Ear pain

Ear pain is most commonly described as a feeling of pressure in the ear. This sensation may begin gradually or suddenly, and it can be very severe. The symptoms of ear pain in adults include:

• Hearing loss
• Fever
• Fluid drainage from the ear
• Ringing in the ear
• Vertigo

In young children, the signs of an ear infection may include:

• Fever
• Irritability
• Pulling at the ear
• Loss of appetite
• Difficulty sleeping
• Difficulty responding to sounds
• Fussiness and crying
• Loss of balance

Injury, infection, and irritation in the ear are common causes of ear pain.

I. Ear Infection

Ear infections are usually caused by bacteria and often begin 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. 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 visible on the outside; it is the curved flap of the ear leading down to the earlobe. Outer ear infections can be caused by swimming, wearing headphones that damage the skin inside the ear canal, or inserting cotton swabs into the ear canal.
• Middle Ear Infection: The middle ear is located between the eardrum and the inner ear. Infections can start from a respiratory tract infection, leading to a buildup of fluid behind the eardrum caused by the infection.
• Inner Ear Infection: This part contains the labyrinth, which helps maintain balance, and the cochlea, a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. An inner ear infection, known as labyrinthitis, is sometimes caused by viral or bacterial infections from respiratory illnesses.

II. Symptoms of Other Conditions

• Ear pain with a toothache in children who are teething. Individuals with an infected tooth, abscess, or impacted wisdom teeth are more likely to experience ear pain.
• Ear pain accompanied by a change in hearing, earwax buildup, an object stuck in the ear (do not attempt to remove it yourself – see a GP), or a perforated eardrum (especially after a loud noise or accident).
• Ear pain with pain when swallowing in cases of sore throat, tonsillitis, and quinsy (a complication of tonsillitis).
• Ear pain associated with a fever, flu, cold, or sinusitis.

III. Ear Wax

Earwax is part of the body's protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds up excessively, it may cause significant ear pain, especially if it presses against the eardrum.

IV. Insertion of a Foreign Object

When a foreign body is inserted into the ear, it causes pain and inflammation. Common objects include hairpins and pointed items often used to scratch or remove earwax.

V. Certain Medical Conditions

• Meniere's Disease: Caused by excess fluid buildup in the inner ear, though the exact reason for this fluid retention is unknown. Along with the classic triad of symptoms—vertigo, ringing in the ears, and hearing loss—some individuals report ear pain or pressure.
• Tumors: Although uncommon, a tumor may cause ear pain. For example, nasopharyngeal cancer (a type of head and neck cancer) may lead to ear fullness, hearing loss, ringing in the ears, and recurrent ear infections. Benign (noncancerous) tumors that may develop in the ear 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).
• Other Causes: Other causes of ear pain include:
  • Change in pressure, such as when flying on a plane
  • Temporomandibular joint syndrome (the joint that connects the lower jaw to the skull)
  • 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.

• Inflammation in the ear
• Fluid buildup in the ear
• Medical conditions such as respiratory tract infections, sinusitis, common cold, allergies, or asthma
• Illnesses that weaken the immune system, such as AIDS (HIV infection)
• Smoking increases the chances of developing an ear infection
• Children with viral infections
• Individuals who swim regularly are at a higher risk due to water entering the ears while swimming

If you experience any symptoms of ear pain such as burning pain or discomfort, hearing loss, or drainage from the ear, it is advisable to consult a doctor. Your doctor may perform a physical examination followed by questions related to your daily routine to determine the cause. Diagnosing ear pain often requires a medical history and physical examination by an ear, nose, and throat (ENT) specialist.

1. Medical History

An ENT specialist may ask several questions regarding the details of your pain, including:

• What the pain feels like
• Whether the pain comes and goes
• Any accompanying symptoms such as fever, hearing loss, 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 its components, including:

• Outer ear
• Middle ear
• Inner ear
• Ear canal
• Tympanic membrane (eardrum)

This is done using an otoscope, an instrument designed for visual examination of the eardrum and the outer ear passage. Common causes of ear pain include:

• Temporomandibular joint syndrome
• Pharyngitis (sore throat)
• Dental disease
• Cervical spine arthritis

The doctor will also review the medical history for asthma, respiratory illnesses, and sinusitis in both children and adults. In some cases, nasal endoscopy may be recommended, which is a non-surgical procedure to examine the middle ear, nasal passages, and openings to the sinuses.

3. Blood Tests

Blood tests may be conducted to help diagnose various ear pain conditions, especially in the case of an ear infection:

• White Blood Cell (WBC) Count: This test helps determine infection or inflammation, as WBCs play a vital role in the immune system.
• Erythrocyte Sedimentation Rate (ESR): This test detects non-specific signs of inflammation resulting from infections, cancers, or certain autoimmune disorders.
• C-Reactive Protein (CRP): This is a marker for inflammation, with levels increasing during bacterial infections and tissue damage.

These blood tests are not specifically for detecting ear pain, but evaluations can help rule out other related diseases like thyroid disorders and syphilis, which may have symptoms similar to Meniere's disease.

4. Imaging

If the diagnosis is unclear from the history and physical examination, imaging studies may be performed:

• X-ray: Evaluates the jaws and adjacent areas of the ear.
• Computed Tomography (CT) Scan or Magnetic Resonance Imaging (MRI): Visualizes the middle and inner ear. An MRI scan is generally advised if hearing loss is sensorineural, indicating a nerve problem or suspecting a possible tumor such as nasopharyngeal cancer as the source of ear pain.

5. Hearing Tests

Hearing tests may be recommended if there have been recurrent infections or delays in speech development in children.

6. Tympanometry

Tympanometry is a test that evaluates the proper functioning of the middle ear, positioned behind the tympanic membrane. The test assesses the condition and movement of the tympanic membrane in response to pressure changes. Results are recorded in a graph called a tympanogram. Tympanometry is useful for diagnosing ear problems that can lead to hearing loss, particularly in children. Through the test, your doctor can check for:

• A middle ear infection
• Fluid in the middle ear
• A perforated tympanic membrane
• Issues with the eustachian tube connecting the upper throat and nose to the middle ear

Some ear pains may be preventable by following these measures:

• Avoid smoking
• Avoid chronic use of cotton swabs
• Avoid inserting sharp or foreign objects into the ear, as this can scratch the ear canal or the wax layer, increasing the risk of infection
• After swimming, blow-dry your ears to prevent water buildup
• Keep swimming pools and hot tubs clean with disinfectants and regular pH testing to reduce the risk of infection and ear pain
• Breastfeed exclusively until your baby is 6 months old and continue breastfeeding for at least 12 months

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.

1. Self-care plan

• 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.
• Perform simple jaw exercises in case of temporomandibular disorder (TMD).
• For a blocked eustachian tube, decongestants and antihistamines can be used.
• If a buildup of wax is causing your ear pain, you may be given wax-softening ear drops, which may help the wax fall out on its own.
• In the case of children, antibiotics cannot be prescribed immediately; watchful waiting and delayed prescribing steps are recommended. This approach allows the immune system time to fight off the infection.

2. Ear flushing

• 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, wax-softening ear drops may be administered to help soften the wax.
• Ear lavage, also known as ear irrigation or ear flush, is a safe method of earwax removal.

3. Medication

• Antibiotics are often not needed for middle ear infections because the body’s immune system can fight off the infection on its own. However, antibiotics such as amoxicillin may be required for severe cases or infections lasting longer than 2–3 days. A standard 10-day course is recommended for younger children and those with severe illness, while a 5 to 7-day course is appropriate for children 6 and older with mild to moderate illness.
• To soothe ear pain, doctors may recommend over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to relieve pain and fever.
• For TMJ syndrome pain, a general practitioner may prescribe a muscle relaxant or a tricyclic antidepressant.
• Ear drops can reduce inflammation, treat the infection, and ease pain. The drops contain active ingredients like acetic acid, benzocaine, and combinations such as benzocaine + chlorbutol + paradichlorobenzene + turpentine oil.

4. Surgery

• In some cases, a surgical procedure called a myringotomy may be necessary to treat chronic middle ear infections that cause persistent ear pain in children and adults. This surgery involves making a tiny incision in the eardrum to drain fluid or pus from the middle ear.
• Sometimes, an ear tube insertion, known as tympanostomy tubes or grommets, is placed into the eardrum to reduce the occurrence of ear infections and allow drainage of excess fluids. This procedure is common and poses minimal risks, particularly for children who are more prone to ear infections than adults.
• Surgery may also be indicated for other ear pain diagnoses, such as tumors, severe mastoiditis, or abscess formation in perichondritis.

• Cold or warm compresses: Putting moist heat around an infected ear can work as a great pain reliever. This remedy is safe for both adults and children. Place the ice pack or warm compress over the ear and alternate between warm and cold after 10 minutes.
• Neck movements and exercises: Some earaches 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.
• Steam inhalation: Taking steam via a steam inhaler or vaporizer can be an effective way to reduce ear pain. A warm shower can also help. The moist air opens and relaxes the airways, thus relieving pressure and ear pain.
• 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 by air pressure differences when traveling on an airplane, chewing gum is very helpful in relieving pressure in the middle ear.
• Ginger (Adrak): It has natural anti-inflammatory properties that can help soothe pain from earaches. 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 in the ear can act as a lubricant and help in getting rid of the infection.