An overview of Earache

Earache (ear pain) is one of the most common reasons we take our children to see their healthcare provider or seek help for our own painful ears. Earaches can be a symptom of ear infections or a sign of an underlying condition. Rarely, an earache or ear pain is a sign of a serious illness. Treatment depends on the cause.

Just about anyone can develop earaches. However, young children are more likely to have ear pain than older children and adults. One study shows that by their third birthday, 80% of children will have a middle ear infection (acute otitis media).

What does it mean when my ears hurt?

Many things may make your ears hurt. Healthcare providers place ear pain in two categories: primary and secondary.

1. Primary ear pain comes from your ears. For example, ear infections cause primary ear pain. More children than adults have primary ear pain. Primary ear pain typically gets worse over time.

2. Secondary ear pain happens when your ears become innocent bystanders to medical conditions that affect other parts of your body. For example, someone with an impacted wisdom tooth may have ear pain. This is referred pain. Referred pain happens because your ears and nearby body parts share the same nerves with your brain.

Common primary causes of ear pain include:

1. Barotrauma (caused by extreme pressure change). Your ears start hurting or feel full while you’re flying in an airplane or scuba diving. Barotrauma can cause ruptured eardrums.

2. Foreign object in your child’s ear. Your ear hurts and you can’t hear as well. Small children exercising their curiosity often end up lodging small objects such as food, pebbles or beads in their ears.

3. Eustachian tube dysfunction. Your ears hurt or feel full. You may have tinnitus (ringing in the ear) or hear popping sounds.

4. Swimmers ear (otitis externa). Middle ear infections often happen when children have upper respiratory infections that cause congestion and swell their eustachian tubes. If a very young child is pulling on their ears, it may be a sign they have an ear infection.

5. Otitis media (middle ear infection). Middle ear infections often happen when children have upper respiratory infections that cause congestion and swell their eustachian tubes. If a very young child is pulling on their ears, it may be a sign they have an ear infection.

6. Otitis interna (inner ear infection). Symptoms include dizziness, hearing loss, nausea and vomiting and rapid involuntary eye movement.

Common secondary causes of ear pain include:

1. Sore throats (pharyngitis) or tonsillitis. You or your child have painful sore throats that either clear up quickly or persist.

2. Dental problems. You or your child have cavities or abscessed teeth.

3. Gastroesophageal reflux disease (GERD).

4. Ear infections.

5. Temporomandibular joint syndrome. Your ear(s) hurt when you open your mouth or when you chew.

Can earaches be prevented?

Earaches happen for lots of reasons. Fortunately, there are steps you can take to reduce your risk of developing an earache:

1. Protect your ears when you fly in airplanes so you don’t have barotrauma.

2. Clean your ears with care. Use a swab to clean your outer ear and avoid digging into your ear canal.

3. Upper respiratory infections can make your ears hurt and may cause painful ear infections. Reduce your risk of developing infections by washing your hands particularly if you’re in the habit of touching your nose, eyes and mouth. You should also avoid people who are sick.

How do healthcare providers diagnose earaches?

Your provider will ask about your symptoms. They’ll examine your ears.

What happens if healthcare providers don’t find anything wrong with my child’s ears?

If your child's ears look healthy, your provider may look for underlying conditions that may cause secondary ear pain. Depending on what they learn, they may recommend you talk to an ear, nose and throat (ENT) provider.

How do healthcare providers treat earaches?

Providers focus on finding and treating earaches’ underlying cause. For example, if your child has an ear infection, your provider may recommend over-the-counter pain medicine to ease ear pain. They may also prescribe antibiotics. Likewise, if sore throats cause your child ear pain, your provider will treat your child’s sore throat.

What can I do for ear pain?

You can try some remedies at home to ease your ear pain. Over-the-counter pain medicine may help. Some people benefit by placing warm or cold compresses on their aching ears. Keep in mind an earache may be a sign of infection or another problem. Talk to your healthcare provider if your ear pain persists for more than two or three days or gets worse.

1. Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually gets better after the infection clears. Ear infections that happen again and again, or fluid in the middle ear, may lead to more-significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.

2. Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.

3. Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).

4. Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.