Earache: What to Do?

Most of us know the symptoms of an earache--your ear hurts! This pain is usually inside your ear, near your jaw.  It may throb or feel sore to touch. It may even feel warm. You may have a headache, sore throat or a stuffy nose too.

Ear pain is unpleasant, upsetting and very common. Ear pain can be caused by a number of health issues. Finding relief for earache starts with finding the cause of the ear pain. 

Ear pain can be caused by an accumulation of ear wax. Ear wax is a normal byproduct of healthy ears, but if there is a buildup, the excess wax can put pressure on the ear canal and even the ear drum, causing discomfort or pain. While home remedies for ear wax removal are readily available, it is best to have the ears examined and the ear wax removed by a physician, especially if there is pain associated with the ear wax. 

Ear infections are another cause of ear pain. There are two types of ear infections. An external ear infection or external otitis is usually the result of a bacterial or fungal infection in the ear canal. These infections are common in swimmers, the aptly named “swimmers’ ear” and in people with diabetes or immune dysfunction. In elderly diabetics this infection can be serious and requires immediate medical attention.

Middle ear infections occur in the middle ear space, behind the ear drum. These infections frequently occur in young children but are seen in people of all ages. Middle ear infections occur when the eustachian tube, the small tube connecting the nose to the middle ear, becomes blocked or plugged, usually due to allergies, upper respiratory infections, or sinus infections. When the tube is blocked, it does not open and allow fluid in the middle ear to drain. This fluid is trapped in a warm, dark space, which unfortunately is a breeding ground for infection. Most middle ear infections will resolve on their own, but medical treatment may be necessary. Any ear infection should be evaluated by a physician to determine the exact cause so that accurate treatment can be provided.  

You should see a doctor immediately if you have any of the following symptoms:

• Fever
• Swollen ear or face
• Drainage from the ear
• Dizziness
• Decreased hearing
• Ringing or buzzing
• If you are elderly and diabetic

If your ear pain is caused by an infection, your health care provider will prescribe an antibiotic.  However, don’t expect your doctor to prescribe an antibiotic for ear pain if you don’t have an infection. Overuse of antibiotics has created antibiotic resistant bacteria and physicians are appropriately cautious to only prescribe these medications when necessary. Your provider will advise you on pain relievers and other palliative care to help you feel better while your ear heals.  

If you don’t have any of the symptoms listed and your pain is mild, there are some at home remedies you can try.

1. Acetaminophen or ibuprofen (check with your doctor first)
2. Warm compress on the ear
3. OTC decongestant (again check with your doctor, especially if you have high blood pressure)

If you have eustachian tube dysfunction – your ears feel plugged and “pop” – chewing sugar free gum can be helpful. Chewing creates a positive pressure in your oral cavity that may help the eustachian tube open more freely. Look for chewing gum with Xylitol which has antimicrobial properties and may help prevent ear infections. 

Of course, the best home remedy is to stay healthy. Drink plenty of fluids and wash your hands to reduce the likelihood you catch a cold.  If you are a diabetic, watch your weight and diet and follow all medication instructions. Quitting smoking is critical to good health. Smoking is a common cause of ear infections in adults and secondhand smoke is a primary cause of ear infections in children.

Sinus infections, nasal congestion, and allergies can also cause ear pain. Inflammation of the upper respiratory tract can cause irritation and swelling of the opening to the eustachian tube.  If this tube becomes plugged, a negative pressure can build up in the middle ear, causing discomfort and pain. The upper respiratory disorder must be treated to resolve this ear pain. Upper respiratory illness usually is self-limiting and resolves without medical treatment. However, if ear pain and sinus or nasal congestion occur with a fever or last longer than 72 hours, evaluation by a physician is recommended.

Dental problems are a surprising cause of ear pain. The ear canal sits above the temporomandibular joint, the joint where the jaw connects to the head. When teeth are out of alignment or if there is clenching or grinding, pain from the irritated jaw joint can radiate into the ear canal. The pain is felt in the ear, but it is not caused by the ear.  Impacted wisdom teeth may also cause ear pain. Ear pain may occur after dental procedures where the mouth is open for an extended period of time. Routine dental evaluations and cleaning along with good oral hygiene can reduce or eliminate referred ear pain. 

Earache is disruptive and uncomfortable. While it is usually a minor problem that resolves quickly, finding the cause of the pain is important to ensure appropriate treatment and to avoid possible long-term damage to your ears and hearing.