Earache: types, causes, treatment and prevention.

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Earache can occur in any of the three parts of the ear. Among the three parts of the ear, a person may have outer ear pain, middle ear pain, or inner ear pain. Earache can also be caused by a problem close to the ear, such as sinusitis, TMJ syndrome, or a dental infection.

A sensation of pain in the ear (aching, sharp, dull, etc.), its intensity, location, and other symptoms you are experiencing (for example, fever, dizziness) may give your healthcare provider a chance to start doing a diagnosis.

Most of the time, your healthcare provider can do this without any tests, although in some cases imaging and blood tests may be needed to rule out more serious causes of earache, such as mastoiditis or swelling of the ear.

Your healthcare provider's ear pain treatment plan will depend on your underlying diagnosis and may include a combination of different treatments.

Get Medical Information / Alexandra Gordon

Causes

Due to the many possible causes of earache, it is easier to treat the primary diagnosis (which occurs inside the ear) and the secondary diagnosis (which occurs outside the ear) separately.

Main reasons

Conditions that often cause earache and occur inside the ear include the following:

Otitis media

Otitis media describes a middle ear infection in which fluid and inflamed tissue collects in the middle ear space, the area between the eardrum (ear drum) and the oval window of the inner ear.

In addition to moderate to severe pain that is felt deep in the ear, you may experience a stuffy nose and / or cough before the earache for several days. Sometimes the temperature can rise.

If the eardrum ruptures as a result of increased pressure, purulent (pus-containing) ear drainage may occur.

Otitis media with effusion

Otitis media with effusion (OME) describes the presence of fluid in the middle ear without evidence of infection. In other words, the accumulation of fluid occurs without inflammation of the tissues. In general, ear pain with OME is usually mild and is associated with a feeling of fullness in the ears and / or hearing loss.

OME usually appears after acute otitis media, but it can also be the result of barotrauma (injury caused by air or water pressure) or allergies. In rare cases, OME is the result of a tumor that blocks the Eustachian tube, the tunnel that connects the middle ear with the upper part of the throat and the back of the nose.

Otitis externa (swimmer's ear)

Otitis externa , an ear canal infection, causes a feeling of congestion in the ear, itching, and significant ear pain when the earlobe is pulled out. A yellowish or brightly colored discharge from the ear can also occur, as well as hearing loss and swelling of the ear canal.

The reason that external otitis is commonly known as "swimmer's ear" is because it often develops when water enters the ear canal. Another common cause of otitis externa is the frequent use of cotton swabs. When inserted into the ear, small incisions can form in the ear canal, which become a breeding ground for bacteria.

A serious complication of external otitis is necrotizing (malignant) otitis externa, in which infection from the ear canal spreads to the base of the skull. This condition is more common in older people with diabetes.

Perforated eardrum

A perforated eardrum is an opening or tear in the eardrum. The eardrum is a fragile structure inside the ear that can easily break due to injury, pressure changes, or explosive noise. It is also often associated with middle ear infections (otitis media).

In addition to acute earache, people with a perforated eardrum may experience sudden hearing loss, loss of fluid from the ear, or ringing or buzzing in the ear.

Cerumen blockage

Wax (wax) is designed to protect the ear canal from water, bacteria, and injury. Sometimes, however, too much wax is produced or the wax is pressed too deeply into the ear canal (which is why healthcare professionals recommend not using cotton swabs to clean your ears).

If the earwax is blocked , ear discomfort can occur, often described as a feeling of fullness or a stuffy place. Hearing problems and ringing in the ear can also be the result of blocked earwax.

Remind

Removing earwax with cotton swabs, fingers, or other objects can worsen the obstruction in the ear and damage the eardrum.

Eustachian tube block

The Eustachian tube is a narrow tunnel that connects the upper part of the throat to the middle ear. Regulates air pressure and drains excess fluid from the middle ear. If the Eustachian tube becomes blocked , often as a result of allergies, infections, or rapid changes in altitude, the following symptoms may appear:

  • Earache
  • Ringing or popping in the ears
  • Dizziness
  • Hearing loss

Ear skin problems

Sometimes earache is caused by the skin of the ear.

Three related conditions include:

  • Ear dermatitis , which causes itching, scaling, and swelling of the skin in the ear canal, can be the result of an allergic reaction (contact dermatitis) or an underlying skin problem (such as seborrheic dermatitis or psoriasis ).
  • Periauricular cellulitis (infected skin in the ear) causes redness, warmth, and a lot of pain in the ear. There may also be a fever.
  • Shingles (ear shingles) causes severe earache along with a vesicular rash (tight fluid-filled sacs). In rare cases, facial nerve palsy can occur along with a rash and earache in so-called Ramsey Hunt syndrome .

Perichondritis

Perichondritis occurs due to an infection of the cartilage of the ear, which causes pain, swelling, and redness of the skin. There may also be a fever, and sometimes an abscess (collection of pus) forms. If left untreated, perichondritis can lead to ear deformities (called cauliflower ear) because the infection cuts off the blood supply to the cartilage, destroying it.

Perichronditis occurs more frequently in people with certain autoimmune diseases, such as granulomatosis with polyangiitis , and in those who have damaged ear cartilage (such as a puncture in the upper part of the ear, burns, or rough contact during sports) .

Labyrinthitis

Labyrinthitis is an inflammation of the structure of the inner ear called the labyrinth. The maze often helps maintain balance. Labyrinthitis can also be associated with damage to the cranial or auditory nerve in the inner ear.

People with labyrinthitis may experience dizziness, nausea, vomiting, or ringing in the ear. This can include earache, but it is rarely painful.

Meniere's disease

Meniere 's disease is caused by an excessive accumulation of fluid in the inner ear, although the exact cause of this fluid retention is unknown. In addition to the classic triad of symptoms (dizziness, ringing in the ears, and hearing loss), some people with Meniere's disease complain of pain or pressure in the ear.

Tumor

A person's earache can be caused by a malignant or benign tumor, although it is rare. For example, nasopharyngeal cancer (a type of head and neck cancer) can cause full ears, as well as hearing loss, ringing in the ears, and recurrent ear infections.

Two examples of benign tumors or growths that can develop in the ear and cause pain include:

  • Cholesteatoma : a benign skin mass in the middle ear.
  • Acoustic neuroma : benign tumor of the inner ear that develops in the vestibular nerve (eighth cranial nerve).

Secondary causes

These conditions can cause earache, although they occur outside the ear.

Sinusitis

Sinusitis is an infection or inflammation of the sinuses, which are hollows located behind the nose, between the eyes, the cheekbones, and the lower part of the forehead. Sinusitis can cause many symptoms, such as:

  • Pressure, discomfort, or a feeling of fullness in the ear
  • Hot
  • Stuffy and runny nose
  • Toothache
  • Headache

Most cases of sinusitis are caused by a viral illness or an allergy; only a small percentage of cases are caused by a bacterial infection.

Dental problems

Dental problems like a cracked tooth, tooth decay, or a tooth abscess can indicate earache. Usually the pain is aggravated by hot or cold stimuli, biting or eating.

Temporomandibular joint disease (TMJ)

The temporomandibular joint (TMJ) connects the lower jaw with the temporal bone of the skull. Arthritis or erosion of the joints or stress / overuse of the surrounding muscles can cause a TMJ disorder .

TMJ pain is often described as a dull, persistent pain in the jaw joints that worsens when the mouth is opened or closed. Headaches and pain around the ear canal are also common.

Giant cell arteritis

Giant cell arteritis (GCA) is an inflammation of the branches of the external carotid artery, a large artery located in the neck. This inflammation can cause pain in the ear canal or outer ear, as well as pain in the temples and / or forehead, fever, fatigue, and loss of appetite. Vision changes and pain when chewing can also occur.

Mastoiditis

If left untreated, a middle ear infection can spread to the mastoid, the air-filled, spongy bone that is part of your skull. A mastoid infection ( mastoiditis ) causes pain, redness, and swelling behind the ear.

If mastoiditis is not recognized and treated early, it can lead to complications such as brain or cranial abscess, meningitis , facial nerve palsy, or hearing loss.

When to contact a healthcare provider

If you experience ear pain that gets worse, is severe, or lasts two or more days, be sure to seek medical attention.

Other examples of situations that require the attention of a healthcare provider include:

  • Earache with fever and / or sore throat.
  • Pain when pulling the earlobe
  • Ear discharge
  • Tinnitus, dizziness, or hearing loss
  • Swelling or a rash in the ear canal or earlobe.

Diagnostics

The diagnosis of earache often only requires a medical history and physical examination by a PCP or an ear, nose, and throat (ENT) specialist . Imaging and blood tests are required less often.

History of the disease

When you see your doctor about ear pain, you can expect them to ask you several questions related to the details of your pain:

  • What does the pain look like?
  • Does the pain come and go or is it constant?
  • Are there any accompanying symptoms, such as fever, hearing loss, balance problems or dizziness, ear discharge, or tinnitus? (tinnitus)?
  • Have you recently gotten sick or suffered an injury to your face or ear?

Physical exam

During a physical exam, your doctor will use an otoscope to examine your outer ear, ear canal, and eardrum (ear drum). Your healthcare professional will also examine your nose, mouth, and sinuses. You can also apply pressure to your TMJ, examine your posterior molars for signs of grinding or clenching, and examine your neck for enlarged lymph nodes or other masses.

Note that as part of your exam, your ENT doctor may perform a non-surgical procedure called a nasal endoscopy to better examine your nose and sinuses. An endoscope, a thin tube with a camera and a light, allows your healthcare provider to better examine your nose, sinuses, and upper throat (where the Eustachian tube opening is).

Finally, if you suffer from hearing loss and / or dizziness (imbalance), your otolaryngologist may refer you for vestibular and / or auditory function tests .

Display

Imaging is sometimes required to make a diagnosis of earache. For example, an X- ray may be done to evaluate a dental problem or to examine the jaw for TMJ disease.

A computed tomography (CT) scan may be required if mastoiditis is suspected, especially if the person is experiencing disturbing complications of mastoiditis, such as a cranial nerve deficiency or signs of meningitis.

A CT scan or magnetic resonance imaging (MRI) may also be ordered if your healthcare provider suspects a possible tumor, such as nasopharyngeal cancer or cholesteatoma, as a source of earache.

An MRI of your brain can be used to diagnose Meniere's disease because central nervous system conditions, such as a brain tumor or multiple sclerosis , can mimic the symptoms of Meniere's disease.

Blood test

Blood tests can be used to diagnose a variety of earaches. For example, if your healthcare provider suspects a serious infection, especially mastoiditis, they may order white blood cell counts and tests for markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) .

Blood tests can also be used to rule out problems like thyroid disease, diabetes, and syphilis, all of which can have symptoms similar to Meniere's disease.

Watch out

Since there are many different causes of earache, there are many possible treatments. The choice of treatment will depend on the underlying cause of the earache.

Self-service strategies

Simple home treatments can sometimes go a long way in relieving an earache, especially if the pain is due to fluid build-up due to a virus or an allergy.

For example, to relieve nasal congestion from sinusitis, otitis media, or a blocked Eustachian tube, your healthcare provider may recommend that you take an over-the-counter decongestant or nasal spray.

Other self-help strategies that may be helpful include:

  • Apply a warm compress to your ear or sinuses.
  • Apply diluted mineral oil or hydrogen peroxide and then take a warm shower to relieve nasal congestion.
  • Yawning or chewing gum to try to snap your ears
  • Drink lots of water (six to eight glasses a day).

Self-help strategies also play an important role in the management of TMJ syndrome. These strategies include:

  • Performing simple jaw exercises
  • Avoid factors that cause TMJ pain (like chewing gum or grinding your teeth)
  • Wear sting protection while sleeping
  • Using relaxation and stress management techniques

Wash ears

Ears rinsing is done by a healthcare professional to remove earwax. This procedure is also used to remove debris, infected material, and dead skin cells when treating otitis externa.

Medicines

Several different medicines can be used to treat earache:

Ear drops

Your healthcare professional may recommend earwax emollient drops if you have accumulated earwax.

Likewise, ear drops are the main treatment for external otitis. There are many different types of ear drops available, including antibiotics, acidifying solutions, and steroids. Many of these ear drops work in combination to reduce inflammation, treat infections, and relieve pain.

Oral or intravenous antibiotics

Oral (by mouth) or intravenous (intravenous) antibiotics are sometimes required to treat more serious causes of earache. Such as:

  • Bacterial sinusitis
  • Severe cases of external otitis, including necrotizing (malignant) otitis externa.
  • Perichondritis
  • Mastoiditis
  • Periauricular cellulitis

Analgesics

To relieve ear pain, your healthcare provider may recommend over-the-counter Tylenol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen). For TMJ pain, your doctor may also prescribe a muscle relaxant or a tricyclic antidepressant.

Operation

Sometimes a surgical procedure called a myringotomy is needed to treat chronic middle ear infections or persistent Eustachian tube dysfunction.

In a myringotomy, a small hole is made in the eardrum to relieve pressure and allow fluid to drain. A tube can then be placed in the eardrum to provide airflow to the middle ear and prevent fluid build-up.

Surgery may also be indicated for other diagnoses of earache, such as swelling, severe mastoiditis, or abscess formation from perichondritis.

Prophylaxis

Here are some strategies that can help prevent certain ear pain diagnoses:

To avoid earwax build-up:

  • Avoid chronic use of cotton swabs or earwax emollient agents such as Debrox (carbamide peroxide).
  • If you suffer from frequent episodes of wax build-up in your ears, Consider using topical emollients regularly or cleaning your ears regularly with your doctor every six to 12 months.

To prevent otitis media (swimmer's ear):

  • After bathing, dry your ears with a hair dryer (on low setting and keeping the dryer at a distance of about 30 cm).
  • Consider wearing special earplugs for swimming.
  • Do not put your fingers or a towel in your ears after bathing.

Get the word of drug information

Earache is not only unpleasant, it is often distracting and frustrating. The good news is that most diagnoses are curable, especially with early treatment. With that said, be sure to see your doctor if you have earaches so you can enjoy life again.

Frequently asked questions

  • Yes, you may have an earache and that does not mean you have an ear infection. Other possible causes include trauma to the ear or surrounding area, improper removal of ear wax, swelling, pain in the jaw, and changes in air pressure.

  • There are some remedies you can try at home to ease your earache, but these remedies will not cure an infection and you should still seek medical attention if an infection is suspected. Some people find that a hot or cold compress can help relieve an earache, but do not heat it or make it too cold and wrap the compress in a towel. Over-the-counter pain relievers like ibuprofen and acetaminophen can also be helpful, and some people find that sleeping with a healthy ear relieves pressure on a sore ear and reduces pain.

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