Earache

What Is It?

Pain in the ear or ears can occur for many reasons, and some are not related to the ear at all. The most common cause of earache is pain in the middle ear that occurs when the Eustachian tube (a passageway between the ear and the back of the throat) becomes blocked. The middle ear is the small, air-filled cavity that sits just behind the paper-thin eardrum. Normally, air enters the middle ear through the Eustachian tube, equalizing the atmospheric pressure between the middle ear and the outer ear. The Eustachian tube also drains fluid out of the middle ear. When this tube becomes blocked, and air and fluid cannot flow freely, then pressure builds in the ear, causing pain.

If the fluid behind the eardrum becomes infected with a virus or bacteria, it causes a middle-ear infection that can lead to pain and fever.

Other causes of pain related to the ear include:

• Injury
• Inflammation and infection in the ear canal (swimmer's ear)
• Infection of the external ear and ear lobe (cellulitis)
• Neuralgia, a pain caused by irritation of the nerves in the ear

Pain may be felt in the ear from a sore throat or a problem with the jaw joints called TMJ (temporomandibular joint disorders).

When the ear is blocked by too much wax, you may feel pressure, but this usually doesn't cause pain.

Symptoms

Earache is most commonly described as a feeling of pressure in the ear that causes ear pain. This may begin gradually or suddenly, and it can be very severe. Other symptoms like loss of hearing, fever and feeling unwell usually indicate an ear infection. When the ear canal is inflamed or if the eardrum ruptures, there may be drainage from the ear. If the eardrum ruptures because of a middle ear infection, the pain is often relieved because the pressure is reduced. In young children, the only signs of an ear infection may be fever, irritability and pulling at the ear.

Diagnosis

Adults and older children with mild ear pain or pressure without fever or hearing loss usually do not need to see a doctor. This type of pain usually is caused by a blocked Eustachian tube.

If the ear pain is more severe, or there are other symptoms, it's a good idea to see a health professional. In the office, your doctor will examine your ears, nose and throat. He or she will use a device called an otoscope (a lighted instrument) to look inside the ears and check for redness and fluid buildup behind the eardrum. The doctor also may blow in a puff of air through the otoscope to see if the eardrum moves normally. Your doctor also may test your hearing. One way is to check how well you can hear fingers rubbed together near your ear.