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Ear pain, medically known as otalgia, (1) is a common problem, especially in children, with multiple causes. It can originate within the ear (primary otalgia) or can be due to secondary reasons.
The treatment for an earache depends on the cause, and therefore, proper diagnosis by a doctor is necessary.
Causes of and Risk Factors for Earache
Earaches have different causes in children and adults.
Ear infections are more prevalent among kids who:
- Are bottle-fed while lying on their back
- Are regularly exposed to irritants such as smoke
- Go to daycare
- Have a family history of ear infections
- Develop allergies as they get older
In adults, earaches are usually caused by:
- An ear infection
- Jaw joint dysfunction (2)
- Some forms of cancer in rare cases
Sinus infections can often lead to ear infections in children or adults who are prone to ear infections. (3) Sinus infections cause swelling and drainage of pus in the back of the nose or the nasopharynx.
This can cause irritation and swelling in the ear and allows the easy spread of the viral or bacterial infection to the middle ear space via the Eustachian tube.
Treatment for an Earache
While some earaches can get better on their own, it is best to consult your doctor and get appropriate treatment to prevent any complications.
Treatment modalities for children
According to the guidelines of the American Academy of Pediatrics, keeping your child under careful observation should be enough to address a unilateral ear infection (one side only). (4)
This may be the case if the child is older than 6 months, does not have any other signs suggesting severe ear infection, and is up-to-date with his/her immunization schedule.
If the child has a bilateral ear infection and is older than 2 years old and does not have indications of a severe ear infection, once again careful observation can be instituted. However, the child should be seen within 24–48 hours for follow-up by a health care provider.
Meanwhile, antibiotic treatment becomes a must to treat middle ear infections in the following cases:
- All infants less than 6 months of age
- All kids less than 2 years of age with a bilateral ear infection
- Any child with signs of severe ear infection, such as high fever (>102.2°F), irritability, pain, ear drainage, and bulging and red eardrum, and those who are behind on their immunization schedule
- Any child who is unavailable for close follow-ups
Treatment modalities for adults
In adults, earaches can be due to many causes.
- If the pain is due to a jaw joint dysfunction, applying heat, massaging the chewing muscles, avoiding chewing for a few weeks, and using a tooth guard can be helpful.
- Most external ear infections can be treated with a variety of antibiotics or antifungal ear drops.
Ear beer, made by mixing one-part rubbing alcohol with one-part white vinegar, can also be used. Put 5 drops of this solution into the affected ear after swimming, or once a week in general, to keep external ear infections at bay.
Preventive Tips
It is best to avoid the risk factors for earache to prevent it from occurring. Here are some tips:
- Make sure the baby is either breastfed or bottle-fed in a more upright position.
- Avoid cigarette smoke or wood-burning stoves.
- Never use a Q-tip inside the ear canal as that can cause trauma and can damage the sensitive inner lining of the ear, often paving the way for external ear infections.
- Adults with diabetes should be very careful and have their external ear infection treated aggressively and promptly to keep the infection from spreading outside the ear canal. (5)
- Persistent ear pain without a clear-cut cause should be referred to an ENT doctor for further evaluation. This will help rule out any serious underlying health concern.
Ear Pain When Lying Down
Ear pain occurs when lying down, particularly during night at the time of sleep. Because you are not in an upright position, the fluid in the ear flows into the Eustachian tube due to the lack of gravity-assisted drainage.
The congestion in the Eustachian tube is made worse by the swelling brought on by an ear infection, which causes further accumulation of pus within the ear and triggers pain. Additionally, kids are usually given medications such as Tylenol or Motrin to reduce fever or pain, but their effects often wear off during sleep time.
As a result, medicated children and sometimes even adults wake up from their sleep with severe ear pain. Lastly, you are usually distracted during the day, which keeps your mind off the pain. However, as you lie down to sleep, your brain can focus more on the pain that was not as noticeable before.
Earache in Children
Earaches in children can be caused by external or middle ear infections. Middle ear infections are known as otitis media and are much more common in kids. (6)
Children have a flat and narrow Eustachian tube that gets blocked easily, and a poorly ventilated middle ear then gets easily infected or filled with fluid. This, coupled with the increased frequency of viral upper respiratory infections, leads to a much higher incidence of middle ear infections in children, especially in ages 6 months to 3 years.
External ear infections, also known as swimmers’ ear, are seen in older children who swim. They can also occur in combination with middle ear infections when the latter cause eardrum rupture and drainage of fluid into the ear canal.
Is Putting a Few Drops of Olive Oil in the Aching Ear Helpful in Relieving Earache?
Although there is no scientific literature or evidence to support the claim that putting a few drops of olive oil in your ear can help relieve earache, different variations of this treatment have been used across many cultures.
Earache Can Be a Symptom of Cancer
In adults, persistent ear pain, especially if associated with a history of smoking and drinking and no significant history of ear problems, can be a concerning symptom that warrants a referral to an ENT specialist.
Ear pain can be symptomatic of cancer (7) in the following cases:
- Throat cancer causes referred pain. The nerve that innervates the throat also innervates the eardrum; hence, irritation of the throat can often lead to referred pain to the ear. This is also why sore throat-inducing tonsillitis can also cause ear pain.
- Cancer in the back of the nose (nasopharynx) or rarely nasal cancer can block the Eustachian tube, usually causing a buildup of ear fluid and less commonly an ear infection.
- It is very rare to have primary cancer of the ear, but it can cause ear pain as well.
Final Word
Earaches are often caused by problems in the ear or near it. The pain may range from a mild discomfort to a sharp or burning sensation in either or both of the ears.
Earaches may be caused by fluid retention, infections, or even jaw problems. Therefore, it is suggested to consult a doctor for the cause and respective treatment of the earache.
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