Ear Pain and Ear Infections: Causes, Home Care and When to Be Seen

What it involves

MedlinePlus describes an earache as a sharp, dull, or burning pain in one or both ears that may last a short time or be ongoing. It names otitis media, swimmer's ear, and malignant otitis externa as related conditions. The most common type of ear infection is otitis media, caused by swelling and infection of the middle ear, just behind the eardrum.

Who this is for

• Adults with ear pain, fullness, or drainage that has not cleared in a day or two
• Patients who get ear pain with every cold, sinus infection, or flare of allergies
• Patients whose ear pain may really be coming from a tooth, the jaw, or the throat
• Parents of a child with ear pain, fever, or unexplained fussiness

What to expect

• Questions about when the pain started, whether there is fever or drainage, and any recent cold or flight
• A look at the ears, nose, and throat during a physical exam
• A plain explanation of whether an infection is likely and whether antibiotics would help
• A plan for comfort care and follow-up, and a referral for a hearing test or an ear specialist if needed

Ear pain is not always an ear problem

MedlinePlus says ear pain in adults is less likely to come from an ear infection than in children. Pain you feel in the ear may come from another place, such as the teeth, the joint of the jaw, or the throat. This is called referred pain, and it is one reason a provider looks at the mouth and throat as well as the ear. Ear noises such as ringing or buzzing can follow an ear infection, and the tinnitus guide explains the other causes and self-care steps.

Common causes of ear pain

MedlinePlus lists these causes:

• A short-term or long-term ear infection
• Ear injury from pressure changes, such as high altitude
• An object stuck in the ear or a buildup of ear wax
• A hole in the eardrum
• A sinus infection or a sore throat
• Jaw problems, including arthritis of the jaw and temporomandibular joint syndrome
• A tooth infection

How an ear infection starts

MedlinePlus explains that the eustachian tube runs from the middle of each ear to the back of the throat and normally drains fluid made in the middle ear. If the tube becomes blocked, fluid builds up and pressure behind the eardrum can lead to infection. Allergies, colds, and sinus infections can swell or block the tube, which the sinus infection or cold guide and the seasonal allergies guide describe from the nose side. Tobacco smoke is another listed cause. Redness and discharge in the eye can show up alongside ear symptoms during a cold, and the pink eye guide lists the signs that mean the eye should be checked.

Symptoms to watch for

MedlinePlus says older children and adults with an acute ear infection may have:

• Ear pain and a feeling of fullness in the ear
• Nasal congestion, cough, and a feeling of general illness
• Hearing loss in the affected ear
• Drainage of fluid from the ear
• Fever, or in younger children, irritability and crying that cannot be soothed

What you can try at home

MedlinePlus suggests a cold pack or cold wet washcloth on the outer ear for 20 minutes, chewing, and resting upright instead of lying down. Another MedlinePlus article suggests a warm cloth on the ear. Over-the-counter pain relievers such as acetaminophen or ibuprofen may help, aspirin should not be given to children, and over-the-counter ear drops are fine only if the eardrum has not ruptured. For altitude changes it suggests swallowing or chewing gum as a plane descends.

Do ear infections always need antibiotics?

No. MedlinePlus says some ear infections clear on their own, a virus or bacteria can cause them, and antibiotics will not help an infection caused by a virus. Most providers do not prescribe antibiotics for every ear infection. They are more likely when a child is under age two, has a fever, looks sick, or does not improve in 24 to 48 hours. If antibiotics are prescribed, MedlinePlus says to take them as directed and finish the course.

Signs you should be seen

MedlinePlus says to contact your provider if:

• Symptoms get worse or do not improve within 24 to 48 hours
• There is a high fever or severe pain
• Severe pain suddenly stops, which may be a sign of a ruptured eardrum
• There is swelling behind or around the ear
• New symptoms appear, such as severe headache, dizziness, or twitching or weakness of the face
• A child younger than 6 months has a fever or ear infection symptoms

What a visit involves

MedlinePlus says your provider takes your history, then looks inside the ears with an instrument called an otoscope, checking for redness, a bulging eardrum, discharge, fluid or air bubbles behind the eardrum, or a hole. It adds that a hearing test may be recommended if you or your child has had repeated ear infections, and a hearing test would be arranged through a referral. Dizziness with ear symptoms has its own guide in the dizziness evaluation.

Sources

• MedlinePlus — Earache
• MedlinePlus — Ear infection, acute