr Monksfield. “If blocked, the Otovent balloon can help the patient to open the tube.
There is also a device called an EarPopper which can help. Both are usually available from a pharmacy. Treating the nose with nasal decongestants or nasal steroids can sometimes help as well.”
Bear in mind that different products will have different age restrictions, and some are not suitable for children; customers should always read the patient information leaflet.
Ménière’s disease
This long-term, progressive condition of the inner ear is rare, but can affect patients of all ages, causing symptoms such as dizziness, tinnitus, hearing loss and a feeling of pressure in the ear.
“If patients are experiencing dizziness, they should see their GP in the first instance,” says a spokesperson for the Ménière’s Society. “If further investigations are needed, the GP may refer to ENT, neurology or an audiological specialist.”
Patients feeling dizzy and showing any signs of a stroke – such as facial drooping, slurred speech or being unable to keep their arms raised – should call 999. Any change in symptoms or customers feeling concerned should be referred to the GP.
While in severe cases surgery may be offered, the condition is usually managed with medication and diet or lifestyle changes, continues the charity. “Stress management can be beneficial, as well as peer support – sharing experiences with others who know what you are going through.
“Anyone experiencing dizziness that is sudden, disabling or recurrent should inform the Driver and Vehicle Licensing Agency [as you could face a fine for up to £1,000 if you do not inform them of a medical condition that affects your driving]. Further information can be found on the gov.uk website.”
Pharmacy teams can contact the charity to access further information or resources at: menieres.org.uk.
Dizziness can be linked to various issues of the ear, including Ménière’s disease.
Stay alert
While many ear infections are short-lived, some symptoms may indicate a more serious condition. These include “fever, severe headache, vertigo, facial nerve weakness, swelling behind the ear, and symptoms not responding to topical or systemic antibiotics,” says Mr Peter Monksfield, consultant ENT surgeon and president of the British Society of Otology, who works for University Hospitals Birmingham.
“Patients with sudden hearing loss in one or both ears should be seen by the emergency service through their GP or hospital emergency department. If a sensorineural or inner ear hearing loss is suspected, they should be treated with steroids urgently, and should be made aware of the Starfish trial which is a national trial trying to work out the optimum steroid treatment for this condition.
“Hearing loss that is not sudden but is only in one ear needs referral to an ear specialist,” he continues, as do “ear infections that are not responding to treatment or if there are any warning signs as above”.
For further information on when to refer, visit: nhs.uk/conditions/ear-infections/.
In Conditions