What Is It?

Pain in the ear or ears can occur for many reasons, and some are not related to the ear at all. The most common cause of earache is pain in the middle ear that occurs when the Eustachian tube (a passageway between the ear and the back of the throat) becomes blocked. The middle ear is the small, air-filled cavity that sits just behind the paper-thin eardrum. Normally, air enters the middle ear through the Eustachian tube, equalizing the atmospheric pressure between the middle ear and the 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, then pressure builds in the ear, causing pain.

If the 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 (swimmer’s ear)
• Infection of the external ear and ear lobe (cellulitis)
• Neuralgia, a pain caused by irritation of the nerves in the ear

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

When the ear is blocked by too much wax, you may feel pressure, but this usually doesn’t cause pain.

Earache is most commonly described as a feeling of pressure in the ear that causes ear pain. This may begin gradually or suddenly, and it can be very severe. Other symptoms like loss of hearing, 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.

Adults and older children with mild ear pain or pressure without 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. In the office, your doctor will examine your ears, nose and throat. He or she will 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 also may blow in a puff of air through the otoscope to see if the eardrum moves normally. Your doctor also may test your hearing. One way is to check how well you can hear fingers rubbed together near your ear.

Earache will continue until the problem that is causing it goes away. If the pain is due to blockage of the Eustachian tube, then an over-the-counter decongestant may help open it up. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) will decrease pain while the underlying condition is resolving.

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.

An infant that is breastfed is less likely to develop ear infections. 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 preferable to hold your infant to keep him or her at least semi-erect during feeding. Children are more prone to earaches if they:

• 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 of low birth weight
• Are male — Boys have more middle-ear infections than girls.

Earaches are treated most effectively with pain medications such as acetaminophen (Tylenol and others). Resting the infected ear on a warm heating pad also can provide some relief. For a blocked Eustachian tube, drugs that are used commonly include decongestants, antihistamines and mucolytics (drugs that make the mucous thinner), but the effectiveness of these medications has not been proven.

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

If your doctor diagnoses an ear infection, he or she may wait a couple of days before prescribing antibiotics to see if it will improve on its own. If the symptoms are severe, or they last beyond a couple of days, then antibiotics are often prescribed for up to 14 days.

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

The outlook for most cases of earache is excellent. Ear pain often goes away on its own. Ear infections usually go away within a few days of starting antibiotic therapy.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.