Ear Pain: Causes, Symptoms & When to See a Doctor

What Causes Ear Pain?

Ear pain can be caused by infections in the middle ear (otitis media) or ear canal (swimmer's ear), fluid buildup, earwax blockage, jaw problems, pressure changes during flying, or referred pain from throat or dental issues. In children, middle ear infections during or after a cold are the most common cause.

Ear pain, medically known as otalgia, affects people of all ages but is particularly common in young children. The pain can originate from within the ear itself (primary otalgia) or be referred from nearby structures like the jaw, throat, or teeth (secondary otalgia). Understanding the underlying cause is essential for appropriate treatment and knowing when medical care is necessary.

The ear is divided into three parts: the outer ear (including the ear canal), the middle ear (containing the eardrum and small bones), and the inner ear (responsible for hearing and balance). Problems in any of these areas can cause pain, though the characteristics of the pain often differ depending on the location.

Infections remain the most common cause of ear pain, particularly in children. The Eustachian tube, which connects the middle ear to the back of the throat, is shorter and more horizontal in children, making it easier for bacteria and viruses to travel from the nose and throat to the ear. This anatomical difference explains why ear infections are so prevalent in young children and become less common as they grow.

Ear Pain During a Cold

When you have a cold, the mucous membranes in your throat, nose, and sinuses become swollen and inflamed. This swelling affects the Eustachian tube, preventing it from properly equalizing pressure in the middle ear. The congestion creates an environment where bacteria that normally live harmlessly behind the nose can multiply and cause an ear infection.

Children in daycare or preschool are particularly susceptible because they are frequently exposed to respiratory viruses. The viral infection itself may cause mild ear discomfort, but bacterial ear infections typically develop as a secondary complication when the immune defenses of the mucous membranes are compromised.

Middle Ear Infection (Otitis Media)

Middle ear infection, or otitis media, is extremely common in children and often follows a cold or upper respiratory infection. During an infection, pus accumulates in the middle ear, causing the eardrum to become red, thickened, and bulging. The pressure buildup is what causes the characteristic sharp, throbbing pain that often worsens when lying down.

In some cases, the pressure becomes so great that the eardrum ruptures, releasing the pus into the ear canal. While this sounds alarming, it actually provides immediate pain relief as the pressure is released. The eardrum typically heals on its own within a few weeks, and most people experience no lasting effects. However, repeated ruptures or chronic infections can sometimes lead to hearing problems.

Most ear infections in children between ages 1 and 12 resolve without antibiotic treatment. However, antibiotics may be necessary for children under 1 year, those over 12, adults, or when the infection is severe or doesn't improve with supportive care.

Fluid in the Middle Ear (Otitis Media with Effusion)

Sometimes called "glue ear," this condition involves fluid accumulation in the middle ear without active infection. The fluid is clear rather than pus-filled, but it prevents the eardrum from moving properly, which can temporarily affect hearing. Many people describe a sensation of having their ear blocked or "underwater."

While otitis media with effusion typically doesn't cause significant pain, it can create discomfort and pressure sensations. In children, it commonly develops after a cold or ear infection. In adults, it may occur when the Eustachian tube doesn't function properly during flying or diving. The condition usually resolves on its own, but persistent cases may require further evaluation and treatment.

Swimmer's Ear (Otitis Externa)

Swimmer's ear is an infection or inflammation of the ear canal, the passage leading from the outer ear to the eardrum. It's called swimmer's ear because it commonly develops when water remains trapped in the ear canal after swimming, creating a moist environment where bacteria can thrive.

However, swimming isn't the only cause. Frequent use of earbuds or hearing aids, inserting objects into the ear canal (including cotton swabs), and skin conditions like eczema can all lead to otitis externa. The condition causes pain that typically worsens when the outer ear is touched or pulled, along with itching, redness, and sometimes discharge.

Other Causes of Ear Pain

Several other conditions can cause ear pain, even when the ear itself is healthy. Referred pain from jaw problems (temporomandibular joint dysfunction), sore throat, dental issues, or nerve problems can all manifest as ear pain. This is because the ear shares nerve pathways with these nearby structures.

• Earwax blockage: A buildup of earwax can press against the eardrum, causing pain and temporary hearing loss
• Foreign objects: Small children may insert beads, stones, or other objects into their ears, causing pain and potential damage
• Trauma: A blow to the ear or sudden pressure change can rupture the eardrum, causing sharp pain and bleeding
• Barotrauma: Pressure changes during flying or diving can stretch or rupture the eardrum if pressure isn't equalized
• Jaw problems: Temporomandibular joint (TMJ) dysfunction often causes pain that radiates to the ear

What Are the Symptoms of Ear Pain?

Symptoms of ear pain include aching or sharp pain in one or both ears, reduced hearing, a feeling of fullness or pressure, fever (with infection), drainage from the ear, and in children, irritability, tugging at the ear, and difficulty sleeping. Symptoms typically peak 12-24 hours after onset.

The symptoms accompanying ear pain often provide important clues about the underlying cause. While pain is the primary complaint, associated symptoms help distinguish between different conditions and determine the urgency of seeking medical care. Understanding these patterns can help you make informed decisions about home care versus professional evaluation.

In adults, ear pain symptoms are usually straightforward to describe and localize. However, infants and young children cannot articulate their discomfort, so parents must watch for behavioral cues such as ear tugging, unusual crying, difficulty sleeping, and loss of appetite. A child who normally sleeps well but suddenly becomes restless at night may be experiencing ear pain that worsens when lying down.

The timing and nature of the pain provide valuable diagnostic information. Pain that develops suddenly and severely often indicates an acute infection, while gradual onset may suggest fluid accumulation or referred pain. Pain that worsens with jaw movement or chewing points toward TMJ problems, while pain that increases when the outer ear is touched suggests swimmer's ear.

Symptoms in Children

Children, especially infants and toddlers, often cannot express that their ears hurt. Instead, they may display behavioral changes that indicate discomfort. Pulling or rubbing the affected ear is a classic sign, though some children do this from habit or when teething. More reliable indicators include changes in sleep patterns, increased fussiness, and difficulty with feeding.

A child with an ear infection may seem fine during the day when upright but become increasingly distressed at bedtime or when lying down for naps. This pattern occurs because horizontal positioning allows fluid and pressure to build up in the middle ear. Supporting the child in a more upright position can provide relief.

When Pain Indicates Something Serious

While most ear pain is benign and self-limiting, certain symptoms suggest more serious conditions requiring prompt medical attention. Severe pain accompanied by high fever and feeling very unwell can indicate a spreading infection. Swelling and redness behind the ear may signal mastoiditis, an infection of the bone behind the ear that requires immediate treatment.

Sudden hearing loss, especially if accompanied by dizziness or a spinning sensation (vertigo), suggests inner ear involvement and warrants urgent evaluation. Discharge from the ear, particularly if bloody or foul-smelling, indicates that the eardrum may have ruptured or that there's an infection in the ear canal.

When Should You See a Doctor for Ear Pain?

See a doctor if ear pain lasts more than 24 hours, occurs with fever, results in fluid drainage from the ear, causes hearing loss, or doesn't improve within 2-3 days. Seek immediate care for severe pain with stiff neck or drowsiness, high fever with feeling very unwell, swelling behind the ear, or ear pain with dizziness.

Knowing when to seek medical care for ear pain can be challenging. Most cases resolve with home treatment and time, but delaying care for certain conditions can lead to complications. The key is recognizing warning signs that distinguish self-limiting problems from those requiring professional intervention.

Age plays a significant role in determining when to seek care. Infants under 6 months with suspected ear pain should always be evaluated by a healthcare provider, as they are more vulnerable to complications and cannot receive all pain medications. Children under 1 year with ear infection symptoms typically need medical assessment, even if symptoms seem mild.

For older children and adults, the decision often depends on symptom severity and duration. Mild to moderate ear pain that develops during or after a cold can usually be managed at home for 24-48 hours with pain relief and supportive measures. If symptoms persist beyond this time frame or worsen despite treatment, medical evaluation is warranted.

The presence of certain associated symptoms changes the urgency level significantly. Fever over 39°C (102.2°F), particularly when combined with looking very unwell or drowsy, suggests a more serious infection. Discharge from the ear indicates either a ruptured eardrum or an ear canal infection, both of which benefit from medical assessment.

Contact a Healthcare Provider If:

• Ear pain lasts more than 24 hours
• Ear pain occurs with fever
• Fluid drains from one or both ears
• Hearing is noticeably reduced in the affected ear
• Pain or drainage persists 2-3 days after a doctor has already evaluated the condition
• A feeling of blockage, ringing, or buzzing in the ears continues for 3-4 weeks after an acute infection

How Is Ear Pain Diagnosed?

Doctors diagnose the cause of ear pain by examining the ear with an otoscope or otomicroscope to view the eardrum, checking for fluid, inflammation, and eardrum movement. Tympanometry may be used to measure middle ear pressure. The examination is painless and takes only a few minutes.

When you visit a healthcare provider for ear pain, the evaluation typically begins with questions about your symptoms: when the pain started, what makes it better or worse, whether you've had recent colds or swimming, and any associated symptoms like fever or hearing changes. This history often provides important clues about the likely cause.

The physical examination focuses on visualizing the ear canal and eardrum using an otoscope, a handheld instrument with a light and magnifying lens. In some cases, an otomicroscope (a larger device similar to a telescope) provides a more detailed view. The doctor looks for signs of infection, fluid behind the eardrum, and how the eardrum moves.

A healthy eardrum appears gray and translucent, moving freely when air is puffed against it using a pneumatic otoscope. An infected middle ear shows a red, bulging eardrum that moves poorly. Fluid behind the eardrum (otitis media with effusion) makes the eardrum look amber or dull. Swimmer's ear shows a red, swollen ear canal, sometimes making it difficult to see the eardrum at all.

Additional Tests

Sometimes additional testing helps clarify the diagnosis. Tympanometry involves placing a small probe in the ear canal that measures how the eardrum responds to pressure changes. This test objectively assesses middle ear function and is particularly useful for detecting fluid that might not be visible on examination.

If swimmer's ear is diagnosed but doesn't respond to initial treatment, the doctor may take a culture of any drainage to identify the specific bacteria or fungus causing the infection. Hearing tests may be recommended if there's concern about hearing loss, particularly for chronic or recurrent ear problems.

What Can You Do at Home for Ear Pain?

Home treatment for ear pain includes keeping your head elevated, taking over-the-counter pain relievers (paracetamol or ibuprofen), applying a warm compress, using saline nasal spray to promote drainage, and staying hydrated. Do not insert anything into the ear canal, and avoid swimming until pain resolves.

Many cases of ear pain can be safely managed at home with supportive measures while waiting to see if the condition resolves on its own. The goals of home treatment are to relieve pain, reduce inflammation, and promote drainage of any fluid from the middle ear. These measures can make a significant difference in comfort while the body's natural healing processes work.

Elevation is one of the simplest yet most effective measures for ear pain relief. When you keep your head elevated, swelling in the nose and ears decreases, and fluid can drain more effectively. This reduces pressure in the middle ear and typically diminishes pain. Use extra pillows when lying down, and consider sleeping in a slightly reclined position rather than flat.

For infants and young children who cannot be propped up with pillows, creative solutions can help. A baby carrier that holds the child upright provides relief while allowing them to rest. Babies can also sit in a parent's lap or a supported infant seat. Raising the head end of the crib slightly by placing books or blocks under the legs can help during sleep.

Pain Relief Medications

Over-the-counter pain relievers are effective for managing ear pain. Adults can choose between paracetamol (acetaminophen) and medications in the NSAID group (such as ibuprofen), which also reduce inflammation. Both are effective, and the choice often depends on individual preference and any other health conditions.

For children, age-appropriate formulations are available in liquid form or dissolvable tablets. Children from 3 months can receive paracetamol, while ibuprofen is suitable from 6 months of age. Always follow package instructions for dosing and never give aspirin-containing products to children under 18 due to the risk of Reye's syndrome.

Nasal Decongestants and Saline

Decongestant nasal sprays can reduce congestion and make breathing easier during a cold, but they do not directly treat ear infections. However, by reducing swelling in the nasal passages, they may help the Eustachian tube function better and promote drainage from the middle ear.

Saline nasal spray or drops are a gentler alternative that helps thin mucus and cleanse the nasal passages. Unlike decongestant sprays, saline has no rebound effect and can be used as often as needed. These products are available without prescription at pharmacies.

Importantly, decongestant nasal sprays should not be used for more than 10 days, as longer use can cause rebound congestion that's difficult to resolve. Saline sprays have no such limitation.

Earwax Removal

If ear pain is caused by earwax blockage, over-the-counter earwax softening drops may help. These products are effective for mild to moderate buildup but may not be sufficient for large, impacted wax plugs. Never try to remove earwax by inserting cotton swabs or other objects into the ear canal, as this typically pushes wax deeper and can damage the eardrum.

If home earwax removal products don't resolve the blockage, a healthcare provider can remove the wax using special instruments or gentle irrigation.

Swimming and Bathing Precautions

When you have ear pain or an active ear infection, avoid swimming until symptoms have fully resolved. If your eardrum has ruptured (you'll know because there was sudden pain relief followed by drainage), keep water out of the ear for at least a week after drainage stops. Use cotton balls coated with petroleum jelly or specially designed ear plugs when showering or bathing.

How Is Ear Pain Treated Medically?

Medical treatment depends on the cause: most middle ear infections in children ages 1-12 heal without antibiotics, but antibiotics are prescribed for severe infections, young infants, and adults. Swimmer's ear is treated with antibiotic ear drops. Chronic fluid in the middle ear may require ear tubes (tympanostomy tubes).

The treatment approach for ear pain depends on identifying and addressing the underlying cause. Modern evidence-based guidelines emphasize that many ear infections, particularly in school-age children, resolve without antibiotic treatment. This "watchful waiting" approach, when appropriate, helps prevent unnecessary antibiotic use and its associated risks, including antibiotic resistance and side effects.

However, antibiotics remain essential for certain situations. The decision to prescribe antibiotics considers the patient's age, severity of symptoms, and presence of complications. Healthcare providers weigh the benefits of treatment against the risks, individualizing the approach for each patient.

Treatment for Middle Ear Infection

For children between 1 and 12 years with uncomplicated middle ear infection, current guidelines recommend "watchful waiting" with pain management for 48-72 hours. During this time, parents provide pain relief with appropriate medications and monitor for improvement. If symptoms don't improve or worsen, antibiotics are then prescribed.

Antibiotics are typically prescribed from the start for:

• Infants under 1 year of age
• Children over 12 years and adults
• Severe infections with high fever or significant distress
• Infection in both ears in young children
• Children with certain underlying health conditions
• Cases where follow-up might be difficult

Treatment for Swimmer's Ear

Swimmer's ear (otitis externa) is primarily treated with antibiotic ear drops, often combined with a steroid to reduce inflammation. The ear canal may need to be cleaned first if significant debris or discharge is present. In severe cases where the ear canal is very swollen, a wick (a small piece of absorbent material) may be placed to help the drops reach the infected area.

Treatment typically lasts 7-10 days. It's important to complete the full course even if symptoms improve quickly. During treatment, keep the ear dry and avoid using earbuds or hearing aids in the affected ear.

Ear Tubes (Tympanostomy Tubes)

Children and adults with chronic fluid in the middle ear or recurrent ear infections may benefit from tympanostomy tubes, commonly called ear tubes or grommets. This minor surgical procedure involves placing a tiny tube through the eardrum to allow air into the middle ear and prevent fluid accumulation.

The tubes typically stay in place for 6-18 months before falling out naturally as the eardrum heals. While in place, they reduce the frequency of ear infections, improve hearing affected by fluid, and help equalize ear pressure. The procedure is performed by an ear, nose, and throat (ENT) specialist and is one of the most common childhood surgical procedures.

Can You Fly with Ear Pain?

Flying with ear pain or an active ear infection is not recommended. Pressure changes during takeoff and landing can worsen pain and potentially rupture the eardrum if you cannot equalize pressure. If you must fly, use decongestant nasal spray before the flight, chew gum during pressure changes, and try the Valsalva maneuver.

Air travel poses challenges for anyone with ear problems because cabin pressure changes during takeoff and landing. When the Eustachian tube isn't functioning properly, as occurs during ear infections, colds, or with fluid in the middle ear, equalizing pressure becomes difficult or impossible. This can cause severe pain and, in some cases, rupture of the eardrum.

People with healthy ears equalize pressure naturally by swallowing, yawning, or performing the Valsalva maneuver (pinching the nose and gently blowing). These actions open the Eustachian tube briefly, allowing pressure to equalize. However, when the tube is blocked by swelling or fluid, these techniques may not work.

If possible, postpone air travel until ear pain has resolved, the infection has cleared, and you can comfortably equalize pressure. If you must fly, several strategies can help minimize discomfort:

• Use decongestant nasal spray 30-60 minutes before takeoff and again before landing
• Chew gum or suck on hard candy during takeoff and landing to promote swallowing
• For infants, breastfeeding or bottle-feeding during pressure changes encourages swallowing
• Try the Valsalva maneuver: pinch your nose closed and gently blow as if trying to exhale through your nose
• Earplugs designed for flying (with filters that slow pressure changes) may help
• Stay awake during descent, as sleeping prevents active pressure equalization

How Can You Prevent Ear Pain?

Prevent ear pain by treating colds promptly, keeping ears dry after swimming, avoiding inserting objects into the ear canal, not smoking around children, ensuring children receive recommended vaccinations, and breastfeeding infants when possible. For recurrent problems, ear tubes may be recommended.

While not all ear pain is preventable, several strategies can reduce the frequency and severity of ear problems. These measures are particularly important for children prone to recurrent ear infections and for adults who regularly swim or are exposed to conditions that promote ear problems.

Respiratory infections are the primary trigger for middle ear infections in children. While you can't prevent all colds, good hand hygiene and limiting exposure to sick individuals can reduce infection frequency. Ensuring children receive pneumococcal and influenza vaccinations as recommended can decrease the risk of ear infections caused by these organisms.

Cigarette smoke exposure increases ear infection risk in children. Parents and caregivers who smoke should avoid smoking around children and ideally quit altogether. Breastfeeding for at least the first 6 months provides immune protection that may reduce ear infection frequency.

Preventing Swimmer's Ear

Swimmer's ear can often be prevented with proper ear care after water exposure:

• Dry ears thoroughly after swimming or bathing by tilting the head and gently pulling the earlobe to help water drain
• Use a towel to dry the outer ear; never insert anything into the ear canal
• Consider using ear plugs designed for swimming if prone to swimmer's ear
• After swimming, use over-the-counter drying drops or a mixture of equal parts white vinegar and rubbing alcohol (unless you have a perforated eardrum or ear tubes)
• Avoid swimming in water with high bacterial counts (such as lakes after heavy rainfall)

Protecting Your Ears

The ear canal is self-cleaning; earwax naturally migrates outward, carrying debris with it. Inserting cotton swabs or other objects disrupts this process and can push wax deeper, cause injury, or introduce bacteria. Clean only the outer ear with a washcloth.

If you use earbuds, hearing aids, or other devices that go in the ear, clean them regularly and give your ears breaks from constant use. Prolonged use in moist or warm conditions can promote bacterial growth and swimmer's ear-like infections even without swimming.