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Earache

(Otalgia; Otalogia)

By

David M. Kaylie

, MS, MD, Duke University Medical Center

Last full review/revision Mar 2021| Content last modified Mar 2021
Click here for the Professional Version
Topic Resources

A Look Inside the Ear

Inside the Ear

Causes of Earache

Ear 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 and/or blood from the ear. Rarely, a middle ear infection spreads to the mastoid bone behind the ear (causing mastoiditis Mastoiditis Mastoiditis is a bacterial infection in the mastoid process, which is the prominent bone behind the ear. Mastoiditis usually occurs when untreated or inadequately treated acute otitis media... read more ).

Pressure changes during airplane flights and underwater diving can cause ear pain (see also Barotrauma of the Ear Barotrauma of the Ear Barotrauma is an injury caused by increased air pressure, such as during airplane flights or scuba diving. Barotrauma can cause ear pain or damage to the eardrum. The eardrum separates the ear... read more ). 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 tympanic membrane 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 pain from disorders affecting the larynx (voice box), including cancer (called referred pain).

Evaluation of Earache

The following information can help people with earache decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with earache, certain symptoms and characteristics are cause for concern:

  • Diabetes, a compromised immune system, or chronic kidney disease

  • Redness and swelling behind the ear

  • Severe swelling at the opening of the ear canal

  • Fluid draining from the ear

  • Chronic pain, especially in people who have other head/neck symptoms (such as hoarseness, difficulty swallowing, or nasal obstruction)

When to see a doctor

People with warning signs or ear discharge Ear Discharge Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have... read more 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 usually 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 Some Causes and Features of Earache Some Causes and Features of Earache Earache usually occurs in only one ear. Some people also have ear discharge or, rarely, hearing loss. Ear pain may be due to a disorder within the ear itself or a disorder in a nearby body part... read more ).

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.

People with a normal ear examination may have ear pain for another reason, such as tonsillitis Tonsillopharyngitis Sore throat is pain in the back of the throat. The pain can be severe and is usually worsened by swallowing. Many people with sore throat refuse to eat or drink. Sometimes pain is also felt... read more Tonsillopharyngitis . If no abnormalities are found during the ear examination but the person has chronic pain, doctors sometimes suspect the ear pain might be due to a TMJ disorder Temporomandibular Disorders read more . However, people with chronic pain 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).

Table
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Testing

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.

Treatment of Earache

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, may 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.

Did You Know...

  • People should avoid digging in their ears with any object, no matter how soft the object.

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.

Key Points about Earache

  • Most earaches are due to infection of the middle or external ear.

  • A doctor's examination is usually all that is needed for diagnosis.

  • If the ear appears normal during the examination, doctors look for a disorder in the structures near the ear.

Drugs Mentioned In This Article

Generic Name Select Brand Names
TYLENOL
ANBESOL
OXYCONTIN
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