What causes an Earache?

There are many causes of earaches. While earaches can occur first with a cold virus, sometimes a secondary ear infection may occur. These ear infections are usually sudden in onset and extremely painful in the beginning.Two primary causes of ear pain are acute ear infection and swimmer’s ear, and an inflamed eardrum or tympanic membrane can cause Myringitis.

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Where do Earaches occur?

Ear pain may occur at many points in the pathway from the outside of the ear to deep in the inner ear. An earache can affect one or both ears and can vary from a mild, dull ache to a throbbing or stabbing pain that is nearly incapacitating. A sense of fullness in the ear, as well as a burning sensation, may accompany an earache. An earache can occur suddenly or progress slowly.

The middle ear, the tympanic membrane and the external auditory canal are structures making up the ear. When those structures swell and become inflamed, pain results because any type of inflammation causes redness, swelling and pain.

In children the eustachian tube is very small and in some cases, not fully developed. This means that only mild inflammation is required to cause a blockage. The adenoid glands are also relatively large and can contribute to blocking of the tube. However, not all children get earache and not all children who have congested ears will complain of symptoms.

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Acute Ear Infection: Otitis Media

What is an Acute Ear Infection?

An acute ear infection is a severe infection in the eardrum and middle ear most common in young children and babies. Although not as common in adults and older children, those individuals may develop the infection as well.

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What causes an Acute Ear Infection?

A viral or bacterial infection located in the middle ear can cause an acute ear infection. The infection often occurs as an individual is recovering from an upper respiratory tract infection or a cold. If the cold or infection causes the Eustachian tube to be inflamed, natural drainage of fluid from the middle ear may not occur.

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• People who have had severe head congestion caused by flu, colds or sinus blockage may suffer from ear pain.

• Foreign objects or fluid trapped in the middle ear can cause a bacterial infection in the ear.

• A less common earache cause may be a change in atmospheric pressure or altitude like that experienced by scuba divers, swimmers and hikers.

Additional causes of Acute Ear Infection

• A malformed head or neck area

• Failing to elevate the head of an infant during bottle-feeding, allowing moisture to collect in the ear canals

• Prevalence of ear infections in family history

• Frequent exposure to secondhand smoke

• Allergies

Risk Factors for Acute Ear Infection

• Exposure of children to people with upper respiratory infections or colds

• Non-immunized children

• Secondhand smoke exposure

• Pacifier use when babies are older than six months

• Feeding babies by bottle while they are lying down

Breastfeeding babies during their first six months may decrease the risk of ear infections.

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Signs and Symptoms of Acute Ear Infection

The common symptoms of an acute ear infection include:

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• Fever

• Loss of hearing

• Sounds of buzzing or ringing in the ear

• Ear feels plugged or full

• Discharge from the ear caused by infected fluid draining out of the ear if the eardrum ruptures

• Itching in the ear or a throbbing pain that is either dull or sharp

• Ear pain

• Tooth pain

The most common symptom of acute ear infection is pain in the ear. Very young children may be unable to identify the source of their pain and simply display irritability and fussiness.

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Infants and Young Children May Have Other Symptoms

• Diarrhea

• Vomiting

• Refusal to eat

• Poor sleeping

• Irritability

Diagnosis of Acute Ear Infection

Healthcare providers use otoscopes to view the eardrum because they cannot see directly into the middle ear without those instruments. Acute ear infection causes swelling and inflammation in the middle ear. At first, the middle ear fills with fluid, and the practitioner may see fluid bubbles behind the eardrum. Air may be present behind the drum as well. As the pressure increases, a tiny puff of air blown through the otoscope may not be able to move the eardrum. When the eardrum appears red and inflamed, the earache diagnosis is usually acute ear infection.

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Treatment for an Acute Ear Infection

• A healthcare practitioner may recommend that adults begin taking antibiotics immediately to treat acute ear infection, dependent on various circumstances.

• Children often recover in two or three days without taking antibiotics. It may be necessary to provide only comfort care and observe the child during that time. Using this approach depends on confidence in the diagnosis, gravity of the illness, the child’s age and the availability of follow-up care if it becomes necessary.

• The practitioner may recommend treating symptoms with prescription or over-the-counter pain medications, humidifiers and plenty of fluids.

When should I call a Doctor?

Treating the symptoms by controlling pain, drinking fluids and humidifying the air may be sufficient for resolving acute ear infection. However, if symptoms persist, consult with a healthcare practitioner.

If you have recurrent middle ear infections, you may need to consult a head and neck physician (otolarngologist) to help manage this. Children with speech delay or signs of hearing loss should similarly seek such evaluation.

Most ear infections heal quickly after treatment, and the pain should subside in several days. However, it may take longer for hearing loss, the sensation of fullness in the ear and other associated symptoms to heal. People who feel well and discontinue taking their medication after only a partial treatment without finishing the recommended course may experience a recurrence of symptoms and a return of the infection.

Individuals who suffer from continuing infections or have numerous, periodic infections may need referrals to an otolaryngologist.If complications occur from ear infections, like vertigo, nausea, hearing loss, fever or recurrent pain, patients should seek follow-up examinations with healthcare practitioners.

People who get recurrent ear infections or children with delayed speech development may need to have hearing tests.If an ear infection does not respond to ordinary treatment, the healthcare provider may send a specimen from the ear drainage to a laboratory to identify the bacteria responsible for the infection.

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Swimmer's Ear: Otitis Externa

What is Swimmer's Ear?

Often occurring after swimming, a skin infection commonly called swimmer’s ear takes place in the outer ear canal where wax forms.

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What causes Swimmer's Ear?

Moisture caught in the ear canal or a slight injury in the ear canal can often cause pain in the outer ear.

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Who is at Risk for Swimmer's Ear?

• You run a risk of developing swimmer’s ear if you fail to dry your ears thoroughly after showering, bathing or swimming. Shake water out of your ears after swimming.. Earplugs worn while swimming may help keep water out of your ears.

• Although rare, a fungus can cause an infection in the ear.

• The ear provides a moist, warm environment that is conducive to the growth and multiplication of infection-causing bacteria.

• Humid, hot weather as well as swimming, showering or bathing can contribute to trapping moisture in the ear canal.

• A scrape or slight injury in the skin of the ear canal can lead to swimmer’s ear. Using objects like paper clips, fingernails or cotton swabs to clean the ear can break the skin. Bacteria can easily enter the ear through the broken skin and allow an infection to begin. Most individuals’ ears clean themselves, but those who have a buildup of wax should see a healthcare provider who will use an otoscope and remove the excess wax under direct vision. Do not attempt to remove insects or other foreign objects from your ear canal. A healthcare practitioner should perform that task as well.

Signs and Symptoms of Swimmer's Ear

The symptoms of swimmer's ear include:

• Earache that develops gradually

• Itch in the ear

• Pulling on or touching the upper rim (helix) of the ear intensifies the pain

• Loss of hearing

• Sounds of buzzing or ringing in the ear

• A sensation of fullness or blockage in the ear

• Swelling in the ear

• Ear canal and helix producing a thick drainage

Diagnosis of Swimmer's Ear

• Healthcare providers normally review the history of a patient and examine him or her to determine the cause of an earache. The diagnosis usually does not require X-rays or other tests.

• A practitioner often evaluates the ear canal and eardrum by looking into the ear with an otoscope. If a patient has swimmer’s ear, swelling and inflammation will be present in the ear canal. A thick drainage may be visible as well. Occasionally, extreme swelling and pain make it too difficult to insert the scope into the canal.

• When circumstances warrant further examining, the healthcare provider may evaluate other areas of the body. The practitioner may look in the throat for signs of tonsillitis or sore throat, check the lungs for indications of pneumonia and feel the neck to assess stiffness and check for swollen lymph nodes.

Treatment for Swimmer's Ear

• Practitioners normally recommend treating swimmer’s ear with ear drops for a week to 10 days.

• The ear drops help combat infection with antibiotics in the drops, and when swelling is present, the drops may contain steroids as well.

• When administering the drops, the patient should lie on his or her side with the affected ear facing up and remain that way for at least five minutes to keep the drops in the ear.

• If necessary, place a small wick or piece of gauze in the ear canal to help the drops reach the proper location when the canal is swollen.

• Keep the ear canal dry while treating it. Coat a small cotton ball with petroleum jelly to plug the ear and keep water out while bathing, or use an earplug for the purpose.

• It may sometimes be necessary to get a prescription for an oral antibiotic in addition to the ear drops.

• You may also need to take pain medication for several days while waiting for the infection to heal.

• Treatment for infections and pain in the middle ear often consists of taking antibiotics and analgesics for ten days to two weeks.

If drainage builds up in the ear, your healthcare provider may refer you to an ear, nose and throat specialist (otolaryngologist) who can remove the drainage and allow the infection to heal.

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When should I call a Doctor?

You should usually consult a doctor for ear pain, especially if the pain is persistent. Determining which type of ear infection is causing the symptoms can be difficult without the help of a health care provider. However, a healthcare provider may recommend treating the ailment at home first. The advice may be for seven to ten days of antibiotic treatment with or without ear drops along with pain medication if needed. The condition may require more in-depth medical attention if the pain-causing drainage accumulates in the ear because that could lead to an infection. Concerning symptoms include:

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• Hearing loss, fever with no other known cause, lethargy or pain that continues for several hours or becomes more intense may be indications that you need medical care.

• Babies who develop fevers should receive medical care if they are less than two months old.

• Individuals who have diabetes or compromised immune systems should get medical care to rule out the presence of malignant Otitis Externa if they develop earache accompanied by redness around the ears along with fever. Those individuals should ask for follow-up examinations after recovering from infections.

• People with earache accompanied by headache, vomiting, fever, lethargy, stiffness in the neck or other encephalitis or meningitis symptoms should seek medical care promptly.

Most ear infections heal quickly after treatment, and the pain should subside in several days. However, it may take longer for hearing loss, the sensation of fullness in the ear and other associated symptoms to heal. People who feel well and discontinue taking their medication after only a partial treatment without finishing the recommended course may experience a recurrence of symptoms and a return of the infection.

Individuals who suffer from continuing infections or have numerous, periodic infections may need referrals to an otolaryngologist.

If complications occur from ear infections, like vertigo, nausea, hearing loss, fever or recurrent pain, patients should seek follow-up examinations with healthcare practitioners.

People who get recurrent ear infections or children with delayed speech development may need to have hearing tests.If an ear infection does not respond to ordinary treatment, the healthcare provider may send a specimen from the ear drainage to a laboratory to identify the bacteria responsible for the infection.

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Infectious Myringitis

What is Myringitis?

Myringitis is an inflammation of the eardrum or the tympanic membrane.

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What causes Myringitis?

Localized trauma to the eardrum or infection of the eardrum can cause myringitis.

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Who is at Risk for Myringitis?

• A foreign object can puncture the eardrum and cause the local trauma that precedes myringitis. Attempting to remove an insect or wax with a paperclip or cotton swab can damage the eardrum.

• A ruptured eardrum can cause barotrauma. Pressure changes because of flying, diving, extremely loud explosions or other noises can rupture the eardrum.

• Viral and bacterial infections of the eardrum may be the source of inflammation and blistering. The condition, called bullous myringitis, indicates the presence of a fluid-filled blister called a bulla.

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Signs and Symptoms of Myringitis

Pain in the ear can be a symptom of bullous myringitis. The pain may be intense but may disappear suddenly if the bulla ruptures spontaneously and reduces the pressure.

Other Symptoms:

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• Loss of hearing

• Fever

• Bloody fluid draining from the ear canal

Diagnosis of Myringitis

A healthcare practitioner can use an otoscope to view the eardrum. Inflamed tissue and fluid blisters are indications of bullous myringitis.

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Treatment for Myringitis

Antibiotic ear drops, oral antibiotics and pain medications are common treatments for eardrum infections.

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When should I call a Doctor?

You should seek medical care if you suspect you may have bullous myringitis.

Most ear infections heal quickly after treatment, and the pain should subside in several days. However, it may take longer for hearing loss, the sensation of fullness in the ear and other associated symptoms to heal. People who feel well and discontinue taking their medication after only a partial treatment without finishing the recommended course may experience a recurrence of symptoms and a return of the infection.

Individuals who suffer from continuing infections or have numerous, periodic infections may need referrals to an otolaryngologist.

If complications occur from ear infections, like vertigo, nausea, hearing loss, fever or recurrent pain, patients should seek follow-up examinations with healthcare practitioners.

People who get recurrent ear infections or children with delayed speech development may need to have hearing tests.

If an ear infection does not respond to ordinary treatment, the healthcare provider may send a specimen from the ear drainage to a laboratory to identify the bacteria responsible for the infection.

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Home Treatment for Myringitis

Earaches are relatively common, particularly in children. This is because the immature ear canal is prone to poor drainage. If the symptoms are mild, you may want to begin treating the fever and pain before getting a medical consultation. Typical remedies for earache symptoms are ibuprofen or acetaminophen,as determined by a patient’s medical history (e.g. anyyone who takes anticoagulation medication or has kidney disease should be cautious about using ibuprofen, and someone who has liver disease should not use acetaminophen.) It is important to consider the weight of a child or infant when determining the correct dosages.

A warm compress placed on the ear can help control the pain of earache. Test the compress to make sure it is not hot enough to burn the skin before placing it on the patient’s ear.

Symptoms are not mild if their is ear drainage, the child is less than 6 months of age, there are other symptoms besides ear pain or there are severe symptoms (e.g. very high fever, vomiting/diarrhea, dehydration, severe irritability in children).