Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.
1
Is any of this happening now?
Call 911
Call emergency services for a seizure, severe confusion, a stiff neck with significant illness, breathing difficulty or loss of consciousness.
These symptoms are not typical of an uncomplicated middle ear infection and need immediate assessment.
Other emergency signs, for anyone
Someone who is struggling to breathe, gasping, choking, or cannot get words out
Someone who has chest pain, tightness or pressure lasting more than a few minutes
Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
Someone who is unconscious, or cannot be woken
Someone who is bleeding heavily and it will not stop with firm pressure
Someone who has had a seizure that will not stop, or does not wake up afterwards
Someone who has lips or skin that look pale, blue, grey or blotchy
Someone who you believe has taken an overdose or swallowed something poisonous
2
Is any of this happening?
Be seen today
Seek same-day urgent medical care for:
Redness, tenderness or swelling behind the ear
An ear that begins to stick out because of swelling
New weakness or drooping on one side of the face
Severe or rapidly worsening pain
Persistent vomiting, marked dizziness or difficulty walking
A baby younger than 3 months with a temperature of 38°C or higher
Symptoms in someone with a significantly weakened immune system
A person who appears very unwell or is difficult to rouse
And for anyone, someone who:
has a fever with a stiff neck, a rash that does not fade under pressure, or severe headache
has a wound that is hot, spreading red, or leaking pus
3
Does any of this apply?
Book an appointment
Arrange routine medical advice if ear pain is not beginning to improve after several days, keeps returning or is accompanied by ongoing reduced hearing.
Follow-up is also appropriate if ear discharge continues, symptoms return soon after treatment, or you are concerned about a child's speech, language or responses to sound.
Every sign above is quoted from the sofidex article on Middle ear infection. If you are not sure, err upward — it is always reasonable to be checked.