Earache
Otalgia; Pain - ear; Ear pain
An earache is a sharp, dull, or burning pain in one or both ears. The pain may last a short time or be ongoing. Related conditions include:
- Otitis media
- Swimmer's ear
- Malignant otitis externa
The ear consists of external, middle, and inner structures. The eardrum and the three tiny bones conduct sound from the eardrum to the cochlea.
The external structures of the ear may aid in diagnosing some conditions by the presence or absence of normal landmarks and abnormal features including earlobe creases, preauricular pits, and preauricular tags.
Considerations
The symptoms of an ear infection may include:
- Ear pain
- Fever
- Fussiness
- Increased crying
- Irritability
Many children will have minor hearing loss during or right after an ear infection. Most of the time, the problem goes away. Lasting hearing loss is rare, but the risk increases with the number of infections.
If your child has a sharp, dull, or burning pain in his ear, he's suffering an earache, a common reason parents take their children to the doctor. Several things can cause earaches, including Swimmer's ear (where the skin of the ear canal is inflamed), pressure or elevation changes (that stretch the sensitive ear drum), and ear infections. The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the tube gets blocked, fluid can build up, leading to infection. This can lead to pressure behind the ear drum or an ear infection. If your child has an earache, your child will complain of ear pain. Babies with an earache will often be fussy and not sleep well. Many children have temporary hearing loss during, and right after, an ear infection or other cause of earache. Children under 6 months old who might have an ear infection need to see a doctor. Your child's doctor will look inside the child's ear using an instrument called an otoscope. The doctor might see areas of redness, air bubbles behind the ear drum, and fluid inside the middle ear. You can relieve an earache by placing a warm or cold pack or a warm or cold wet wash cloth to your child's ear for 20 minutes. For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an earache. Oral pain medications or over-the-counter ear drops can help, as long as your child's eardrum has not ruptured. Vibrating devices, such as the EarDoc, are one way to relieve pain without medications. If an infection caused your child's earache, it is very treatable, but it may come back again. If your child has to take an antibiotic, make sure he takes all of the medicine.
Causes
The eustachian tube runs from the middle part of each ear to the back of the throat. This tube drains fluid that is made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. This may lead to pressure behind the eardrum or an ear infection.
Ear pain in adults is less likely to be from an ear infection. Pain that you feel in the ear may be coming from another place, such as your teeth, the joint in your jaw (temporomandibular joint), or your throat. This is called referred pain.
Causes of ear pain may include:
- Arthritis of the jaw
- Short-term (acute) ear infection
- Long-term (chronic) ear infection
- Ear injury from pressure changes (from high altitudes and other causes)
- Object stuck in the ear or buildup of ear wax
- Hole in the eardrum
- Sinus infection
- Sore throat
- Temporomandibular joint syndrome (TMJ)
- Tooth infection
Ear pain in a child or infant may be due to infection. Other causes may include:
- Ear canal irritation from cotton-tipped swabs
- Soap or shampoo staying in the ear
Home Care
The following steps may help an earache:
- Place a cold pack or cold wet washcloth on the outer ear for 20 minutes to reduce pain.
- Chewing may help relieve the pain and pressure of an ear infection. (Gum can be a choking hazard for young children.)
- Resting in an upright position instead of lying down can reduce pressure in the middle ear.
- Over-the-counter ear drops can be used to relieve pain, as long as the eardrum has not ruptured.
- Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do not give aspirin to children.)
For ear pain caused by a change of altitude, such as on an airplane:
- Swallow or chew gum as the plane descends.
- Allow infants to suck on a bottle or breastfeed.
The following steps can help prevent earaches:
- Avoid smoking near children. Secondhand smoke is a major cause of ear infections in children.
- Prevent outer ear infections by not putting objects in the ear.
- Dry the ears well after bathing or swimming.
- Take steps to control allergies. Try to avoid allergy triggers.
- Try a steroid nasal spray to help reduce ear infections. (However, over-the-counter antihistamines and decongestants do not prevent ear infections.)
When to Contact a Medical Professional
Contact your health care provider if:
- Your child has a high fever, severe pain, or seems sicker than is usual for an ear infection.
- Your child has new symptoms such as dizziness, headache, swelling around the ear, or weakness in the face muscles.
- Severe pain suddenly stops (this may be a sign of a ruptured eardrum).
- Symptoms (pain, fever, or irritability) get worse or do not improve within 24 to 48 hours.
What to Expect at Your Office Visit
The provider will do a physical exam and look at the ear, nose, and throat areas.
Pain, tenderness, or redness of the mastoid bone behind the ear on the skull is often a sign of a serious infection.
References
Earwood JS, Rogers TS, Rathjen NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27. PMID: 29365233
Haddad J, Dodhia SN. General considerations and evaluation of the ear. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 654.
Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.
Player B. Earache. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 5.
Version Info
Last reviewed on: 1/24/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 02/03/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
