Earache

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is an earache?

An earache is pain or discomfort of the ear. Ear pain is also called otalgia. Your ear is divided into three sections: the outer ear (includes the external ear and ear canal), the middle ear (includes the eardrum, three tiny bones called ossicles, and the eustachian tube), and the inner ear. The eustachian tubes are responsible for equalizing air pressure in the middle ear and allowing mucus to drain from the middle ear to the throat.

An earache can affect one or both ears and can vary from a mild, dull ache to a throbbing or stabbing ear pain that is nearly incapacitating. A sense of fullness in the ear, as well as a burning sensation, may accompany an earache. An earache can occur suddenly or progress slowly.

The most common cause of earaches in children is a middle ear infection (otitis media). Otitis media is far less common in adults. In adults, ear pain is most often caused by an underlying condition in another region of the body that leads to a secondary earache, called referred ear pain. Possible causes of referred ear pain include disorders of the temporomandibular joint (TMJ), the jaw, and the teeth. Referred ear pain increases with age.

Depending on the cause, an earache can begin suddenly and disappear quickly, such as an earache due to a change in altitude. An earache that does not go away within 24 to 48 hours or gets worse may be due to a variety of disorders and conditions including TMJ arthritis, an ear infection, or a foreign body in the ear.

Because an earache may be due to a serious infection or other abnormal process, you should seek prompt medical care for an earache that gets progressively worse or does not improve within 24 to 48 hours. An earache that suddenly stops or occurs with a bloody discharge may be a sign of a ruptured eardrum. Although this is not a medical emergency, you should seek prompt medical care if you suspect a ruptured eardrum.

For ear pain along with excessive crying, high fever, dizziness, change in alertness, ear swelling, or facial weakness, seek immediate medical care (call 911).

What other symptoms might occur with an earache?

An earache may occur with a variety of other symptoms depending on the underlying disease, disorder or condition. Possible symptoms that occur with an earache include:

  • Facial pain

  • Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)

  • General ill feeling (malaise)

  • Hearing unusual sounds or decreased hearing

  • Itching in the ear

  • Jaw pain

  • Neck pain

  • Pain behind the ear

  • Popping or clicking sound while chewing or yawning

  • Pulling or rubbing the ear in infants and toddlers

  • Tooth pain

Serious symptoms that might indicate a life-threatening condition

In some cases, an earache may occur with other symptoms or certain combinations of symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) for an earache along with the following symptoms:

  • Bleeding draining from the ear, especially after a head injury

  • Change in alertness or consciousness or confusion

  • Crying inconsolably or intense distress

  • Difficulty or pain with swallowing

  • Dizziness or feeling of vertigo

  • Facial weakness

  • Hearing loss

  • High fever (higher than 101°F)

  • Redness and warmth of the ear and surrounding tissue

  • Seizure

  • Severe headache

  • Unexpected weight loss

What causes an earache?

In children, an earache is most likely due to a middle ear infection, but it can also be caused by irritating substances in the ear and other conditions. A middle ear infection (otitis media) often follows an upper respiratory infection, such as the common cold.

In adults, ear pain is often due to disorders and conditions in another area that spread to the ear. This is due to the variety of nerves and connective tissues that are shared by other head and neck structures. Ear pain when swallowing is often caused by a blocked eustachian tube, sore throat, or sinusitis. In some cases, an earache is a symptom of a serious infection or other condition that should be evaluated as soon as possible or in an emergency setting.

Infectious earache causes 

Earaches are associated with different types of infections:

  • Blocked eustachian tube, often from a cold

  • Ear cellulitis (skin infection)

  • Eardrum infection (myringitis)

  • External (outer) ear and ear canal infection (otitis externa), often called swimmer’s ear

  • Mastoiditis (infection of the bone behind the ear that is often caused by spread of a middle ear infection)

  • Middle ear infection (otitis media)

  • Ramsay Hunt syndrome (shingles infection of the facial nerve, also called herpes zoster oticus)

Other earache causes  

Earaches can be caused by other disorders including:

  • Foreign body, such as ear wax or cotton-tipped swab. It is common for toddlers and preschoolers to put small objects, such as beads, beans, and small parts from toys, into their ears.

  • High altitudes or other pressure changes (barotrauma)

  • Irritating substances, such as shampoo or soap

  • Ear trauma or other injury

Causes of referred earache (secondary ear pain)

Ear pain can be caused by disorders, diseases and conditions that do not originate in the ear, such as:

When should you see a doctor for earache?

An earache is usually a sign that it is time to see a doctor. See a doctor promptly when:

  • An infant less than 6 months of age may have an earache

  • Drainage, pus or blood is coming from the painful ear

  • Ear pain or other symptoms last more than a day 

  • Ear pain suddenly stops, which could be a sign of a ruptured eardrum

Call 911 or go to your nearest emergency room for ear pain when:

  • Ear pain is associated with a head injury

  • Ear pain is causing excessive crying in a child that makes them inconsolable

  • Ear pain is severe or accompanies a high fever, hearing loss, difficulty swallowing, or seizures

  • Ear pain occurs with swelling behind or around the ear, facial weakness, severe headache, or dizziness

How do doctors diagnose the cause of earache?

To diagnose the underlying cause of an earache, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor make ask about ear pain include:

  • When did the pain start?

  • What does the pain feel like?

  • On a scale of 1 to 10 with 10 being the worst pain ever, how would you rate your pain?

  • Is the pain getting worse?

  • Did you have a cold recently?

  • Has there been discharge or bleeding from the ear?

  • Have you had any change in hearing or hearing loss?

  • What other symptoms do you have?

  • Is ear pain interfering with your sleep?

  • Do you have a history of ear infections?

During the physical exam, your doctor will use an otoscope—a lighted tool—to look in your ears, nose and throat. The doctor may also examine the area around the ear and jaw and listen to your heart and lungs. Using a pneumatic otoscope, the doctor will be able to tell if there is fluid in the middle ear. This otoscope bounces a puff of air off the eardrum. If the eardrum does not move easily, fluid is likely present. Usually, this is enough to diagnose the cause of the earache.

In some cases, additional testing may be necessary including:

  • Additional ear tests, such as acoustic reflectometry and tympanometry, to evaluate the eardrum and pressure in the middle ear

  • Blood tests to check blood cell counts and to look for signs of inflammation or autoimmune disorders

  • Hearing tests

  • Imaging exams, including CT (computed tomography) and MRI (magnetic resonance imaging)

  • Nasolaryngoscopy, which involves inserting a thin tube with a camera through the nose into the throat

It is not always possible to diagnose an underlying cause or condition. If ear pain persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

How do you treat earache?

Earache treatment will depend on the underlying cause. Treating the condition causing ear pain will usually improve symptoms. This may involve oral medications or earache drops including:

  • Antibiotics to treat ear infections

  • Antihistamines for allergies

  • Decongestants to relieve congestion in the ears

  • Pain relievers, such as acetaminophen (Tylenol), or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin)

If children develop recurrent or chronic ear infections leading to earache, surgery may be necessary to place ear tubes. These tubes are called tympanostomy tubes or pressure-equalization tubes. They are tiny tubes that ventilate the ear (relieving painful pressure) and will eventually fall out on their own.

What are some home remedies for earache?

You can try an earache home remedy in addition to treatment your doctor prescribes to help ease the pain. Self-care strategies for earache relief include:

  • Applying a warm or cold compress to your ear and surrounding area. Use whichever temperature is comforting for you. Do not use temperature extremes or allow water to enter the ear.

  • Sleeping with an extra pillow or two to elevate your head and laying on the opposite side. These tips will reduce pressure on your ear during sleep, which will lessen the pain.

  • Taking over-the-counter pain relievers

What are the potential complications of earache?

Complications associated with an earache can be progressive and vary depending on the underlying cause. Because an earache can be due to serious diseases, failure to seek treatment can result in complications and permanent damage.

It’s important to visit your healthcare provider when you experience any persistent symptoms that concern you. Once the underlying cause is diagnosed, following the treatment plan can lower your risk of potential complications including:

  • Hearing loss (temporary or permanent)

  • Recurrent ear infections

  • Ruptured eardrum

  • Spread of infection to the base of the skull and other surrounding structures and tissues
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Aug 20
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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