Earache

An earache is a very common complaint, particularly among children. It usually affects one ear, but in some rare cases, it may affect both ears. An earache may be persistent or intermittent. It may be felt as a dull or sharp pain. Some feel it as a burning sensation in the affected ear.

An earache may be accompanied by other symptoms like: 

• Fever
• Irritability
• Increased crying in children
• Fussiness

Many children rub their ears as if to indicate that it is hurting.

Injury, infection, and irritation are the major causes of an earache. In some cases, pain that has onset in jaws or teeth may be felt in the ear as an earache. Such a pain that originates elsewhere but is felt in some other region is known as referred pain.

An earache may also be caused by wax buildup, the presence of a foreign object in the ear, sinus infection, strep throat, trapping of water in the ear and excessive cleaning of ears using cotton swabs.

There are some less common causes of an earache like an infected tooth, eczema of the ear canal, arthritis that affects jaws, and perforation of the ear drum.

In children, an earache accompanied by high fever with temperature in the range of 104˚F or more needs medical attention. For infants, fever above 101˚F requires evaluation. In some cases, an earache may be characterized by severe pain which stops all on a sudden.

This should be immediately brought to the attention of the physician as it may be a sign of eardrum rupture, a more serious condition.

Some other symptoms which when seen along with an earache require medical attention include dizziness, headache, swelling around the ear, droopy face, and pus leaking from the ear.

One should also ensure that pain does not persist for more than 2 days, beyond which one should take an appointment with the doctor.

An earache is diagnosed based on the symptom and ear examination using an otoscope. Inflammation, swelling, and reddish color in the ear may indicate an ear infection.

The doctor may also look at nose and throat during the physical examination to diagnose the underlying cause. Other tests and investigations are suggested based on the probable cause of the condition.

Earaches can be alleviated with some home remedies like relieving ear pressure by sitting upright, using over-the-counter eardrops, chewing gum, taking painkillers, and applying the warm or cold compress to the ear.

Oral antibiotics or eardrops are usually recommended to treat an ear infection. Compliance with antibiotics is very important to completely resolve the infection. One should not stop the medication when the symptom reduces.

Wax softening eardrops help to clear the block in the ear that causes pain. Ear lavage is another procedure that helps in removing wax.

Other treatments are based on the underlying cause of an earache. Earaches can be prevented by avoiding smoking, keeping ears safe from foreign objects, drying the ears thoroughly, and avoiding allergies.

An earache may occur due to problems in any of the parts of the ear like an outer, middle or inner ear.

Causes of an outer earache:

The outer part of the ear cartilage is made up of helix and auricle either of which may become infected or inflamed leading to outer earaches. This may be caused by: 

• Cellulitis
• Sunburn
• Chronic skin diseases like atopic dermatitis
• Trauma that leads to injury in the auricle

Inflammation of the ear canal, commonly known as swimmer’s ear is another cause of an earache. Swimmer’s ear may be caused by: 

• Minor trauma that injures the ear canal leading to inflammation. Cleaning the ear wax with sharp objects is an example of mild trauma that can irritate the ear canal.
• Retention of water in the ear canal may also lead to inflammation. Moist conditions in the ear canal increase the risk of bacterial infections.
• Accumulation and hardening of ear wax may also cause pain in the ear, particularly when the wax squeezes the eardrum.
• The presence of foreign body in the ear canal is a common cause of an outer earache. Pain and inflammation results when narrow objects are inserted into the ear canal. This includes small objects like hair clips that are inserted into the ear to clean the wax.

Causes of a middle earache:

Infection and inflammation of the middle ear may also result in pain. The increase in pressure within the middle ear is one of the common causes of a middle earache. Middle ear infections are caused by bacteria or viruses which may be present in the fluid retained in the middle ear.

Middle ear infections are very common among children. Abnormal functioning of Eustachian tube results in fluid retention in the middle ear region. Accumulation of fluid in the region increases the pressure within the region leading to an earache.

In most of the cases, this earache may resolve over a period of time without any specific treatment. But if infection occurs in the fluid within the middle ear, it may worsen the pain.

Causes of an inner earache:

Inflammation of the eardrum is a common cause of an inner earache. This may be caused by: 

• Infection of eardrum by bacteria, virus or fungus
• Extension of infection from the ear canal or middle ear
• Injury to ear canal by poking or other types of mild trauma
• Rupture of eardrum due to increased pressure in the region. This may be caused by a blow to the ear, or due to increased pressure in an airplane, or an explosion.
• Electrocution may also lead to rupture of ear drum

Other causes of an earache:

Other causes of an earache include the referred pain in which pain from a neighboring organ radiates to the ear.

• Inflammation of temporomandibular joint, the joint next to the external ear canal, may cause ear pain.
• Sinusitis that lead to increased pressure within middle ear leads to an earache.
• Toothaches and other dental issues also are causes of pain in the ear.
• Infection of mastoid bone or mastoiditis also is a cause of an earache.
• Inflammation of throat and tonsils also have an earache as a symptom as the pain radiates to the ears.
• Thyroid inflammation is also a cause of referred pain.
• Trigeminal neuralgia, characterized by inflammation of the fifth cranial nerve, may lead to an earache.

The actual cause of an earache is diagnosed based on the accompanying symptom, medical history, and physical examination. An otoscope is used to evaluate the condition of the ear canal, middle ear and eardrum.

Swelling and inflammation of the ear canal indicates otitis externa or external ear inflammation. The canal may be swollen with indications of thick drainage. The presence of fluid blisters in the ear drum is also seen using otoscope.

This may indicate middle ear infection and inflammation. Previous infections are seen in the form of scars in the eardrum. Tubes used in the treatment of chronic ear infection also may be noted using otoscope.

Other parts of the body including throat, neck, and lungs are also checked. This examination is important in persistent earaches which do not show any specific problems in ear examination.

In children, particularly those who have a delay in speech development, hearing tests may be recommended. Hearing test is suggested also for people with vertigo. Laboratory tests or imaging techniques are generally not suggested in the diagnosis of earaches.

In some rare cases, a sample of drainage from the ear may be analyzed in the laboratory to identify the causative bacteria. Imaging studies like x-ray or CT scan may be recommended only if the probable cause of the pain is a tumor or a structural problem in a region near the ear.

A number of home remedies are used to reduce an earache and inflammation:

• Warm or cold compress placed outside the ear often helps to alleviate pain. The compress is held for about 20 minutes.
• Over-the-counter pain medications are also commonly used to reduce the pain. These include ibuprofen, naproxen, and acetaminophen.
• Keep oneself well hydrated by drinking plenty of water
• Over-the-counter ear drops are useful in relieving pain
• Chewing and yawning to reduce the pressure buildup in the middle ear that causes pain.
• Nasal sprays are useful in controlling pain caused by sinusitis.

External ear infection or swimmer’s ear is treated by prescription ear drops. These medications contain steroids to control inflammation and antibiotics to treat the infection.

In some cases, an oral antibiotic may be recommended for infection. Treatment of middle ear infection depends on the situation. If the symptoms resolve within few days, treatment may not be required.

In other cases, antibiotics and pain killers may be used to alleviate pain and to treat the infection. Oral antibiotics, ear drops and pain killers are suggested for treating infection of the eardrum.

In some cases, an earache may recur even after successful treatment. Recurrent pain, fever, nausea and vertigo call for follow-up visits with the doctor. Hearing tests may be recommended for people with recurrent ear pain.

If ruptured eardrum does not resolve on its own, a visit to the ENT specialist is recommended. Follow-up is important also for people with weakened immune system and those with diabetes.

Earaches can be prevented in most of the cases. Shaking out excess water and drying the ear canal is very important in keeping the ear dry and to prevent infection.

Use of sharp objects to clean the ear should be strictly avoided. Preventing respiratory infections and avoiding passive smoking are also steps in preventing earaches.