Earache

Ear pain can come on suddenly and cause a lot of anguish. Adults can often name their symptoms of earache, like fever and pain. But ear infections are most common in kids, especially infants between 6 and 15 months old, and they can’t verbalize their symptoms. Because of this, it’s important that parents and caregivers know the symptoms of earache, including unexpected ones, like clumsiness. 

Continue reading to learn more about symptoms and treatments for earache in adults and children.

Symptoms of Earache

The most common symptoms of earache are:

• Pain
• Hearing loss
• Fever
• Fussiness and irritability
• Fluid draining from the ear

These main symptoms present differently in children who might not have the verbal capacity to express that they are in pain. Signs of earache in kids can include:

• Pulling or tugging on the ear
• Crying or being fussier than usual
• Trouble sleeping or more frequent waking
• More falls, clumsiness, or balance issues
• Lack of responses because they’re having trouble hearing

Symptoms of ear infection in adults can also include muffled or reduced hearing and sore throat. 

Rare Symptoms

Some ear infection symptoms are rare. In adults, it’s uncommon for an ear infection to affect balance.

In children, rare ear infection symptoms include:

• Vertigo
• Ringing in the ear

Causes of Earache

The most common causes of earache include:

• Middle ear infection (otitis media): An infection or inflammation behind the eardrum
• External otitis (swimmer's ear): An infection of the ear canal
• Eustachian (auditory) tube dysfunction: Blocked eustachian tube
• Referred pain from sinusitis (sinus inflammation), tooth infection, arthritis of the jaw,temporomandibular joint disorder (TMJ), or other disorders

Otitis media causes pain due to a buildup of fluid and pus behind the eardrum. It can occur after drainage of the middle ear is blocked, often due to a cold or allergies. Viruses or bacteria are introduced to the middle ear and result in inflammation.

External otitis often occurs when water or irritating substances such as soap or shampoo get trapped in the ear. You may also be more at risk if you use cotton swabs in your ear or other methods to remove ear wax, which protects against infection.

In eustachian tube dysfunction, the channel that equalizes air pressure changes is blocked. Fluid can build up behind the eardrum, causing pain. It happens more often in children because the tube is smaller and aligned more horizontally in them than in adults. A rapid change in air pressure can cause it (barotrauma). The tube can also become blocked during colds, allergies, or due to growths.

Ear infections are less often the cause of ear pain in adults. A variety of conditions can cause pain from other sites to be felt in the ear. Conditions affecting the trigeminal nerve (which provides sensation to the face, eye, and jaw) are the most common sources of referred pain to the ear.

How to Treat Earache

You should report an earache to a healthcare provider and get a diagnosis and treatment plan aimed to correct the underlying condition.

To relieve the pain, a healthcare provider is likely to recommend over-the-counter (OTC) pain relievers such as Advil (ibuprofen) or Tylenol (acetaminophen). Be sure to adhere to the dosages recommended by age or weight. Do not give aspirin to babies, children, or teens.

Discuss with a healthcare provider whether OTC ear drops may be helpful for your condition. These should not be used if you have a perforated eardrum.

Other home remedies to help relieve ear pain include:

• Cold therapy: Use a cold pack or cold wet cloth on the outside of the ear for 20 minutes at a time. Do not place ice directly on the skin.
• For older children and adults, chew gum as chewing can help relieve pressure.
• Don't lie down flat. Rest in a propped-up position.

Medical treatment for common underlying causes of earache include:

• Middle ear infection: If the earache doesn't clear up after two to three days, antibiotics may be prescribed. Ear tubes may be placed in cases with repeated or chronic middle ear infections.
• Otitis externa: Antibiotic ear drops are often prescribed.
• Auditory tube dysfunction: In persistent cases, ear ventilation tubes may be placed.
  

Complications and Risk Factors Associated With Earache

Five out of six kids will have an ear infection by the time they’re 3. Complications from ear infections are rare. Still, serious complications can occur. They’re most common in young children. Here are the complications you should be aware of:

Speech and Language Delays

Kids who have repeat ear infections are at higher risk for hearing loss. In turn, that can lead to developmental delays, especially when it comes to speech and language development. These delays are often temporary. They can be treated with ear tubes and early interventions like speech therapy. 

Ruptured Eardrum

Rarely, an infection can lead to a ruptured eardrum. The symptoms include:

• Fluid or blood draining from the ear
• Ear pain and a sudden stop to ear pain
• Sudden hearing loss
• Vertigo or dizziness
• Ringing in the ear

A ruptured eardrum will usually repair itself within two months, but it’s still a good idea to see your healthcare provider to make sure you don’t need any other treatment. 

Mastoiditis

Mastoiditis is a rare infection of the bone beneath and behind the ear. It can happen when an ear infection spreads and affects the area behind the ear. The symptoms of mastoiditis include:

• Pain, swelling, redness, and tenderness behind the ear
• High fever
• Headache
• Hearing loss
• Creamy discharge from the ear

If you or your child has mastoiditis, you’ll need antibiotics in the hospital and possibly surgery. 

Cholesteatoma

Cholesteatoma is a growth in the ears that can lead to hearing loss. It can happen when cells build up in the ear after repeat ear infections. 

The symptoms of cholesteatoma include:

• Temporary or permanent hearing loss
• Pressure or aching in or behind the ear
• Vertigo
• Foul-smelling discharge from the ear
• Paralysis of facial muscles

The condition is treated with surgery to remove the growth and prevent or reverse hearing loss. 

Labyrinthitis (Vertigo)

Labyrinthitis is an inflammation of the inner ear. This causes vertigo. The symptoms of labyrinthitis may include:

• Sudden, severe vertigo (sense of spinning)
• Nausea and vomiting
• Dizziness
• Lightheadedness
• Balance trouble
• Difficulties concentrating
• Ringing in the ears
• Hearing loss

Facial Paralysis

If an ear infection causes inflammation and swelling, it can pinch the facial nerve, leaving a child or adult unable to move their face. Facial paralysis is very alarming but usually temporary when it’s associated with an ear infection.

Are There Tests to Diagnose the Cause of Earache?

A healthcare provider will consider your medical history and report of symptoms. They will conduct a physical examination, including looking inside the ear with an otoscope. They will also pull on the auricle of the ear and press on the tragus (the inner side of the external ear).

Most conditions can be diagnosed with these methods alone. If they don't see abnormalities with these examinations, the healthcare provider may recommend further testing such as:

• Nasolaryngoscopy: A small flexible scope is passed through the nose into the throat to look for abnormalities.
• Tympanometry: A tool is inserted into the ear canal that creates changes in pressure and sound waves to evaluate the function of the eardrum.
• Audiometry: This testing evaluates the range and sensitivity of hearing.
• Blood tests: A complete blood count and erythrocyte sedimentation rate look for signs of infection and inflammation.
• Imaging: Advanced imaging is usually done after referral to an otolaryngologist, a specialist in conditions of the ear, nose, and throat.
  

When to See a Healthcare Provider

Ear infections are common and usually resolve on their own. However, you should call a healthcare provider if you or your child experience:

• Severe pain or high fever
• Pain that stops suddenly
• Dizziness or headache
• Swelling around the ear
• Facial weakness or paralysis
• Symptoms that last longer than 48 hours

Summary 

Earaches are most often due to middle ear infection, external ear infection, eustachian tube dysfunction, or referred pain.

Young children may be unable to express their pain verbally, so caregivers should look for other symptoms of earache, including tugging at the ear, trouble sleeping, fussiness, or lack of balance. Adults with an ear infection may experience pain and fever.

Ear infections are very common. But in rare cases, they can cause serious complications. A healthcare provider can usually diagnose the cause of ear pain by a physical examination and your report of symptoms.

Ear pain may be relieved with OTC pain relievers and home remedies such as applying a cold pack, chewing gum, and not lying flat. Further treatment will be geared to address the underlying condition.