Earache usually occurs in only one ear. Some people also have 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 or, rarely, hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 15% of people in the United States have some degree of hearing loss that affects their... read more 
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A Look Inside the Ear
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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 ).
People with diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more and those who have a compromised immune system (due to HIV Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more 
infection or chemotherapy for cancer Chemotherapy and Other Systemic Cancer Treatments Systemic treatments are those that have effects throughout the body rather than being applied directly to the cancer. Chemotherapy is a form of systemic treatment that uses drugs to kill cancer... read more ) or chronic kidney disease Chronic Kidney Disease Chronic kidney disease is a slowly progressive (months to years) decline in the kidneys’ ability to filter metabolic waste products from the blood. Major causes are diabetes and high blood pressure... read more may develop a particularly severe form of external otitis termed malignant or necrotizing external otitis Malignant External Otitis Malignant external otitis is a dangerous infection of the external ear that has spread to the skull bone (temporal bone) containing the ear canal, the middle ear, and the inner ear. Malignant... 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
Chronic eustachian tube dysfunction
Chronic external ear infection
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 ). Doctors may also do tuning fork tests Testing to evaluate hearing.
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 
. 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 temporomandibular joint (TMJ) disorder Temporomandibular Disorders . 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).
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 base of the skull.
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.
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
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.
