Earache
Too painful to hear
Anyone who has ever had an earache can tell you how unpleasant it is. (So can anyone who has stayed awake nursing a sick child's earache all night). To make matters worse, earaches often accompany a sore throat, chest cold, or allergies. The combination makes getting an earache a dreaded event.
Ear infection is the most common cause of earaches and one of the most common childhood illnesses. By age six, 90% of all children have suffered at least one middle ear infection. If you have a child, you will likely treat them with an earache, if you have not done so already.
In addition to infection, another cause of earaches is damage to the eardrum, which requires medical attention. Changes in air pressure can cause temporary earaches that resolve over a short period of time.
Learning the causes of earaches will help you understand how to overcome them, or better yet, prevent you from getting them in the first place. There are many methods to ease the pain of an earache and many ways for your doctor to treat the underlying cause.
Detailed Description
An infection of the middle or outer portion of the ear causes most earaches. These infections may be bacterial, viral, or fungal. Allergies can also lead to an earache.
The sore throat, head cold, allergies, or other seemingly unrelated illnesses that often accompany earaches frequently move from the nose and throat area to the ears by way of the eustachian tube. The eustachian tube connects the nasal passages to the middle ear, and serves as an ideal path for many infectious organisms to reach the ear.
Children suffer from earaches much more frequently than adults do, perhaps because eustachian tubes are much shorter and narrower in children than adults, so they plug up more easily with the increased mucus levels of an upper respiratory infection. Infection from the nasal passages, therefore, has a shorter distance to travel to the ear region, making children especially vulnerable.
Allergies, respiratory infections, and other infections have all been linked to middle ear infections, known as otitis media. Studies indicate that 25% to 40% of upper respiratory infections in children younger than age three are accompanied by an episode of otitis media, and 40% to 50% of children older than age three with persistent otitis media also have allergies.
Synonyms
- External otitis
- Otitis media
- Swimmer's ear/tropical ear
- Otitis externa
- Otitis interna
- Airplane ear
How Common Are Earaches?
Children are much more vulnerable to an earache (ear infection) than adults. Swimmers, as a group, suffer frequent ear infections, since a wet ear canal creates prime conditions for fungi and other infectious organisms to grow.
Possible Underlying Causes
The ear canal is a narrow tunnel about one inch long that extends from the outer ear to the eardrum. Because the ear canal contains many nerve endings, even the slightest pressure or touch can cause great discomfort. The inner parts of the ear are also filled with nerve endings. When any portion of the ear becomes infected, fluid and pus bulge against the eardrum and cause pain.
Triggers of Earaches
Allergies, upper respiratory tract infections, and head colds can all cause earaches. Changes in air pressure -- as with air travel or scuba diving -- can spur a temporary earache caused by barotrauma (see below). Injury to the ear canal or eardrum by cotton swabs or other means can also trigger an earache.
Drugs That Can Cause or Aggravate Earaches
The anti-acne drug Tretinoin (Retin-A) can cause earaches.
Diagnosing the Underlying Cause
Not surprisingly, infections of the different parts of the ear often cause earaches. Perhaps less obvious is that infections of the throat and nasal passages also cause earaches. This is because the nasal passages and ears are closely connected by the eustachian tubes which can easily transmit infectious organisms from the nose and throat to the ears. Earaches can also have more worrisome causes such as growths on the ear and damage of ear structures, but these causes are much less frequent. If you have coronary artery disease or angina (a condition characterized by a lack of blood and oxygen going to the ear muscle, due to blockage in the coronary artery), those conditions may cause you ear pain.
The following conditions may include earache among their symptoms, but the presence of an earache should not lead you to conclude that you have a more serious disorder. You should not attempt to diagnose yourself with a medical condition, even if your symptoms match those of a certain disorder. If your symptoms concern you, the best thing to do is to seek medical advice. To understand your symptoms and reach a diagnosis, your doctor will consider your medical history, the symptoms you're having, and the results of a physical examination and laboratory tests.
Earache without hearing loss
- Laryngitis: inflammation of the voice box, usually caused by a viral infection, leading to a tickling dry cough, sore throat, hoarseness, interference with speech, and possibly fever.
- Pharyngitis: inflammation of the pharynx (the part of the throat from the back of the mouth to the esophagus) usually caused by viral or bacterial infections. Sore, red throats accompanied by sore neck glands, painful swallowing, fever, and headache can also lead to earache.
- Sinusitis: inflammation of the lining of the nasal passages and air pockets. Sometimes stemming from allergy infection, sinusitis causes a feeling of congestion often accompanied by headache, runny nose, fever, and throbbing pain in the eye area that can extend to the ears.
- Tonsillitis: inflammation and infection of the tonsils often accompanied by sore throat, swollen neck glands, headache, and fever. In children, tonsillitis can cause more severe symptoms such as abdominal pain, nausea, and vomiting.
- Tooth abscess/decay: occasionally, dental problems can cause pain that extends to the ear. If you lack the sore throat or typical signs of ear infection, your doctor might suggest a visit to the dentist.
- Earwax buildup: accumulation of earwax (cerumen) can put pressure on parts of the middle or inner ear and cause pain or a feeling of blockage. You might make this problem worse if you regularly use cotton swabs.
- Temperomandibular joint disease (TMJ/TMD): inflammation of the jaw exacerbated by teeth-grinding. Pain can extend up to the ear.
Earache with hearing loss
- Middle ear infection: infection (usually bacterial) of the middle part of the ear that includes the eardrum and the tiny bones that create sound. Also called otitis media, it can additionally cause ringing in the ear (tinnitus), fluid discharge, fever, and dizziness.
- Outer ear infection: infection of the outermost part of the ear canal that extends from the eardrum. Also called otitis external or swimmer's ear, this kind of infection often occurs when water becomes trapped in this part of the ear canal. Outer ear infections can have viral, bacterial, fungal, or allergic origins, or can be caused by foreign objects becoming lodged in the outer ear canal. These infections cause redness and itching of the ear canal, pain, discharge, and hearing loss.
- Inner ear infection: Usually viral, labyrinthitis can cause permanent deafness if left untreated. Labyrinthitis is often accompanied by dizziness, nausea and vomiting, buzzing or ringing in the ear (tinnitus), and, more rarely, an earache.
- Airplane ear (barotrauma): eardrum strain or damage due to rapid changes in atmospheric pressure. Also called barotitis, this happens often during scuba diving, flying, skydiving, or high-impact sports and is usually temporary and harmless. Occasionally, however, it may cause serious and permanent damage.
- Perforated eardrum: a tear or rupture of the eardrum caused by injury. This may cause a sudden onset of pain, partial hearing loss, slight bleeding or discharge from the ear, and ringing or buzzing in the ear (tinnitus). This also may occur in otitis media, when pressure builds up too much.
- Ear tumor/growth: Rarely, a growth or tumor within the ear is the cause of an earache. If your doctor is unable to treat your earache with more conventional methods, he or she may refer you to one who specializes in ear diseases to rule out such a problem.
Diagnostic Procedures
Physicians have several tools at their disposal to examine the ear and determine where the problem exists. They will first ask you about your symptoms, such as sore throat, runny nose, fever, stuffy nose, or headache. Your doctor will then look into your ear with an otoscope, a lighted instrument that gives a magnified view of the inside of the ear. Diagnostic equipment is also available to measure your ear's responses to air pressure changes and sound, as well as its hearing ability. Your doctor may take a sample of your ear pus or discharge to determine what organism is causing an infection. Your doctor may also use similar diagnostic procedures to find out what organisms are causing a related illness, such as pharyngitis.
Goals of Treatment
The treatment of an earache varies according to its cause. For a bacterial infection, your doctor will likely prescribe an antibiotic (either an eardrop or an oral medication) to prevent the spread of infection to other parts of your body. If you have chronic or severe otitis media, your doctor may suggest the surgical insertion of a small plastic drainage tube into the eardrum to prevent further accumulation of fluids within the middle ear.
A ruptured eardrum will usually heal itself in about a month if attended to promptly and properly, though your middle ear will be vulnerable to infection during that time. A ruptured eardrum that does not heal within a month may require surgical repair.
You can treat swimmer's ear with over-the-counter eardrops as well as antibiotics, antifungal medications, or corticosteroid eardrops, depending on the cause. Your doctor may also prescribe oral antibiotics, and will probably recommend a course of prevention as well (see Preventive Measures, below). For middle ear infections, your doctor drains accumulated fluids and treats the infection as necessary. You may need surgery to remove the infected tissues as well.
Treatment Options
Drugs most commonly used
- Aspirin (aspirin should not be given to anyone under 18 years of age, due to the risk of Reye's syndrome, a potentially fatal complication)
- Acetaminophen
- Ibuprofen
- Topical pain-relieving drugs
Second choices
- Antibiotics or antifungals (if indicated) for treatment of infection
- Decongestants for accompanying nasal congestion
Considerations for Children and Adolescents
The eustachian tubes are a pair of openings that connect the nasal passage with the ear. In children, these tubes are much shorter and narrower than in adults. This makes it easier for infections to travel from the nose to the ear. For this reason, children are much more vulnerable to earaches than adults.
Swimmers are also particularly vulnerable to ear infection. The damp environment in the ear canal created by repeated exposure to water is ideal for infectious organisms, especially different kinds of fungus.
Herbs
- Ma huang: for fluid in the middle ear, try Chinese ephedra -- ma huang -- which contains the natural precursor of the decongestant drug in Sudafed. [1] If you use a tincture, follow package directions. With bulk herb, simmer one teaspoon in one cup of boiling water for 10 minutes, then strain. Drink up to two cups a day. As with any decongestant, it may or may not help.
- Echinacea and goldenseal can help prevent infections with a ruptured eardrum, since they both stimulate the immune system and have antimicrobial action. [2] Use a tincture in juice. Follow package directions.
Last updated October 1999.
Sources 1 Castleman, M. The Healing Herbs. New York: Bantam, 1991.
2 Duke, J. Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
Preventive Measures
Many types of earaches can be prevented. Preventive measures depend on the underlying cause of the earache. Here are some guidelines for preventing the most common kinds of ear problems leading to earache:
- Middle ear infection: Wash hands frequently to prevent the spread of infection. Ask your doctor about the use of decongestants or antihistamines to prevent swelling of the eustachian tubes if your child becomes ill. Feed your baby in a sitting position to prevent milk from entering the eustachian tubes. In adults, prevent mucus from being forced into the eustachian tubes by blowing the nose gently, perhaps one nostril at a time, and avoid sniffing.
- Outer ear infection: Do not insert objects (even cotton swabs) into the ear canal. Using alcohol and over-the-counter solutions to cleanse the ear canals is not always advisable. If earwax interferes with your hearing, it is best to let your doctor remove it safely or try over-the-counter wax softeners. Avoid swimming in waters that may be polluted. Try using over-the-counter ear drops after each swim or shower.
- Perforated eardrum: Do not insert objects such as cotton swabs into the ears. Use over-the-counter earwax softeners or let your doctor remove earwax safely if you feel this will help you hear better. If you have an allergy, cold, or other infection, avoid scuba diving or flying -- these activities put additional pressure on the eardrum.
- Swimmer's ear: Avoid swimming in potentially polluted waters. Wear earplugs or a bathing cap while swimming. Some members of swim teams use prescription eardrops that alter the pH balance of the ear. A nonprescription solution of boric acid and alcohol is available, which acts in much the same way. If you are vulnerable to swimmer's ear, place a few drops of a solution made with equal parts of white vinegar and isopropyl alcohol in both ears. After showering or swimming, tilt the ear to one side to allow any water to drain out. Then, direct warm air into the ear using a hair dryer set to low or medium a few inches away from the ear.
Self-Care Measures
- For infections of the outer ear, ear canal (swimmer's ear), and middle ear, see Ear Infections.
- For uninfected fluid buildup in the middle ear (serous otitis media):
- Try an oral decongestant like Sudafed.
- If the fluid buildup is associated with hay fever-type allergies, antihistamines may help.
- Chewing gum can also help open the ear's eustachian tubes. Most cases of serous otitis media clear up within a month.
- Explosions, blows to the ear, or sharp objects can rupture the eardrum, as can otitis media. Ruptured eardrums usually heal without treatment within a week or two. You can usually relieve pain with the help of a heating pad and aspirin, acetaminophen, or ibuprofen. As the eardrum heals, hearing almost always returns to normal.
The biggest problem with a ruptured eardrum is increased vulnerability to infection, as the break in the eardrum may allow potentially harmful microorganisms into the ordinarily sterile middle ear. Take reasonable precautions:
- Keep the ear clean and dry.
- Avoid cotton swabs.
- When in doubt, cover the ear with a plastic patch.
- Don't swim until it's healed.
- When bathing, place a wad of cotton covered with petroleum jelly (Vaseline) in the outer ear canal. Don't push it too far in.
- Many people suffer earaches in airplanes (barotitis). Barotitis is eardrum damage caused by the rapid changes in barometric pressure that happen as aircraft cabin pressure changes. Normally, the barometric pressure inside the ears is the same as the pressure outside. But when the outside pressure changes rapidly, the two pressures may differ enough to cause tension on the eardrum and pain. Adults can usually alleviate the problem by swallowing, yawning, chewing gum, or by gently attempting to exhale while holding the nose with the mouth closed. Gum or pinched-nose blowing usually work for older children as well. Infants should be given a breast or bottle to suck.
- Sometimes, earache is actually caused by temporomandibular joint (TMJ) problems in the jaw. If you suspect a TMJ problem, consult a dentist.
When to Call the Doctor
Consult a doctor if you have the following:
- Ear pain that lasts more than one week
- Sudden or severe pain in the ear
- Severe ear pain suddenly ceases
- Slight bleeding or discharge from the ear
- Reduced hearing
- Dizziness or ringing in the ear
Websites & Organizations
Agency for Health Care Policy and Research
American Academy of Otolaryngology-Head and Neck Surgery
One Prince Street
Alexandria, VA 22314-3357 USA
Phone: 703-836-4444
American Association For Respiratory Care
11030 Ables Lane
Dallas, TX 75229
Phone: 214-243-2272
Atlantic Coast Ear Specialists
933 First Colonial Road
Virginia Beach, VA 23454
Phone: 757-422-9300 or 800-535-2828
Fax: 757-425-6118
Better Hearing Institute
Box 1840
Washington, DC 20013
Phone: 703-642-0582 or 800-327-9355
Sources & Further Reading
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Castleman, M. The Healing Herbs. New York: Bantam, 1991.
Duke, J. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, L.M., McPhee, S.J., and Papadakis, M.A. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Bluestone, CD. "Modern Management of Otitis Media." Pediatr Clin North Am. 36(6):1371-87. Dec 1989.
Bojrab, DI, Bruderly, T, Abdulrazzak, Y. "Otitis Externa." Otolaryngol Clin North Am. 29(5):761-82. Oct 1996.
Burke, P, Conroy, M, Crossley, N. "How I Treat.A Night Call for Earache." Practitioner. 238(1538):337, 339-40, 342. May 1994.
Keim, RJ. "Common Ear Diseases: Recognition and Management." Postgrad Med. 61(5):72-80. May 1977.
Librach, I. "Layman's Guide to Common Complaints." 6. Earache. Nurs Mirror. 149(9):16. Aug 30, 1979
Marchant, CD, Collison, LM. "Serous and Recurrent Otitis Media. Pharmacological or Surgical Management?" Drugs. 34(6):695-701. Dec 1987.
Murtagh, J. "The Painful Ear." Aust Fam Physician. 20(12):1779-83. Dec 1991.
Thaller, SR, De Silva, A. "Otalgia with a Normal Ear." Am Fam Physician. 36(4):129-36. Oct 1987.
Thaller, SR, Thaller, JL. "Head and Neck Symptoms. Is the Problem in the Ears, Face, Neck, or Oral Cavity?" Postgrad Med. 87(5):75-7, 80, 83-6. Apr 1990.
Wazen, JJ. "Referred Otalgia." Otolaryngol Clin North Am. 22(6):1205-15. Dec 1989.