Earache usually occurs in only one ear. Some people also have ear discharge (see Symptoms of Ear Disorders: Ear Discharge) or, rarely, hearing loss (see Hearing Loss and Deafness: Hearing Loss).
Pain may be due to a disorder within the ear itself or a disorder in a nearby body part that shares the same nerves to the brain as the ear. Such body parts include the nose, sinuses, throat, and temporomandibular joint (TMJ).
With acute pain (pain for less than 2 weeks), the most common causes are
Middle and external ear infections cause painful inflammation. A middle ear infection also causes a build up of pressure behind the eardrum (tympanic membrane [TM]). This build up of pressure is painful and also causes the eardrum to bulge. After the eardrum bulges, it occasionally bursts and releases a small amount of pus from the ear. Rarely, a middle ear infection spreads to the mastoid bone behind the ear (causing mastoiditis—see Middle Ear Disorders: Mastoiditis).
People with diabetes and those who have a compromised immune system (due to HIV infection or chemotherapy for cancer) may develop a particularly severe form of external otitis termed malignant or necrotizing external otitis.
Pressure changes during airplane flights and underwater diving can cause ear pain. Such ear pain occurs when the tube that connects the middle ear and the back of the nose (eustachian tube) is blocked or fails to function normally. The blockage or dysfunction keeps pressure in the middle ear from equalizing with outside pressure. The pressure difference pushes or pulls on the eardrum, causing pain. Pressure changes can also cause the TM to rupture.
With chronic pain (pain for more than 2 to 3 weeks), the most common causes are
A less common cause of chronic pain is a cancer, mainly in older people.
The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.
In people with earache, certain symptoms and characteristics are cause for concern:
When to see a doctor:
People with warning signs or ear discharge should see a doctor as soon as possible, unless the only warning sign is chronic pain. Then, a delay of a week or so is not harmful. People with acute pain should see a doctor within a few days (or sooner if pain is severe).
What the doctor does:
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination that is focused on the ears, nose, and throat. What they find during the history and physical examination often suggests a cause of the earache and the tests that may need to be done (see Table 1: Symptoms of Ear Disorders: Some Causes and Features of Earache).
In addition to the presence of warning signs, an important feature is whether the ear examination is normal. Middle and external ear disorders cause abnormalities, which, when combined with the person's symptoms and other medical history, usually suggest a cause (see Table 1: Symptoms of Ear Disorders: Some Causes and Features of Earache).
People with a normal ear examination may have a visible cause, such as tonsillitis, for their ear pain. If no abnormalities are found during the ear examination but the person has chronic pain, doctors suspect the ear pain might be due to a TMJ disorder. However, people should have a thorough head and neck examination (including fiberoptic examination) to rule out cancer or a tumor in the nasal passages and upper throat (nasopharynx).
Most often, the doctor's examination provides a diagnosis, and tests are not needed. However, people with a normal ear examination, particularly those with chronic or recurrent pain, may need tests to look for cancer. Such tests usually include examination of the nose, throat, and voice box (larynx) with a flexible viewing scope (endoscope) and magnetic resonance imaging (MRI) of the head and neck.
The best way to treat earache is to treat the underlying disorder.
People may take a pain-relieving drug by mouth. Usually a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen is adequate. However, some people, particularly those who have a severe external ear infection, need to take an opioid such as oxycodone or hydrocodone for a few days. For a severe external ear infection, doctors also often suction pus or other discharge from the ear canal and insert a small foam wick. The wick can be soaked with antibiotic and/or corticosteroid ear drops.
Ear drops that contain pain relievers (such as antipyrine/benzocaine combinations) are generally not very effective but can be used for a few days. These drops (and any other ear drops, such as those to remove earwax) should not be used by people who might have a perforated eardrum, so a doctor should be consulted before drops are used.
People should avoid digging in their ears with any objects (no matter how soft the object or how careful people think they are). Also, people should not try to flush out their ears unless instructed by a doctor to do so, and then only gently. An oral irrigator (such as used for teeth cleaning) should never be used in the ear.
Last full review/revision January 2013 by Debara L. Tucci, MD, MS