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Earache: The Basics

Earache Overview

Earache is very common medical problem for both children and adults. The 2 most common conditions that cause earache are infection of the outer ear (otitis externa) and infection of the middle ear (otitis media).

Otitis externa

Skin infection of the outer ear or ear canal

Often occurs after swimming (commonly called swimmer's ear)

Otitis media

Infection of the middle ear and eardrum

Very common in infants and children aged 6 months to 2 years

Can also affect older children and adults

Earache Causes

The 2 common causes of otitis externa are trapped moisture and minor injury to the ear canal. Otitis media is caused by bacteria growing in the middle ear behind the eardrum. It often follows a cold or upper respiratory tract infection. There are other risk factors identified with increased frequency of otitis media.

Risk factors of otitis externa

Moisture trapped in the ear canal
- The condition commonly called swimmer's ear can occur after swimming or bathing or sometimes just from hot humid weather.
- Bacteria that cause the infection are able to grow and multiply easily in the warm moist environment.

Minor injury or scrape to the ear canal skin
- This usually happens during attempts to clean the ear with objects, such as a cotton-tipped swab or paper clip.
- The break in the skin allows bacteria to penetrate and start an infection.

Risk factors of otitis media

Cold or upper respiratory tract infection
- These conditions cause swelling at the back of the nose where the ear normally drains. The ear is connected to the nose by the eustachian tube.
- If the eustachian tube does not function properly, fluid can become trapped behind the eardrum (serous otitis media). If bacteria grow in that fluid, then infection occurs (otitis media).

Allergies
Daycare
Secondhand smoke exposure
Bottle (rather than breast) feeding
Family history of ear infections
Malformations of the head and neck area

Earache Symptoms

Otitis externa
- Typically, there is an earache, which can be severe.
- Mild cases may have more of an itch than pain.
- Touching or pulling on the ear worsens the pain.
- Hearing loss
- Ringing or buzzing sounds in the ear
- Blocked or full sensation in the ear
- Swelling of the ear
- Thick drainage from the ear
Otitis media
- Pain in the ear (most common symptom)
- Hearing loss
- Ringing or buzzing sounds in the ear
- Full or plugged sensation in the ear
- Fever
- Occasionally, discharge from the ear (eardrum ruptures and the infected fluid drains out)
- Other symptoms in infants
  - Vomiting or diarrhea
  - Irritability
  - Poor feeding
  - Poor sleeping

When to Seek Medical Care

Any severe earache that lasts more than a few hours, or even a mild earache that persists for more than a day should receive medical attention. An infection responds much better to treatment if therapy is started early, rather than waiting until it is severe.

Other warning signs

Hearing loss

Fever

Generally feeling unwell or weak

Ear infections rarely need to be treated in the hospital. A doctor can safely handle most ear infections in an office setting.

Exceptions that would require hospital treatment are as follows:

Illness in an infant under 3 months

Illness in an infant who is becoming lethargic or running a very high fever (104ºF or higher)

Severe headache, stiffness of the neck, or swelling in the neck may represent a complication of an ear infection and may require immediate attention.