Ear Discomfort

Ear pain, Earache, Otalgia

Ear discomfort is one of the most common reasons people visit their healthcare providers, affecting both children and adults. While ear pain can be uncomfortable and worrying, it usually isn’t dangerous and often improves on its own within a few days.

Table of contents

• What is ear discomfort?
• Types of ear pain
• What causes ear discomfort?
• Signs and symptoms
• How is ear discomfort diagnosed?
• Treatment options
• Home remedies and self-care
• How to prevent ear discomfort
• When to see a doctor

What is ear discomfort?

Ear discomfort, also known as an earache or by its medical name otalgia (pronounced oh-TAL-gee-uh), is a symptom that can point to many different health conditions. The pain can be dull, sharp, mild, or severe, and some people experience ear pain that comes and goes^[1].

Earaches are especially common in children, though they can affect people of any age. In fact, children are more likely than adults to get ear infections^[2][5]. Most of the time, ear pain isn’t dangerous, but if it lasts longer than three days or happens frequently, it could point to something more serious^[1].

Types of ear pain

Healthcare providers divide ear pain into two main categories based on where the pain originates^[1]:

Primary ear pain starts in your ears themselves. This type of pain usually means there is something wrong with your ear, such as an infection or injury. When you have primary ear pain, your doctor can usually find abnormal findings when they examine your ear^[4].

Secondary ear pain, also called referred ear pain, happens when a condition unrelated to your ears causes ear discomfort. This occurs because your ears and nearby body parts share the same nerves with your brain^[1]. Primary ear pain is more common in children, while secondary ear pain is more common in adults^[4]. In adults, the absence of hearing loss is an important sign that suggests the pain may be coming from somewhere other than the ear^[4].

What causes ear discomfort?

Ear discomfort can be caused by many different conditions. Understanding the cause helps determine the best treatment^[3].

Common causes of primary ear pain include^[1]:

• Ear infections of the middle ear or outer ear (such as swimmer’s ear)
• Barotrauma, which is discomfort from air or water pressure changes
• Earwax buildup
• Eustachian tube dysfunction
• Foreign objects stuck in the ear
• Ruptured eardrum

The most common cause of primary ear pain is an ear infection, particularly otitis media (middle ear infection) and otitis externa (outer ear infection)^[4]. Middle ear infections happen when the space behind the eardrum becomes infected. These infections can cause narrow tubes that run from the middle ear to the back of the throat (called eustachian tubes) to become swollen and blocked, leading to fluid buildup^[2].

Bacteria are a common cause of ear infections. Streptococcus pneumoniae and Haemophilus influenzae are the two most common bacteria causing middle ear infection. Viruses, like those that cause colds, can also cause middle ear infection^[5].

Common causes of secondary ear pain include^[1]:

• Allergies
• Colds
• GERD (gastroesophageal reflux disease)
• Toothaches or tooth abscess
• TMJ disorders (temporomandibular joint problems)
• Tonsillitis
• Sore throat
• Sinusitis
• Teething in young children

Sometimes earache may not be related to a problem with your ears at all. Earache with pain when swallowing is most often caused by a sore throat or tonsillitis. Earache and toothache together are most commonly caused by a tooth abscess or teething in young children^[3].

Signs and symptoms

The main symptom of ear discomfort is pain in your ear. The pain can affect one or both ears^[3].

In children, ear infection symptoms often come on quickly and may include^[2][5]:

• Ear pain
• Tugging or pulling at an ear
• Trouble sleeping
• Crying more than usual
• Fussiness or irritability
• Trouble hearing or responding to sounds
• Loss of balance
• Fever
• Fluid coming from the ear
• Headache
• Loss of appetite

A baby or young child may have earache if they rub or pull their ear, don’t react to sounds, have a temperature of 38°C or above, are irritable or restless, are off their food, or keep losing their balance^[3].

In adults, common symptoms of ear infections include^[2]:

• Ear pain or pressure
• Fluid coming from the ear, which can be from a torn eardrum
• Trouble hearing

Earache with a change in hearing is most often caused by glue ear (otitis media with effusion), an object in the ear, or an ear infection of the middle ear or outer ear. Earache with fever is most often caused by an ear infection of the middle ear or outer ear, the flu, or a cold^[3].

How is ear discomfort diagnosed?

Your doctor will ask about your symptoms and examine your ears. They will use a special device called an otoscope to look inside your ear. This allows them to check your ear canal and eardrum^[3].

A healthcare provider can often diagnose an ear infection based on symptoms and an examination. The exam includes looking inside the child’s ears with the lighted otoscope. If the eardrum is red and bulging, there’s likely an infection^[8]. They will look inside your child’s ear to examine the eardrum and look for pus in the middle ear^[5].

History and physical examination usually lead to the underlying cause. However, if the diagnosis is not immediately clear, a trial of symptomatic treatment, imaging studies, and consultation may be reasonable options^[4].

Treatment options

Treatment for ear discomfort depends on what is causing your pain^[3]. The body’s immune system can often fight off middle ear infections on its own, so sometimes you do not need antibiotics^[5].

Many ear infections clear up on their own within three days. Symptoms of ear infections usually get better in a couple of days, and most ear infections clear up in a week or two without treatment^[8][11].

Medication options

Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be all you need for ear pain relief^[1]. These pain medicines are safe to use with or without antibiotics, but be sure to follow the dosing instructions on the label^[6].

In some cases, your healthcare provider may prescribe medications in ear drops or pill form, including^[1]:

• Antibiotics
• Antifungals
• Corticosteroids

Severe middle ear infections or infections that last longer than 2-3 days need antibiotics right away. For mild middle ear infection, your healthcare provider might recommend watchful waiting or delayed antibiotic prescribing^[5].

Watchful waiting means your child’s healthcare provider may suggest watching and waiting for 2-3 days to see if your child needs antibiotics. This gives the immune system time to fight off the infection. If your child’s symptoms don’t improve, the healthcare provider may prescribe an antibiotic^[5].

Delayed prescribing means your child’s healthcare provider may prescribe an antibiotic but suggest that you wait 2-3 days before filling the prescription. Your child may recover on their own and may not need the antibiotic^[5].

Home remedies and self-care

There are several things you can do at home to help relieve earache and feel better^[3][12]:

Heat or cold therapy. Apply heat or use cold packs on your ear. Cold can reduce pain and inflammation while heat relaxes your muscles and improves blood flow^[1]. Hold a warm cloth or heat pack on your ear. You can also soak a washcloth in either cool or warm water, wring it out, and then put it over the ear that’s bothering you. Try both temperatures to see which one works better for you^[6]. Another option is using a heating pad, but lay your painful ear on a warm, not hot, heating pad, and do not go to sleep with a heating pad on your skin^[12].

Elevate your head. Sleep with your head resting on two or more pillows. This helps ease pressure inside your ear^[1][3]. Resting or sleeping sitting up rather than lying down can encourage fluid in your ear to drain, which could ease pressure and pain in your middle ear^[6].

Over-the-counter ear drops. You can use over-the-counter ear drops, but ask your healthcare provider what type is best for your situation. Don’t use ear drops if you have a ruptured eardrum^[1]. If you think that you might have swimmer’s ear, you can try an over-the-counter product that contains isopropyl alcohol or glycerin^[6].

What NOT to do^[3][12]:

• Do not put anything inside your ear, including cotton buds or your finger
• Do not try to remove ear wax yourself
• Do not let water get inside your ear

How to prevent ear discomfort

Earaches happen for many reasons, and you can’t always avoid them. However, doing the following may reduce your overall risk for ear pain^[1][5]:

• Clean your ears with care. You can use cotton swabs to clean your outer ears, but avoid sticking them into your ear canal
• Protect your ears when you fly to prevent airplane ear
• Wash your hands frequently to reduce your risk of infections
• Receive recommended vaccines, such as flu vaccine and pneumococcal vaccine. Pneumococcal vaccine protects against a common cause of middle ear infections
• Breastfeed exclusively until your baby is 6 months old and continue to breastfeed for at least 12 months
• Don’t smoke and avoid exposure to secondhand smoke
• Dry your ears thoroughly after swimming

When to see a doctor

Sometimes earaches go away on their own. However, it’s important to know when to seek medical help^[1][3].

You should see your doctor if^[3]:

• You have an earache for more than 3 days
• You keep getting earaches
• You have ear pain with tinnitus (sounds in your ears)
• Your child is under 12 months old and you think they have an ear infection

If you still have ear pain after three days, you should call your healthcare provider^[1].

Seek urgent medical care if you or your child have^[1][3][5]:

• A fever of 102.2°F (39°C) or higher, or fever of 103 degrees Fahrenheit (39.4 degrees Celsius) or higher
• Pus, discharge, or fluid coming from the ear
• Worsening symptoms
• Symptoms of a middle ear infection that last for more than 2-3 days
• Hearing loss
• Chills
• Nausea and vomiting
• Severe sore throat
• Swelling around your ear or skin discoloration
• Feeling generally unwell
• Something stuck in your ear
• Your child is under 2 years of age with sore ears
• Your child is under 3 months old with a fever of 100.4°F (38°C) or higher

Ear pain isn’t always a sign of something serious, but if it lingers for more than three days, you should see your healthcare provider. If you have an infection, it can spread to nearby structures like your jaw or skull. Left untreated, ear infections can lead to serious complications like mastoiditis or meningitis^[1].