Earache

What is it?

Pain in one or both ears can occur for many reasons, some not related to the ear at all. When the pain is caused by an ear problem, the most common reason is blockage of the passageway between the middle ear and the back of the throat. This passageway is called the Eustachian tube.

The middle ear is the small, air-filled cavity just behind the paper-thin eardrum. Normally, air enters the middle ear through the Eustachian tube, equalizing the pressure between the middle ear and outer ear. The Eustachian tube also drains fluid out of the middle ear. When this tube becomes blocked, and air and fluid cannot flow freely, pressure builds in the ear, causing pain.

If fluid behind the eardrum becomes infected with a virus or bacteria, it causes a middle ear infection that can lead to pain and fever.

Other causes of pain related to the ear include:

• Injury
• Inflammation and infection in the ear canal (the channel between the eardrum and the outside part of the ear). It is often referred to as swimmer's ear
• Infection of the external ear and ear lobe (cellulitis)
• Neuralgia, pain caused by irritation of the nerves in the ear.

Pain from a sore throat or a problem with the jaw joints called temporomandibular joint disorders (TMJ) may be felt in the ear.

When too much wax blocks the ear, you may feel pressure, but this usually doesn't cause pain.

Symptoms

Earache 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. Other symptoms such as hearing loss, fever and feeling unwell usually indicate an ear infection.

When the ear canal is inflamed or if the eardrum ruptures, there may be drainage from the ear. If the eardrum ruptures because of a middle ear infection, the pain is often relieved because the pressure is reduced. In young children, the only signs of an ear infection may be fever, irritability and pulling at the ear.

Diagnosis

Adults and older children with mild ear pain or pressure who do not have a fever or hearing loss usually do not need to see a doctor. This type of pain usually is caused by a blocked Eustachian tube.

If the ear pain is more severe, or there are other symptoms, it's a good idea to see a health professional. Your doctor will examine your ears, nose and throat, and use a device called an otoscope (a lighted instrument) to look inside the ears and check for redness and fluid buildup behind the eardrum. The doctor may blow a puff of air through the otoscope into your eye to see if the eardrum moves normally.

Your doctor may test your hearing. One way is to check how well you can hear fingers rubbed together near your ear.

Expected duration

An earache will continue until the problem causing it goes away or is treated. If the pain is due to a blocked Eustachian tube, an over-the-counter decongestant may help open it up. Acetaminophen (Tylenol), ibuprofen (Advil, Motrin and others) or naproxen (Aleve) will decrease pain until the underlying condition is treated or goes away.

Prevention

Some people, particularly young children, are prone to recurring earaches. If a child continues to have frequent ear infections, the doctor may surgically insert a ventilation tube into the eardrum to prevent the ear from becoming blocked.

Children are more prone to earaches if they: Breastfed infants are less likely to develop ear infections because breast milk contains antibodies that help to protect the baby from infection. Also, when a baby sucks on a bottle, the fluid is more likely to get pulled into the Eustachian tube, particularly if the infant drinks from a bottle while lying on his or her back. For this reason, it is better to hold the baby at least semi-erect during feeding.

• Have had ear infections before their first birthday
• Are frequently exposed to cigarette smoke
• Have a family history of ear infections
• Stay in day care
• Were born premature or at low birth weight
• Are male (boys have more middle ear infections than girls).

Treatment

Over-the-counter pain relievers will usually be enough to control pain. Examples include acetaminophen, ibuprofen and naproxen. Resting the infected ear on a warm (not hot) heating pad can provide some relief. For a blocked Eustachian tube, drugs commonly used include decongestants and antihistamines.

Children with earaches and fever should not take aspirin without a doctor's approval because aspirin has been linked to Reye's syndrome, a potentially fatal illness that can occur in children who have certain viral infections.

If you have an ear infection, antibiotics may not be needed. A trial of a decongestant and pain medicine may be sufficient. However, if the symptoms are not getting better after a few days or they are quickly getting worse, contact your doctor to discuss treatment with an antibiotic. If the symptoms are severe when you first see your doctor, he or she may advise starting an antibiotic right away.

When to call a professional

Call your doctor if you or your child has a fever or hearing loss with an earache. See a doctor if you develop ear pressure that lasts for several days, even if you don't have other symptoms.

Prognosis

Most earaches resolve within several days. Even with more prolonged ear infections, the outlook is positive.

Additional info

American Academy of Otolaryngology — Head and Neck Surgery
https://www.entnet.org/