What Is Ear Pain?
Ear pain, also known as earache, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt. Most causes of ear pain are non-life-threatening. Primary ear pain is more common than secondary ear pain, and it is often due to infection or injury. The conditions that cause secondary (referred) ear pain are broad and range from temporomandibular joint syndrome to inflammation of the throat.
In general, the reason for ear pain can be discovered by taking a thorough history of all symptoms and performing a physical examination, without need for imaging tools like a CT scan. However, further testing may be needed if red flags are present like hearing loss, dizziness, ringing in the ear or unexpected weight loss. Management of ear pain depends on the cause. If there is a bacterial infection, antibiotics are sometimes recommended and over the counter pain medications can help control discomfort. Some causes of ear pain require a procedure or surgery. 83 percent of children have at least one episode of a middle ear infection by three years of age.
Earache symptoms
Earaches can develop from ear infections or injury. Symptoms in adults include:
- ear pain
- impaired hearing
- fluid drainage from ear
Children can typically show additional symptoms, such as:
- ear pain
- muffled hearing or difficulty responding to sounds
- fever
- sense of fullness in the ear
- difficulty sleeping
- tugging or pulling at the ear
- crying or acting irritable more than usual
- headache
- loss of appetite
- loss of balance
What are the common causes of earaches?
Injury, infection, irritation in the ear, or referred pain may cause earaches. Referred pain is pain felt somewhere other than the infection or injured site. For example, pain that originates in the jaw or teeth may be felt in the ear. Causes of earaches can include:
Ear infections
Ear infections are a common cause of earaches or ear pain. Ear infections can occur in the outer, middle, and inner ear.
Outer ear infection can be caused by swimming, wearing hearing aids or headphones that damage the skin inside the ear canal, or putting cotton swabs or fingers in the ear canal.
Skin in the ear canal that gets scratched or irritated can lead to infection. Water softens the skin in the ear canal, which can create a breeding ground for bacteria.
Middle ear infection can be caused by infections that stem from a respiratory tract infection. Fluid buildup behind the ear drums caused by these infections can breed bacteria.
Labyrinthitis is an inner ear disorder that’s sometimes caused by viral or bacterial infections from respiratory illnesses.
Other common causes of earaches
- change in pressure, such as when flying on a plane
- earwax buildup
- a foreign object in the ear
- strep throat
- sinus infection
- shampoo or water trapped in the ear
- use of cotton swabs in the ear
- temporomandibular joint (TMJ) syndrome
- perforated eardrum
- arthritis affecting the jaw
- infected tooth
- impacted tooth
- eczema in the ear canal
- trigeminal neuralgia (chronic facial nerve pain)
Less common causes of earaches
- temporomandibular joint (TMJ) syndrome
- perforated eardrum
- arthritis affecting the jaw
- infected tooth
- impacted tooth
- eczema in the ear canal
- trigeminal neuralgia (chronic facial nerve pain)
Causes of Outer Earaches
The helix and auricle form the outer part of the ear cartilage and may become inflamed and infected. Inflammation may be due many reasons including:
- Skin infection or cellulitis
- Sunburn
- Chronic skin irritations, like atopic dermatitis
- Trauma. An injured auricle is a common wrestling injury. If a hematoma (bruise/blood clot) forms, it can be very painful and may cause damage to the underlying cartilage, resulting in a cauliflower ear.
- The ear canal may be a source of pain due to infection or trauma.
Earaches in Babies and Children
Earaches and ear pain in children are a fact of life for parents and are one of the most common reasons they call their pediatrician after hours. Experts estimate that 3 out of 4 babies develop ear infections, when fluid in the middle ear builds up and inflammation develops, but diagnosing the exact cause can be challenging.
Young children and babies who have ear infections tend to be fussy and irritable. They may also cry and tug at or rub their ears. Other signs of earaches in babies include trouble sleeping, waking at night, fever, clumsiness, and difficulty hearing. Very rarely, earaches in children can result in hearing loss.
Temporary Ear Pain
Many people experience ear pain and mild hearing loss or muffling due to sudden changes in air pressure, such as traveling on an airplane or riding on an elevator. While disconcerting, this kind of ear pain is temporary and rarely leads to lasting hearing problems. Try chewing gum or swallowing for quick ear pain relief.
Excessive earwax that builds up in the ear canal can also cause pressure and pain in the ear. But that old saying that you should never stick anything smaller than your elbow into your ear still holds true: People who try to clean wax from their ears with cotton swabs or other objects can inadvertently damage the eardrum and push the wax farther back into the ear, making it harder to remove. Excessive earwax should be diagnosed and treated by a healthcare professional.
What is a Ruptured Eardrum?
People who experience intense ear pain accompanied by clear or bloody fluid from the ear may have a ruptured eardrum. Ruptured eardrums can be caused by injuries to the head and neck area, changes in air or water pressure — from going scuba diving, for example — inner ear infections, and less commonly by being around loud noises.
A ruptured eardrum is a hole or perforation in the membrane that separates the inner and outer ear. Ruptured eardrums can be very painful and may result in temporary or permanent hearing loss, but they usually heal on their own.
Ear Pain and Other Conditions
Chronic ear pain in adults can also be associated with related conditions, including tinnitus, a ringing or buzzing in the ear that affects about 1 in 5 people.
Some ear pain comes from a “referred source,” meaning the sensation of pain is felt in the ear but originates elsewhere in the body, such as the brain, jaw area, or throat. Though it’s rare, ear pain can also be caused by structural changes in the jaws or teeth. People with damage to or disorders of the temporomandibular joint (TMJ), which connects the jaws, can feel pressure or fullness, or experience tinnitus.
Treating earaches at home
You can take several steps at home to reduce earache pain. Try these options to ease the ear pain:
- Apply a cold washcloth to the ear.
- Avoid getting the ear wet.
- Sit upright to help relieve ear pressure.
- Use over-the-counter (OTC) ear drops.
- Take OTC pain relievers.
- Chew gum to help relieve pressure.
- Feed an infant to help them relieve their pressure.
Medical treatment for earaches
If you have an ear infection, your doctor will prescribe oral antibiotics or eardrops. In some cases, they’ll prescribe both.
Don’t stop taking the medication once your symptoms improve. It’s important that you finish your entire prescription to ensure that the infection will clear up completely.
If a buildup of wax is causing your ear pain, you may be given wax-softening eardrops. They may cause the wax to fall out on its own. Your doctor may also flush out the wax using a process called ear lavage, or they may use a suction device to remove the wax.
Your doctor will treat TMJ, sinus infections, and other causes of earaches directly to improve your ear pain.
Causes of Swimmer’s Ear (Otitis Externa) Earache
Otitis externa is inflammation of the ear canal, and is often referred to as “swimmer’s ear.”
- Irritation to the skin that lines the canal may be due to minor trauma, like trying to clean ear wax with a sharp object and causing a scratch that becomes inflamed or infected.
- swimmer’s ear describes inflammation caused by retained water in the ear canal. The dark, warm, moist area may promote bacterial growth and predispose to infection.
- Cerumen (ear wax) impaction. Ear wax is part of the body’s protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds excessively, it may cause significant pain. This is especially true if the wax presses against the eardrum.
- Foreign body. When a foreign body is inserted in the ear and cannot be removed, pain and inflammation may occur. These may include Q-tips, hair pins, and other narrow objects that are often used to scratch an itch or to remove ear wax. This is never safe, and nothing should be inserted into the ear canal. In addition to irritation of the external canal, the ear drum may also be perforated or damaged.
Causes of Middle Ear (Otitis Media) Earache
The middle ear is separated from the external ear canal by the eardrum, and this is the location of nerves involved with hearing. It is a relatively closed space and anything that increases pressure in the middle ear will cause pain.
- Middle ear infections are a common cause of otitis media especially in children. These are commonly caused by a virus or bacteria that invades and infects stagnant fluid in the middle ear.
- Serious otitis media describes fluid collection within the middle ear and is usually due to Eustachian tube dysfunction. This is the tube that drains fluid and equalizes pressure between the middle ear and the back of the throat. Increased pressure may cause pain and fullness but usually resolves over time. However, this fluid may also become infected, causing pain and fever.
Causes of Inner Ear Earache
- The inner ear is adjacent to the middle ear. The inner ear is the site of the labyrinth system that sends messages to the brain to help with balance. Inflammation of the inner ear is associated with vertigo but not necessarily pain.
Eardrum (Tympanic Membrane) and Earache
The eardrum, or tympanic membrane, separates the external ear canal from the middle ear. It vibrates when sound hits it and transmits that vibration to allow the sense of hearing. Myringitis describes inflammation of the eardrum.
- Bullous myringitis causes inflammation and blistering of the tympanic membrane and can be very painful. Then infection may be due to bacteria, virus, or fungus.
- Myringitis may be due to extension of an infection from the external canal or from the middle ear
- Traumatic myringitis may occur from a direct injury like poking a sharp object into the ear canal.
- Trauma may also cause increased pressure in the area of the eardrum, causing it to rupture. This may include a blow to the ear with the palm of the hand, change in air pressure within an airplane, an explosion or other situations in which air is forced into the ear canal.
- Electrocution injury is often associated with perforation of the eardrum.
Other Causes of Earache or Ear Pain
Ear discomfort may be due to pain from a nearby structure that that radiates to the ear:
- TMJ pain. The temporomandibular joint, where the jaw attaches to the skull, is located adjacent to the external ear canal, and inflammation of this joint may be associated with ear pain. TM joint pain may be due to trauma or arthritis. Teeth grinding may cause irritation and ear pain as well.
- Sinusitis may be associated with increased pressure within the middle ear, causing pain.
- Dental problems and toothaches may radiate pain to the ear area.
- Mastoiditis. The mastoids are bony prominences of the skull filled with air cells and are located behind the ear. Infection of these areas may cause ear pain.
- Pharyngitis (throat inflammation) and tonsillitis may cause pain that radiates to the ear. A peritonsillar abscess will often result in ear pain in addition to difficulty opening the mouth and difficulty swallowing.
- Thyroid inflammation and carotid artery pain (carotidynia) may also be associated with ear pain
- Trigeminal neuralgia. Inflammation of the fifth cranial nerve may cause significant facial pain including ear pain.
- Tinnitus. While not truly pain, ringing in the ear may cause significant discomfort
- Barotrauma describes injury to the ear because an acute change in pressure within the middle and inner ear. This may include changing pressures from flying in an airplane, scuba diving or snorkeling, or trauma due to a blast injury. Damage may occur to any or all of the eardrum, middle and inner ear.
How to Prevent Ear Pain
To prevent ear pain, avoid smoking and exposure to secondhand smoke, and allergy triggers like dust and pollen, all of which can irritate your sinuses and cause earaches.
People at risk for ear pain should avoid loud music, concerts, and environmental noise, such as banging construction. If you can’t avoid loud noises, it’s worth investing in a good pair of earplugs or noise-canceling headphones.
Keep all foreign objects out of the ear and, if you swim, wear earplugs and a bathing cap. Always take time to carefully dry your ears after swimming, showering, or bathing.
Treatment for Ear Pain
Treatment for ear pain depends on the underlying cause. It may include over-the-counter, age-appropriate painkillers, such as aspirin or ibuprofen (Advil, Motrin) for pain and fever. Treatment may also include warm compresses, acetaminophen (Tylenol), other nonsteroidal anti-inflammatory medication (NSAIDs), or a short course of narcotic pain medication. Treatment for otitis media may include oral antibiotics, while treatment for otitis externa requires antibiotic eardrops. Your doctor may prescribe antibiotics for ear infections, although some research suggests antibiotics may not always be an effective treatment.
A pharmacist may be able to recommend over-the-counter eardrops for quick at-home ear pain relief. Olive oil, as well as some eardrops, may also help loosen earwax. Never use eardrops or olive oil if you suspect your eardrum — the membrane that separates the outer and middle parts of the ear — may have burst.
Holding a warm flannel or cloth-covered hot water bottle to the painful ear for around 20 minutes is one DIY form of treatment. But if an ear infection is suspected, avoid getting the inside of the ear wet.
In most cases, ear pain subsides without any treatment at all, but if it doesn’t go away, or is accompanied by other, more serious symptoms, you should see a healthcare provider — either your primary care physician or an otolaryngologist, a doctor who specializes in ear, nose, and throat disorders.
Preventing earaches
Some earaches may be preventable. Try these preventive measures:
- Avoid smoking and exposure to secondhand smoke.
- Keep foreign objects out of the ear.
- Dry the ears after swimming or bathing.
Avoid allergy triggers, such as dust and pollen.