Earache

Common causes of earache include infection, a build-up of wax or fluid in your ear, or damage to the inside of your ear. In general, these factors tend to cause an earache by interfering with your eardrum, either directly or indirectly. Sometimes though, pain from another area of the face, head or neck may feel as though it is coming from your ear.

Causes

The most common causes of earache include:

Middle ear infection

In most cases, earache starts as an infection of the nose and throat with a virus, such as the type that causes a cold or flu. Infection then spreads to the middle ear through a connecting passage, known as the Eustachian tube. The Eustachian tube, in turn, becomes blocked, which prevents excess mucus from draining away as normal. Pain is felt when this build-up of mucus stretches your eardrum.

Although middle ear infections can occur in anyone, they are most common in infants aged 6-12 months and children who are starting school. The medical name for a middle ear infection is acute otitis media.

Glue ear

Glue ear is a build-up of sticky fluid behind the eardrum that can last for weeks or months. It often follows a middle ear infection, but can also occur on its own. The main symptom of glue ear is short-term hearing loss, but a mild earache may also develop due to increased pressure in the ear.

Sometimes, glue ear can develop into a middle ear infection, causing mild pain to grow into a severe earache. Glue ear is also known as otitis media with effusion or chronic suppurative otitis media.

Glue ear is a result of sticky fluid build-up behind the eardrum, resulting in earache and short-term hearing loss. 

Ear damage

Earache can sometimes result from damage to the inside of your ear canal or ear drum. For example, this could happen from pushing a foreign object into your ear, or cleaning out ear wax with a cotton bud.

Alternatively, an underlying medical condition, such as eczema, may cause the skin in the ear canal to become dry and inflamed, which can result in earache. Pressure changes during airplane travel or diving can also push or pull on the eardrum, leading to earache, or less frequently, a burst eardrum.

Earwax

Although earwax is usually harmless, a build-up can cause earache if it pushes on your eardrum. However, the most common symptoms of an earwax build-up are mild hearing loss and a feeling of fullness in your ear.

Build-up of earwax can cause mild hearing loss. 

Referred pain

Earache in adults is often pain that is 'referred' from another area of the head, such as the teeth, throat or jaw joint (also known as the temporomandibular joint, or TMJ), or from the neck due to joint or disc disease in that region. The pain is felt in the ear, rather than in the affected area.

Signs and symptoms

Apart from pain in one or both ears, other symptoms that often occur with earache include:

• Fever;
• A general feeling of being unwell;
• A blocked or runny nose;
• Mild hearing loss, and;
• Discharge of fluid from the ear.

In young children and babies who are unable to voice their symptoms, you may also notice general irritation, more crying than usual and a frequent rubbing or pulling on the ear.

Types

Earache is sometimes divided into two types: primary and secondary earache. A primary earache relates to a cause in the ear itself, while a secondary earache is caused by factors outside the ear, such as referred pain.

Methods for diagnosis

Your doctor will most likely diagnose earache by asking about symptoms and looking in your ear with an instrument, called an otoscope.

From this examination, your doctor may be able to see signs of infection, including:

• A bulging eardrum that looks red or cloudy;
• Fluid, blood or pus behind the eardrum, or;
• A burst eardrum.

If further tests are required, you may be referred to an ear, nose and throat (ENT) specialist.

An otoscope is used to check for signs of infection in the ear. 

Types of treatment

In most cases of earache, the pain clears on its own within 2-3 days. For this reason, your doctor may suggest a 'watchful waiting' period of 48 hours before suggesting treatment.

Self care

During the initial monitoring period, some home-care measures to relieve pain could include applying a warm compress to the affected ear, resting in an upright position, rather than lying down, and chewing to reduce the pressure.

Medications

Over-the-counter medications may also be taken for pain. Some examples include oral medications such as acetaminophen and ibuprofen, or ear-drop medications that contain benzocaine and phenazone. However, ear drops are not usually recommended if the eardrum has burst.

If an earache remains after 48 hours and a middle ear infection is thought to be the cause, your doctor may prescribe an antibiotic medication, such as amoxicillin or cefaclor.

Treatment options for other underlying medical conditions will differ from person to person, depending on the level of pain and cause of symptoms.

Potential complications

A primary earache usually clears up without causing any further medical issues. However, some possible complications associated with secondary earaches include:

• Temporary hearing loss;
• Dizziness (vertigo);
• Ringing in the ears (tinnitus);
• A burst eardrum;
• In young children, delayed speech and language development, and;
• A middle ear infection that spreads or keeps coming back.

Prognosis

Most earaches pass in 2-3 days without the need for any treatment and, in many cases, the cause is never determined. Some children get a number of earaches, but most outgrow them without any further issues.

Prevention

Although an earache generally cannot be prevented, it may be possible to reduce the chances of developing an underlying middle ear infection - the most common cause of an earache. For example, staying away from people with cold or flu symptoms and teaching children good hygiene habits can help to limit the spread of an infection. You may also wish to discuss vaccinations against Streptococcus pneumonia, Haemophilus influenza type B (Hib) and the seasonal flu virus with your doctor.

Earache caused by damage to the ear canal may be avoided by only cleaning the outer, visible part of the ear, rather than using a cotton bud or any other foreign object. Drying the ears well after swimming or bathing is also usually recommended.