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Ear painAlso known as Otalgia and Earache
Ear pain or earache can occur due to infections and inflammation of the external, middle, or inner ear. Earaches usually occur in children, but they can occur in adults as well. An ear pain may affect one or both ears, but the majority of the time it’s in one ear.
The ear pain can be constant or it can come and go, the pain can be dull, sharp, or burning. The symptoms of ear pain include pain in the ear, impaired hearing, and fluid discharge from the ear. Children can show additional symptoms like muffled hearing, fever, difficulty sleeping, headache, getting irritated more than usual, and loss of balance.
Some of the common causes of ear pain include injury, infection, irritation in the ear, or pain that originates in the jaw or teeth, earwax buildup, water trapped in the ear, and sinus infection.
The treatment of ear pain includes taking over-the-counter pain relievers to treat the ear pain and antibiotics, in case of an infection. Also, not getting the ear wet and sitting upright can help relieve ear pressure and pain.
- Children below 3 years of age
- Both men and women
- Worldwide: 709 million (2012)
- Tooth infection
- Ear barotrauma
- TMJ syndrome
- Arthritis of jaw
- Trigeminal neuralgia
- Blood tests: White blood cell count (WBC), Erythrocyte sedimentation rate (ESR) & C- reactive protein (CRP)
- Imaging: X-ray, Computed tomography (CT) scan & Magnetic resonance imaging (MRI)
- Medications: Amoxicillin, Ibuprofen, Acetic acid & Benzocaine
- Surgical procedures: Myringotomy & Ear tubes
- General physician
- ENT specialists (Otolaryngologists)
Symptoms Of Ear Pain
Ear pain is most commonly described as a feeling of pressure in the ear. This feeling may begin gradually or suddenly, and it can be very severe.
The symptoms of ear pain in adults include:
Fluid drainage from the ear
Ringing of the ear
In young children, the signs of an ear infection may be the following:
Pulling of the ear
Loss of appetite
Difficulty in sleeping
Difficulty in responding to sounds
Fussiness and crying
Loss of balance
Causes Of Ear Pain
Injury, infection, and irritation in the ear are the common causes of ear pain.
1. Ear infection
It is usually caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. The ear has three major parts -- the outer ear, the middle ear, and the inner ear. If the upper respiratory infection is bacterial, the same bacteria may spread to the middle ear and if the upper respiratory infection is caused by a virus, such as a cold, bacteria may move into the middle ear as a secondary infection.
Outer ear infection: The outer ear, also called the pinna, includes everything we see on the outside; it is the curved flap of the ear leading down to the earlobe. The outer ear infection is caused by swimming, wearing headphones that damage the skin inside the ear canal, or putting cotton swabs in the ear canal.
Middle ear infection: The middle ear is located between the eardrum and the inner ear. The infection can start from a respiratory tract infection and leads to a buildup of fluid behind the eardrums caused by the infections.
Inner ear infection: This part contains the labyrinth, which helps in maintaining balance. The other part is the cochlea, a part of the labyrinth, which is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. The infection of the inner ear is labyrinthitis which is sometimes caused by viral or bacterial infections from respiratory illnesses.
2. Symptoms of other conditions
Ear pain with a toothache in children who are teething. Individuals with an infected tooth having an abscess or impacted wisdom teeth are more likely to have an ear pain.
Ear pain with a change in hearing, earwax build-up, an object stuck in the ear (do not try to remove it yourself – see a GP), and perforated eardrum (particularly after a loud noise or accident).
Ear pain with pain when swallowing in case of sore throat, tonsillitis, and quinsy (a complication of tonsillitis).
Ear pain with a fever, flu, cold or sinusitis.
3. Ear wax
It is part of the body's protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds excessively, it may cause significant ear pain, if the wax presses against the eardrum.
4. Insertion of a foreign object
When a foreign body is inserted into the ear, it causes pain and inflammation. These may include hairpins and pointed objects that are often used to scratch or remove ear wax.
Other causes of ear pain
1. Meniere's disease
Meniere's disease is caused by excess fluid buildup in the inner ear, although the exact reason behind this fluid retention is not known. Along with the classic triad of symptoms—vertigo, ringing in the ears, and hearing loss -- some people with Meniere's disease report ear pain or pressure.
Although not common, a tumor may be the reason behind a person's ear pain. For example, nasopharyngeal cancer (a type of head and neck cancer) may cause ear fullness, along with hearing loss, ringing in the ears, and recurrent ear infections.
Two examples of benign (noncancerous) tumors or growths that may develop in the ear and cause pain include:
- Cholesteatoma: A benign skin growth that forms in the middle ear.
- Acoustic neuroma: A benign inner ear tumor that develops on the vestibular nerve (eighth cranial nerve).
- Change in pressure, such as when flying on a plane
- Temporomandibular joint (the joint that connects the lower jaw to the skull) syndrome
- Arthritis affecting the jaw
- Eczema in the ear canal
- Trigeminal neuralgia (chronic facial nerve pain)
- Thyroid inflammation
- Carotid artery pain (carotidynia)
Learn more about the five most common causes of ear pain and how to deal with them.
Risk Factors For Ear Pain
The following conditions are related to increased risk of ear pain:
Inflammation in the ear
Fluid buildup in the ear
Medical conditions like respiratory tract infection, sinusitis, common cold, allergies or asthma
Illnesses that weaken the immune system such as AIDS (HIV infection)
Smoking also increases the chances of developing an ear infection
Children having viral infection
People who swim regularly are at a higher risk due to the water getting into the ears while swimming
Diagnosis Of Ear Pain
If you experience any symptoms of ear pain such as burning pain or discomfort, hearing loss, or drainage from the ear, then it is wise to consult a doctor. Your doctor might do some physical examination followed by a few questions related to your daily routine to know the cause of it.
Diagnosing ear pain often only requires a medical history and physical examination by an ear, nose, and throat (ENT) specialist.
1. Medical history
An ENT specialist can ask several questions related to the details of your pain like what the pain feels like, does the pain come and go, and whether a person is experiencing symptoms such as fever, hearing loss, and balance problems, ear drainage or tinnitus (ringing in the ears).
2. Physical examination
During your physical exam, the general physician will inspect the ear and parts of the ear including the outer, middle, and inner ear, ear canal, and tympanic membrane (eardrum) with an otoscope (an instrument designed for visual examination of the eardrum and the passage of the outer ear, typically having a light and a set of lenses). The most common causes are temporomandibular joint syndrome, pharyngitis (sore throat), dental disease, and cervical spine arthritis. The doctor will also look for the medical history of asthma, respiratory illness, and sinusitis in both children and adults.
In some cases, nasal endoscopy is recommended. It is a non-surgical procedure that allows for the examination of the middle ear, nasal passages, and openings to the sinuses and/or the upper section of the gastrointestinal tract.
3. Blood tests
These may be used to help diagnose various ear pain conditions in case of an ear infection.
White blood cell (WBC) count: This test can help to determine an infection or inflammation as WBCs play a vital role in your immune system. They assist in fighting infection and help in defense against other foreign materials.
Erythrocyte sedimentation rate (ESR): This test can be commonly used to detect non-specific signs of inflammation resulting from infection, cancers, or certain autoimmune disorders.
C- reactive protein (CRP): It is a marker for inflammation, and its level increase during bacterial infection and tissue damage.
These blood tests are not precisely done for detecting ear pain, but the evaluation can help rule out other related diseases like thyroid disorders and syphilis, all of which may have symptoms similar to those of Meniere's disease.
If the diagnosis is not clear from the history and physical examination, imaging studies are done for a precise outcome. Imaging is sometimes needed to sort out an ear pain diagnosis.
X-ray: It is done to evaluate the jaws and adjacent areas of the ear.
Computed tomography (CT) scan or magnetic resonance imaging (MRI): It can be done for visualizing the middle and inner ear. The MRI scan is generally advised by the doctor when he finds that your hearing loss is sensorineural which means there is a problem with the nerves, to suspect a possible tumor such as nasopharyngeal cancer as the source of your ear pain.
5. Hearing tests
These may be recommended if there have been recurrent infections or if there has been a delay in speech development in children.
It refers to a test that helps in the evaluation of the proper functioning of the middle ear. The middle ear is positioned behind the eardrum, also known as the tympanic membrane.
The test seeks to establish the condition and movement of the tympanic membrane as it responds to changes in pressure. The test helps doctors to identify and monitor any problems with the middle ear. After the test, the doctor records the results in a graph called a tympanogram.
Tympanometry is helpful in the diagnosis of ear problems that can lead to hearing loss, mostly in children. Through the test, your doctor can check if you have:
A middle ear infection
Fluid in the middle ear
A perforated tympanic membrane
Issues with the eustachian tube that connects the upper throat and nose to the middle ear
Prevention Of Ear Pain
Some ear pains may be preventable by avoiding some preventative measures like:
Avoid chronic use of cotton swabs
Avoid putting sharp and foreign objects into the ear as this can scratch up the ear canal or the wax layer, which can increase the risk of infection
After swimming, blow-dry your ears to avoid buildup of water in the ear
Keeping swimming pools and hot tubs clean with disinfectants and regular pH testing will also reduce the risk of infection and ear pain
Breastfeed exclusively until your baby is 6 months old and continue to breastfeed for at least 12 months
Specialist To Visit
The symptoms of ear pain are often easy to deal with the use of over-the-counter pain medications. However, consult a doctor in case:
You experience severe ear pain or discomfort that seems different or worse than usual
You notice fluid (such as pus or blood) oozing out of ear
You have a high fever
You have a headache or feel dizzy
You feel an object is stuck in your ear
You see swelling behind your ear, especially if that side of your face feels weak or you can’t move the muscles
You’ve had severe ear pain and it suddenly stops (which could mean a ruptured eardrum)
Your symptoms don’t get better (or get worse) in 24 to 48 hours
Specialists that can help to manage ear pain include:
Pediatrician (in case of children)
If you, your children or any family members are facing such issues, contact and seek medical help immediately.
Treatment Of Ear Pain
As there are many different causes of ear pain, there are similarly many possible treatments. The treatment of choice will specifically depend on the root cause of your ear pain.
Home therapies can sometimes go a long way in easing ear pain, especially if the pain is related to fluid build-up from a virus or allergies.
Hold a warm compress against your ear or sinuses.
Performing simple jaw exercises in case of temporomandibular disorder (TMD).
For a blocked eustachian tube, drugs commonly used include decongestants and antihistamines can be used.
If a buildup of wax is causing your ear pain, you may be given wax-softening ear drops. They may cause the wax to fall out on its own.
In case of children, antibiotics cannot be prescribed immediately, watchful waiting and delayed prescribing steps are what doctors recommend. Watchful waiting for the child and waiting to check if the child needs antibiotics. This gives the immune system time to fight off the infection.
This procedure is done to remove impacted wax, debris, infected material, and dead skin cells in the treatment of otitis externa (external ear).
If a buildup of wax is causing your ear pain, you may be given wax-softening ear drops, this causes the wax to soften.
Ear lavage also known as ear irrigation or ear flush, is a safe method of earwax removal.
Antibiotics are often not needed for middle ear infections because the body’s immune system can fight off the infection on its own. However, sometimes antibiotics, such as amoxicillin, are needed to treat severe cases right away or cases that last longer than 2–3 days. A standard 10-day course is recommended for younger children and children with severe illness; whereas a 5 to 7 day course is appropriate for children 6 and older with mild to moderate illness.
To soothe ear pain, sometimes the doctor may recommend over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such ibuprofen. This medication can help in getting relief in pain and fever.
For the pain of TMJ syndrome, your general practitioner may also prescribe a muscle relaxant or a tricyclic antidepressant.
Ear drops work in combination to reduce inflammation, treat the infection, and ease the pain. The drops contain active ingredients like acetic acid, benzocaine, benzocaine + chlorbutol + paradichlorobenzene + turpentine oil, and paradichlorobenzene + benzocaine + chlorbutol.
In a few cases, a surgical procedure called a myringotomy is sometimes needed to treat chronic middle ear infections which causes persistent ear pain in children and adults. The term myringotomy is a surgery where a tiny incision is made on the eardrum to drain out any fluid or pus that may have accumulated in the middle ear.
Sometimes, an ear tube insertion is also placed, known as tympanostomy tubes or grommets, into the eardrum to reduce the occurrence of ear infections and allow drainage of excess fluids. The procedure is very common and poses minimal risks. An ear tube insertion is more common for children, who tend to suffer ear infections more often than adults.
Surgery may also be indicated for other ear pain diagnoses like a tumor, severe mastoiditis, or abscess formation in perichondritis.
Alternative Therapies For Ear Pain
1. Cold or warm compresses
Putting moist heat around an infected ear can work as a great pain reliever. You can use this for both adults and children as this is a very safe remedy. Place the ice pack or warm compress over the ear and alternate between warm and cold after 10 minutes.
2. Neck movements and exercises
Some ear aches are caused by pressure in the ear canal. Certain neck movements and exercises can alleviate discomfort. Neck rotation can be one of the most beneficial exercises for relieving pressure in the ear canal.
3. Steam inhalation
Taking steam via a steam inhaler or vaporizer can be a great way to reduce ear pain. A warm shower can also be taken. The moist air opens and relaxes the airways, thus relieving the pressure and ear pain.
4. Home remedies
Garlic (Lehsun): It has both analgesic and antibiotic properties. Its extracts help ease ear pain caused by an ear infection. Warm equal amounts of garlic and eucalyptus oil. Cool, filter the oil, and put 2 or 3 drops of this garlic oil in the aching ear.
Chewing gum: If the ear pain is caused due to air pressure difference when traveling on an airplane. Chewing gum is very helpful in relieving the pressure in the middle ear.
Ginger (Adrak): It has natural anti-inflammatory properties that can help soothe pain from ear pains. Apply warmed ginger juice around the outer ear canal. Do not put it directly into the ear.
Onion: It is one of the most easily available home remedies for ear pain. Onions have antibiotic, antioxidant and anti-inflammatory properties.
Olive oil: A few drops of olive oil into the ear can act as a lubricant and helps in getting rid of the infection.
Frequently Asked Questions
- Ear infection in children. National Institute on Deafness and Other Communication Disorders. March 2022.
- Ear Infection. Centers for Disease Control and Prevention. July 2021.
- Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: a systematic review and global estimates. PLoS One. 2012.
- Ely JW, Hansen MR, Clark EC. Diagnosis of earache. Am Fam Physician. 2008 Mar 1.
- Worrall G. Acute earache. Can Fam Physician. 2011 Sep.
- SMITH EJ. Earache. Can Med Assoc J. 1952 Mar.
- Jones W. Earache. Dent Regist. 1882 Mar.