Ear Pain: Causes, Symptoms & When to Seek Care

What Are the Different Types of Ear Pain?

Ear pain can originate from infections in the middle ear (otitis media) or outer ear canal (otitis externa), from non-infectious conditions like earwax buildup or eustachian tube dysfunction, or from referred pain caused by problems in the jaw, throat, or teeth. The type of pain and accompanying symptoms help determine the underlying cause.

Pain in one or both ears can have many different causes. The most common culprits include viral infections, bacterial infections, and inflammation in the ear canal. It's often difficult to determine the exact cause of ear pain without a medical examination, which is why understanding the different types can help you communicate effectively with your healthcare provider.

The ear is divided into three main sections: the outer ear (the visible part and ear canal), the middle ear (behind the eardrum, containing the small bones that transmit sound), and the inner ear (responsible for hearing and balance). Problems in any of these areas can cause pain, though middle ear and outer ear issues are the most common sources of earache.

Additionally, the ear shares nerve pathways with the jaw, throat, and teeth. This means that pain from these areas can be "referred" to the ear, causing earache even when there's nothing wrong with the ear itself. This phenomenon explains why ear pain sometimes accompanies sore throats, dental problems, or temporomandibular joint (TMJ) disorders.

Ear Pain During a Cold

When you have a cold, the mucous membranes in your throat, nose, and sinuses become swollen. This swelling affects the eustachian tube, a small canal that connects the middle ear to the back of the throat. The eustachian tube normally helps equalize pressure and drain fluid from the middle ear, but when it's swollen shut, these functions are impaired.

A cold makes it harder for the mucous membranes in the nose and ear to defend against bacteria that can cause ear infections. These bacteria may already be present behind the nose without causing illness, only becoming problematic when a viral infection compromises the mucosal defenses. This is particularly common in preschool-aged children, whose eustachian tubes are shorter and more horizontal than adults', making them more susceptible to ear infections following colds.

Middle Ear Infection (Otitis Media)

Otitis media, or middle ear infection, is extremely common in children and often occurs alongside a cold. While adults can also develop middle ear infections, it is less frequent. During an ear infection, pus forms in the middle ear, and the eardrum becomes red and thickened. The eardrum may bulge outward due to the pressure and become less mobile.

The pain associated with middle ear infection results from increased pressure in the middle ear space, which pushes against the inflamed eardrum. This pressure can become intense, and in some cases, the eardrum ruptures to release the built-up fluid. While a ruptured eardrum sounds alarming, the pain typically decreases dramatically once the pressure is relieved, and the eardrum usually heals on its own without lasting problems.

Most cases of otitis media resolve spontaneously, though some patients require antibiotic treatment. The decision to prescribe antibiotics depends on factors including the patient's age, the severity of symptoms, and whether the infection affects one or both ears.

Fluid in the Middle Ear (Otitis Media with Effusion)

Otitis media with effusion, sometimes called "glue ear" or serous otitis media, is not an infection. In this condition, clear (not infected) fluid accumulates in the middle ear space. While this fluid doesn't usually cause pain, it can make the eardrum less mobile, dampening sound waves and causing temporary hearing loss. Many patients describe a sensation of fullness or "blocked" feeling in the ear.

This condition commonly develops in children after a cold or middle ear infection. In adults, fluid in the middle ear most often occurs when the eustachian tube doesn't function properly, such as when pressure cannot be equalized during flying or diving. Most cases resolve on their own, but persistent fluid buildup may require medical evaluation and treatment to prevent long-term hearing problems.

Swimmer's Ear (Otitis Externa)

Ear pain can also result from inflammation of the outer ear canal, known as otitis externa or swimmer's ear. This condition can cause temporary hearing loss because the swollen ear canal partially blocks sound transmission. The name "swimmer's ear" reflects that water exposure is a common trigger, though the condition can develop from other causes as well.

Mild cases of swimmer's ear are very common, particularly among people who swim frequently, use earplugs regularly, or frequently clean their ears with cotton swabs. The ear canal has a natural protective layer that can be disrupted by excessive moisture or mechanical irritation, allowing bacteria or fungi to cause infection. Symptoms include itching, pain (especially when touching the outer ear), and sometimes discharge.

Other Causes of Ear Pain

Sometimes ear pain occurs when foreign objects enter the ear canal. Young children may insert beads, small stones, or other objects into their ears. Insects can also occasionally enter the ear canal, causing significant discomfort. These situations typically require professional removal of the foreign body.

Earwax (cerumen) buildup can create a sensation of fullness in the ear and sometimes causes pain. While earwax normally protects the ear canal and moves outward on its own, it can sometimes accumulate and form a hard plug that requires treatment. Attempting to remove earwax with cotton swabs often pushes it deeper into the canal, making the problem worse.

Trauma to the ear, such as a blow to the side of the head or a ball hitting the ear, can rupture the eardrum and cause pain, bleeding, hearing loss, and sometimes dizziness. Similar injuries can occur from rapid pressure changes during diving or flying when adequate pressure equalization isn't achieved.

Referred pain from the temporomandibular joint (TMJ), throat infections, dental problems, or other conditions in the head and neck can also manifest as ear pain. This referred pain occurs because the nerves serving these areas share pathways with the nerves that supply the ear.

When Should You See a Doctor for Ear Pain?

See a doctor if ear pain lasts more than 24 hours, is accompanied by fever, causes hearing loss, or involves fluid draining from the ear. Seek emergency care immediately if you experience severe ear pain with neck stiffness, high fever and feeling very unwell, swelling and redness behind the ear, or dizziness with ear discharge.

While most ear pain resolves on its own or with simple home care, certain situations require professional medical evaluation. Understanding these warning signs helps ensure you receive appropriate care when needed while avoiding unnecessary medical visits for self-limiting conditions.

The timing of symptoms, their severity, and accompanying signs all play important roles in determining when medical attention is warranted. Children, particularly infants, may need evaluation sooner than adults because they cannot communicate their symptoms clearly and because ear infections can progress more rapidly in young children.

Contact a healthcare provider or urgent care clinic if you or your child experience any of the following:

• Ear pain lasting more than 24 hours
• Ear pain accompanied by fever
• Fluid or discharge draining from one or both ears
• Decreased hearing in one or both ears
• Ear pain or drainage that hasn't improved 2-3 days after being evaluated by a doctor
• Persistent sensation of fullness, ringing, or buzzing in the ears lasting 3-4 weeks after an acute ear infection

If symptoms are mild and occur during times when your regular healthcare provider is closed, it's generally safe to wait until the next business day rather than seeking emergency care. However, certain symptoms warrant immediate attention.

How Is Ear Pain Diagnosed?

Doctors diagnose the cause of ear pain primarily through otoscopy, a visual examination of the ear canal and eardrum using a handheld instrument with a light and magnifying lens. Additional tests like tympanometry may be used to assess eardrum movement and middle ear pressure.

The diagnostic process for ear pain typically begins with a thorough history of symptoms, including when the pain started, its character and severity, and any associated symptoms like fever, hearing changes, or discharge. This information helps guide the physical examination and any additional testing that may be needed.

To examine the ear, doctors use an otoscope or an otomicroscope. An otoscope is a handheld device similar to a small flashlight with a magnifying lens, while an otomicroscope provides a more detailed view similar to a microscope. These instruments allow the examiner to see the ear canal and eardrum clearly.

During the examination, the doctor assesses several aspects of ear health: the appearance of the eardrum (color, thickness, bulging), the presence and character of any fluid behind the eardrum, and how the eardrum moves. Eardrum mobility can be tested by gently puffing air against it using a pneumatic otoscope attachment. Alternatively, a tympanometer may be used to measure eardrum movement and middle ear pressure more precisely. This test involves placing a small, soft plug in the ear canal opening that produces a humming sound while measuring how the eardrum responds. The test is painless and provides objective information about middle ear function.

If swimmer's ear is present, swelling of the ear canal may make it difficult to see the eardrum clearly. In these cases, treatment for the external ear infection is typically started first, with a follow-up examination scheduled a few days later once the swelling has subsided to ensure no other ear problems are present.

What Can You Do at Home for Ear Pain?

Home treatment for ear pain includes keeping your head elevated to reduce swelling, using over-the-counter pain relievers like paracetamol (acetaminophen) or ibuprofen, applying warm compresses, and using saline nasal spray to help with congestion. These measures can provide relief while symptoms resolve.

Many cases of ear pain improve on their own without specific medical treatment. While waiting for symptoms to resolve, several home care measures can help reduce discomfort and support healing. These approaches are appropriate for mild to moderate ear pain while monitoring for any warning signs that would require professional evaluation.

The effectiveness of home remedies varies depending on the underlying cause of ear pain. For pain related to infections, these measures provide symptom relief while the immune system fights the infection. For pain related to pressure changes or congestion, they address the underlying mechanism. Understanding which approaches work best for different situations helps optimize self-care.

Keep Your Head Elevated

Both children and adults feel better when keeping their head elevated during an ear problem. This position helps reduce swelling in the nose and ears, decreasing pain. Elevation also promotes natural drainage of fluid from the middle ear through the eustachian tube. When sleeping, use extra thick pillows or raise the head of the bed by placing a pillow under the mattress.

For infants under one year, try holding them upright in a carrier, letting them sit in your lap, or using a bouncy seat. When sleeping, the head of the crib can be elevated by placing thick books under the legs at the head end. Always ensure that any sleep position modifications follow safe sleep guidelines for infants.

Nasal Sprays and Congestion Relief

Decongestant nasal drops or sprays reduce nasal congestion and can make breathing easier during a cold. However, they do not treat ear infections themselves. This applies to both children and adults. Decongestant sprays should not be used for more than 10 days, as prolonged use can cause rebound congestion that becomes difficult to resolve.

Saline nasal spray or drops offer a gentler alternative that can be used long-term. These help thin mucus and keep nasal passages moist without the risk of rebound congestion. Ready-made saline drops and sprays are available at pharmacies and can provide relief for both nasal and ear symptoms related to congestion.

Pain Relief for Adults

Several over-the-counter pain relievers can help manage ear pain. Options include medications containing paracetamol (acetaminophen) and those in the NSAID category, such as ibuprofen. These medications reduce pain and, in the case of NSAIDs, also reduce inflammation. Follow package directions for dosing and consider any personal health conditions that might affect which medication is most appropriate for you.

Pain Relief for Children

Always consult a healthcare provider before giving any medication to infants younger than 6 months. For older children:

• Children 3 months and older can take medications containing paracetamol (acetaminophen)
• Children 6 months and older can take medications containing ibuprofen

These medications come in various child-friendly forms, including tablets that dissolve in the mouth and liquid formulations. A pharmacist can help you choose the appropriate product and dose for your child's age and weight. Follow package instructions carefully and avoid combining different pain medications unless specifically advised by a healthcare provider. Children and teenagers under 18 should not take aspirin (acetylsalicylic acid) for fever without first consulting a doctor due to the risk of Reye's syndrome.

Swimming and Bathing with Ear Pain

When ear pain is present or fluid is draining from the ear, avoid swimming. If you've had an ear infection that ruptured the eardrum, avoid getting water in the ear for about a week after the drainage stops. Use petroleum jelly-coated cotton balls or specialized ear plugs during showering or bathing to protect the healing ear.

Earwax Removal

Over-the-counter earwax removal products are available at pharmacies and can effectively treat mild earwax buildup. These products typically soften the wax, making it easier to drain naturally. For large or impacted wax plugs, professional ear cleaning by a healthcare provider may be necessary. Never attempt to remove earwax by inserting objects like cotton swabs into the ear canal, as this can push wax deeper and potentially damage the eardrum.

How Is Ear Pain Treated?

Treatment for ear pain depends on the underlying cause. Middle ear infections in children ages 1-12 often resolve without antibiotics, while infants, older children, and adults typically receive antibiotics. Swimmer's ear is treated with ear drops. Persistent problems may require ear tube placement.

The appropriate treatment for ear pain varies significantly based on the diagnosis, the patient's age, and the severity of symptoms. Understanding the rationale behind different treatment approaches helps patients and caregivers make informed decisions about their care and know what to expect during the recovery process.

Modern treatment guidelines emphasize avoiding unnecessary antibiotic use to prevent antibiotic resistance while ensuring that patients who truly need antibiotics receive them promptly. This balanced approach has evolved from decades of research showing that many ear infections resolve spontaneously while also recognizing which patients benefit most from antibiotic treatment.

Treatment of Middle Ear Infection

Middle ear infections in children between one and twelve years of age typically heal on their own and usually don't require antibiotics. However, antibiotics may be prescribed if the infection is severe or if the child is particularly vulnerable to complications. Pain management with appropriate over-the-counter medications remains an important part of treatment regardless of whether antibiotics are used.

Children under one year, children over twelve, and adults generally receive antibiotic treatment for middle ear infections. This age-based approach reflects differences in immune system maturity, eustachian tube anatomy, and risk of complications. When antibiotics are prescribed, it's important to complete the entire course as directed, even if symptoms improve quickly.

Treatment of Swimmer's Ear

The most important step in treating swimmer's ear is thorough cleaning of the ear canal, which is typically performed by a healthcare provider. Additional treatment often includes ear drops containing antibiotics, antifungal agents, or corticosteroids to reduce inflammation. In rare cases of severe infection, oral antibiotics may be necessary. During treatment, keeping the ear dry is essential for healing.

Ear Tubes (Tympanostomy Tubes)

Children and adults who experience frequent fluid buildup in the middle ear or recurrent ear infections may benefit from having ear tubes placed. This minor surgical procedure, performed at an ear clinic, involves inserting a small plastic tube through the eardrum to allow air to enter the middle ear.

The tube helps the eardrum move more freely, reduces fluid accumulation behind it, improves hearing, and can decrease the frequency of new ear infections. The tubes typically remain in place for 6-18 months before falling out naturally as the eardrum heals. Some patients require repeat tube placement if problems recur.

How Can You Prevent Ear Pain During Air Travel?

Ear pain during flying occurs due to pressure changes affecting the eustachian tube. Prevention includes pressure equalization techniques (swallowing, yawning, or the Valsalva maneuver), using decongestant nasal spray before flight, chewing gum during ascent and descent, and for infants, nursing or sucking on a pacifier.

People who have difficulty equalizing ear pressure often experience ear pain when flying. This occurs because air pressure changes during takeoff and landing create a pressure difference between the outside of the eardrum and the middle ear space. When the eustachian tube doesn't function properly, this pressure imbalance can cause significant discomfort.

In all children and some adults, the eustachian tube doesn't work as efficiently as it should. Colds and ear infections temporarily impair eustachian tube function in everyone. Understanding how to manage pressure changes can help prevent or minimize ear pain during air travel.

Pressure Equalization Techniques

The most effective way to relieve ear pressure is to actively equalize it. The simplest method is to hold your nose closed and gently try to blow air out through your nose. This forces air up through the eustachian tube and into the middle ear. Using decongestant nasal drops or spray before the flight can reduce swelling in the nasal passages and make equalization easier. Specialized earplugs designed for flying are also available at pharmacies.

Chewing gum during takeoff and landing can help because the chewing motion repeatedly opens the eustachian tube. For infants and young children who cannot perform the Valsalva maneuver or chew gum, sucking on a pacifier or nursing during ascent and descent provides the same benefit.

In some cases, pressure differences can cause the eardrum to rupture. While this sounds alarming, it is not dangerous, though it can be quite painful. Testing your ability to equalize pressure before flying can help you determine whether air travel is advisable.

How Can You Prevent Ear Pain?

Preventing ear pain involves avoiding known triggers like water in the ear canal for those prone to swimmer's ear, not inserting objects into the ear, managing allergies and congestion, and practicing good hygiene to reduce upper respiratory infections that often precede ear infections.

While not all ear pain can be prevented, understanding risk factors and taking appropriate precautions can significantly reduce the frequency of ear problems. Prevention strategies vary depending on which type of ear pain you're trying to avoid and your personal risk factors.

For children, who are most susceptible to ear infections, reducing exposure to respiratory infections through good hand hygiene, avoiding secondhand smoke, and maintaining up-to-date vaccinations can help decrease the frequency of ear problems. Breastfeeding has also been shown to provide some protection against ear infections in infants.

Preventing Swimmer's Ear

If you're prone to swimmer's ear, keeping your ears dry is the most important preventive measure. After swimming or bathing, tilt your head to each side to help water drain from your ears. You can also use a hair dryer on the lowest heat setting held at arm's length to gently dry the ear canal. Over-the-counter ear drops designed to dry the ear canal can be used after swimming.

Avoid inserting cotton swabs, fingers, or other objects into the ear canal, as this can damage the protective skin lining and increase infection risk. If you use hearing aids or earplugs regularly, ensure they are kept clean and allow your ears periods of "rest" when possible.

Preventing Middle Ear Infections

Since middle ear infections often follow colds and other respiratory infections, general infection prevention measures can help. Frequent handwashing, avoiding close contact with sick individuals, and keeping vaccines current all contribute to reducing respiratory infection frequency and, consequently, ear infections.

For infants, breastfeeding provides antibodies that help protect against infections. If bottle-feeding, hold the baby in a more upright position rather than lying flat to prevent milk from flowing into the eustachian tube. Avoiding pacifier use after six months of age may also reduce ear infection risk.