Earache

Earache is a term used to describe various kinds of pain felt in one or both ears. Other symptoms may be muffled hearing or a feeling of pressure or blockage. Earache, especially in an infant or child, should be checked by a doctor.

Causes

Earache (also known as otalgia) is a common condition that mainly affects infants and children but can also occur in adults. It can have many causes, including:

• Ear infection (e.g. middle ear infection, outer ear infection)
• Throat infection (e.g. tonsillitis, strep throat)
• Nose infection or sinusitis
• Mouth infection (e.g. dental abscess)
• Teething in children
• Flu or common cold
• Measles
• A build-up of ear wax
• Injury to the ear from air pressure changes (e.g. changes in altitude)
• An abscess or growth in the ear
• A foreign object (e.g. an insect) stuck in the ear
• Injury or trauma from inserting objects (e.g. fingernails, cotton buds) in the ear
• A disease (e.g. mumps) affecting the parotid gland, which is close to the ear.

An ear infection is a common cause of earache in children but is less likely to be a cause of earache in adults.

As shown in the list above, earache is not always caused by a problem with the ear itself. Ear pain or discomfort may be due to a problem in another place, such as infections or disorders of the throat, mouth, or the joint in the jaw. This is known as referred pain.

Ears generally clean themselves and rarely if ever require cleaning. Ear wax build-up and blockage often happens when people use items like a cotton bud to try to clean their ears but end up pushing the ear wax farther into the ears and possibly causing injury to the ear.

An important part of the proper functioning of the ear is the eustachian tube, which links the middle part of each ear to the back of the throat. The eustachian tube drains fluid that is produced in the middle ear. If the eustachian tube becomes blocked, fluid can build up and cause glue ear. This may lead to increased pressure behind the eardrum or an ear infection, which may be felt as pain or a blockage.

Another function of the eustachian tube is to allow the equalisation of air pressure in the middle ear with the outside (i.e. atmospheric) pressure. If the eustachian tube becomes blocked the ear may not be able to equalise leading to increased pressure in the middle ear, which can cause pain or discomfort and possibly injury.

Signs and symptoms

Earache can be pain that is sharp, burning, dull, or throbbing. It can affect one or both ears. The pain may be constant, or come and go. Other signs and symptoms may be a feeling of pressure or blockage in the ear and muffled hearing.

In infants and very young children, signs and symptoms indicating that they might have earache include:

• Rubbing or pulling their ear
• Fever (temperature of 38°c or higher)
• Nausea or vomiting
• Dizziness or loss of balance
• Fluid coming out of the ear
• Not reacting to certain sounds
• Difficulty sleeping or irritability and restlessness
• Crying more than usual
• Lack of interest in food.

Treatment

While many cases of earache will improve on their own within a few days, it’s recommended you see your GP if you or a family member has earache. If the family member with earache is an infant or child, contact your GP or practice nurse immediately. If you are uncertain, call Healthline on 0800 611 116.

If the earache is caused by a bacterial ear infection your GP will most likely prescribe a course of antibiotics. The antibiotics should be used exactly as instructed by your GP or a pharmacist.

New fluid discharge from the ear, dizziness, nausea, vomiting, a severe headache, stiff neck or extreme ear pain are reasons to return to your GP immediately.

In addition to seeing a doctor, the following self-treatment suggestions may help to lessen the symptoms of earache:

• Using over-the-counter pain medication such as paracetamol or ibuprofen (note, children aged under 16 years shouldn’t take aspirin)
• Placing a cold or warm pack or wet flannel on the affected ear to help relieve the pain
• Chewing may help to relieve the pain and pressure of an ear infection
• Sitting upright instead of lying down may reduce the pressure in the ear
• Sucking on a lolly or chewing gum or allowing infants to breastfeed or suck on a bottle or may help to relieve pain caused by a change of altitude (e.g. when an airplane is landing).

Prevention

The following recommendations can help to prevent earache:

• Don’t stick objects in your ears (e.g. fingers, cotton buds)
• Try to avoid water getting inside your ears
• Dry your ears thoroughly but gently after bathing or swimming
• Don’t smoke around children (second-hand smoke is a cause of ear infection in children)
• Only use eardrops if told to by your GP.

Further information and support

Healthline

Freephone: 0800 611 116
Website: www.healthline.govt.nz

Royal New Zealand Plunket Society

Freephone: PlunketLine 0800 933 922
Website: www.plunket.org.nz

References

Cleveland Clinic (2017). Ear wax build-up and blockage (Web Page). Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14428-ear-wax-buildup--blockage [Accessed: 24/01/19]
Ministry of Health (2018). Earache (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/earache [Accessed: 23/01/19]
MedlinePlus (2018). Earache (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/003046.htm [Accessed: 23/01/19]
NHS (2017). Earache (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/earache/ [Accessed: 24/01/19]
NHS inform (2018). Earache (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/earache [24/01/19]
O’Toole, M.T. (Ed.) (2013). Earache. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.

Created: February 2019

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