Earache: A Treatable Condition

What is an earache?

Earache is pain in the ear that can interfere with being able to hear. You may have it in one or both ears, depending on the cause. It can be in the inner ear, outer ear, or middle ear. Or it can even be all of them at once.

The outer ear is the external part of the ear that you can see along with the ear canal, which leads to the eardrum. The middle ear is behind the eardrum. The inner ear is inside the skull and includes the organs responsible for hearing and balance

Injuries and infections can cause earache. Sometimes, what feels like an earache is actually pain from the jaw or the teeth.

Infections of the middle ear are often caused by fluid build-up behind the eardrum. The fluid can become infected.

Infections of the inner ear can develop when the fluid goes into the inner ear. It can also be from infections that spread from the throat to the inner ear.

Most common symptoms

Symptoms vary depending on what part of the ear is affected. A sign of an earache in children, especially if they can’t speak, is tugging or pulling on the ear. They may also be extra cranky.

Outer ear symptoms

• Pain when you touch the outer part of the ear or pull on the earlobe
• Itching and drainage (fluid) from the ear canal
• Redness and irritation
• Scaly skin around the opening of the ear canal

Middle ear symptoms

• Pain in the inner part of the ear
• Muffled hearing or a sense of fullness in the ear
• Fever
• Pus draining from the ear canal

Inner ear symptoms

• Pain in the inner part of the ear
• Dizziness
• Difficulty keeping your balance
• Vertigo (feeling like the room is spinning)
• Hearing loss
• Ringing in the ears
• Nausea
• Vomiting

Causes

1. Ear infections (otitis media and otitis externa)

Symptoms

• Pain in the inner part of the ear
• Muffled hearing or a sense of fullness in the ear
• Fever
• Pus draining from the ear canal

Infections of the ear can be caused by bacteria, viruses, or fungi. Outer ear infections (otitis externa) are more common if the outer ear or ear canal is often exposed to water or moisture, such as in frequent swimmers. Outer ear infections can also be caused by minor injury or trauma to the ear canal, even by things like using cotton swabs.

Infections of the middle and inner ear are often caused by build-up behind the eardrum.

2. Blockage

Symptoms

• Hearing loss
• Sense of fullness in the ear
• Earache
• Itchiness

Your body naturally creates earwax (cerumen) to keep your ear canal lubricated and trap bacteria and debris. It also clears it out as needed. Sometimes it builds up faster than it can be cleared. Or sometimes trying to clean out the ear may push the earwax into the ear. Impaction is when wax blocks the ear canal.

When your ear canal is blocked, you can try to unclog it with over-the-counter ear drops that contain baby oil, mineral oil, or hydrogen peroxide. Saline may also be used to soften the wax to help it come out.

In more severe cases, your doctor may need to use special tools to remove the ear wax.

3. Foreign objects

Symptoms

• Hearing loss
• Sense of fullness in the ear
• Earache
• Itchiness

Foreign objects can accidentally become lodged in the ear canal. It happens more in children as they often stick objects in their ears. But it can also happen with adults, like when they try to clean the ear with cotton swabs.

It can cause irritation to the skin of the ear canal. If it gets stuck deep enough, it could tear the eardrum. Go to a doctor to have it removed or you could damage the ear canal and eardrum.

4. Trauma or injury

Symptoms

• Earache that can be severe if the eardrum is ruptured due to trauma
• Itchiness
• Drainage of blood or clear fluid from the ear canal
• Hearing loss
• Facial muscle weakness

Trauma or injury to the ear can occur with:

• A direct hit to the ear
• Trauma to other parts of the head
• A tear or rupture in the eardrum
• Fractures of the temporal bone

A direct blow to the ear can cause a tear in the eardrum due to changes in ear pressure. Trauma to the head may cause fractures of the temporal bone, which houses different parts of the ear.

A fracture of the temporal bone can include the inner, middle, or outer ear. The nerve that allows movement of the face also travels within the temporal bone. It can be damaged during head or ear trauma and cause facial muscle weakness.

Go to a doctor for any ear or head trauma. Depending on the severity, your doctor may need to do a procedure to repair it or to prevent complications.

Other possible conditions

A number of conditions may also cause earache. These are either rare or the earache is not the defining symptom. They include:

• Temporomandibular joint syndrome
• Tooth infection
• Tonsil or throat infections
• Changes in air pressure
• Teething in young children

Medical care

Primary care

You should make an appointment with your doctor if an earache gets worse or doesn’t improve in 24 to 48 hours.

Call the doctor if you have these symptoms:

Children (younger than 6 months):

• Earache (or pulling or tugging at the ears) with or without fever
• Foreign body in the ear (e.g., toy)
• Drainage of blood, pus, or clear fluid
• Hearing loss (not responding to loud sounds)
• Increased irritability
• Fewer wet diapers—and not less than 4 per day
• Breastfeeding less or drinking less formula

Children (6 months or older):

• Earache (or pulling/tugging at the ears) not improving with over-the-counter pain relievers for 48 hours
• Earache (or pulling/tugging at the ears) with fever for more than 48 hours
• Foreign body in the ear (e.g., toy, pencil)
• Drainage of blood, pus, or clear fluid
• Hearing loss (not responding to sounds as usual, turning non-affected ear towards sound)
• Disrupted sleep in a child who previously sleeps through the night
• Increased irritability
• Fewer wet diapers—and at least 4 per day
• Eating and/or drinking less

Adults:

• Earache not improving with over-the-counter pain relievers for more than 48 hours
• Earache with fever for more than 48 hours
• Foreign body in the ear (e.g., cotton swab)
• Drainage of blood, pus, or clear fluid
• Hearing loss
• Tooth, jaw, or throat pain

Treatment & relief

Your doctor will ask about your symptoms, as well as any medications that you take. They may use an instrument called an otoscope to look at the eardrum and ear canal for signs of an infection. This procedure may be accompanied by a small puff of air. This checks how the eardrum reacts to air being pushed against it.

Treatments depend on the diagnosis:

• Ear infections can be treated with antibiotics if you have a bacterial infection, or antifungal medication if it’s caused by a fungus.
• Try to gently remove earwax with over-the-counter ear drops containing baby oil, mineral oil, hydrogen peroxide.
• Over-the-counter pain relievers including acetaminophen, ibuprofen, and naproxen can help reduce pain and inflammation.
• Warm compresses applied to the ear can help with pain.
• If your earache was triggered by changes in altitude (e.g., after flying on an airplane), try chewing gum or yawning to relieve the pressure.

Preventative steps

Although ear infections aren’t contagious, the bacteria and viruses that can cause them are. It’s important to vaccinate your children on schedule, get them the flu vaccine yearly, and follow good hygiene and routine handwashing. Other prevention tips:

• Keep foreign objects out of your ear.
• Dry ears after swimming or bathing.
• Avoid allergy triggers, such as dust and pollen.
• Don’t smoke. Smoking weakens the immune system and damages tissues in the nose and throat.
• If possible, breastfeed exclusively until children are at least 6 months old—and ideally until 12 months.