Earache and Ear Pain
Earache or pain in the ear can affect anyone, but it’s especially common in children. According to the NHS, while earache can be worrying it’s usually caused by a minor infection, and in many cases it will clear up in a few days without any treatment (i).
In other words, you shouldn’t usually need to see your doctor if you or your child has earache. Whether the pain is sharp, dull or causes a burning sensation, whether it’s constant or comes and goes, or whether it affects one or both ears, there are several things you can do at home that can provide relief.
If you need to treat the pain, over-the-counter painkillers such as paracetamol and ibuprofen are suitable for earache. If you’re buying pain medicine for children, make sure you get a product that’s suitable for their age group and that you know what dose you should give them and how often. Children under the age of 16 should never be given aspirin.
Over-the-counter eardrops may also be suitable – ask a pharmacist to recommend drops that may help (do not, however, use eardrops if you have a perforated eardrum – see below).
You can often also help ease the pain of earache by putting a warm cloth or flannel against the affected ear.
When to see your GP
While most cases of minor ear infections clear up by themselves, you may need medical advice in certain situations, including the following:
If the person affected is a child younger than three months.
If you or the person affected also feels unwell in other ways, including having a high temperature, a very sore throat or a rash, or if they’re vomiting, if they have discharge coming from the ear, if they’re confused or drowsy or if the area around the ear becomes swollen.
If the person affected is a child younger than six months who has a temperature higher than 38ºC.
If there’s something stuck in the ear – something that’s particularly common in children.
If the pain is severe and over-the-counter painkillers aren’t helping.
If the pain doesn’t improve after three days.
If the person affected has an existing medical condition that may reduce their ability to fight off an infection.
There are two main types of ear infections, namely middle ear infections (otitis media) and outer ear infections (otitis externa), also sometimes referred to as infections in the ear canal.
Middle ear infections
According to the NHS, anyone can develop a middle ear infection but infants between six and 15 months old are the most commonly affected. Plus an estimated one in every four children will have at least one middle ear infection by the time they reach their 10th birthday (ii).
Most are caused by a build-up of mucus in the middle ear during a cold or other infection, which makes the tube that runs from the middle ear to the back of the nose (the Eustachian tube) blocked or swollen. This stops the mucus from draining away normally, which can cause an infection. Children are thought to be more at risk of this type of ear infection because their Eustachian tubes are smaller than those of adults, which means they can get blocked more easily.
Enlarged adenoids can also cause middle ear infections as they can block the Eustachian tube. Adenoid is soft tissue at the back of the throat, and children’s adenoids are relatively much larger than those of adults.
Earache is the main symptom, but a middle ear infection may also cause a high temperature, sickness and low energy. If fluid builds up inside the ear, the condition is known as glue ear. This can cause temporary hearing loss (or dull hearing) in the affected ear, and may or may not also cause earache. Glue ear usually affects children who’ve had several middle ear infections, and like the infections it often clears up on its own.
In babies, a middle ear infection may also cause irritability and restlessness, poor feeding, ear rubbing or pulling, coughing, a runny nose, diarrhoea, dulled hearing (they may not respond to quiet sounds) and balance problems.
How is it treated?
Unless the symptoms of a middle ear infection are particularly persistent or severe, they don’t usually need any treatment other than over-the-counter painkillers. If, however, the infection doesn’t clear up after a few days or is causing severe pain, you or the person affected may need antibiotics (though these aren’t routinely given to treat middle ear infections).
Outer ear infections
While middle ear infections are more likely to affect children, infections of the ear canal are more common in adults – particularly swimmers (according to the NHS, repeated exposure to water can make the ear canal more vulnerable to inflammation(iii)).
Estimates suggest one in 10 people will have an outer ear infection at some time in their lives, most commonly between the ages of 45 - 75. Women are more likely to be affected than men too. People who have eczema or a similar skin condition in or around their outer ear are also more susceptible to outer ear infections (iii).
The symptoms of an outer ear infection include ear pain, itching, dull hearing or a feeling of the ear being blocked, as well as a discharge coming from the ear. The most common cause is a bacterial infection. But fungal infections, allergies, getting water in the ear on a regular basis and damaging the skin inside the ear – by scratching, for example – can all make an outer ear infection more likely to develop.
How is it treated?
Outer ear infections can clear up on their own, but the NHS recommends those who think they may have one to see their GP. This can mean the difference between the infection clearing up within a few days of using ear drops and putting up with the symptoms for several weeks or more if you decide not to have any treatment.
The type of ear drops your GP may prescribe may include antibiotic ear drops, steroid ear drops (to reduce swelling), antifungal ear drops (if the infection is caused by a fungal infection) or acidic ear drops that help kill bacteria. You may need one or a combination of drops, depending on what has caused the infection.
Other causes of earache
There are several other things that can cause earache, including the following:
If you have a cold or flu it could cause earache without the ear becoming infected. This is usually the result of excessive mucous collecting in the middle ear and putting pressure on the ear drum. Over-the-counter painkillers such as paracetamol and ibuprofen may help ease the pain of cold-related earache, or you could try an over-the-counter decongestant remedy (do not give decongestants to children under the age of six – those aged six to 12 years can take decongestants but only for five days maximum and with advice from a pharmacist).
Having a throat infection such as tonsillitis can make it painful for you to swallow, but it can also cause earache. According to the NHS, tonsillitis usually clears up after a few days – though see your GP if you don’t feel better after four days or if the symptoms are severe (iv).
If a tooth infection causes an abscess, the intense pain that affects the tooth or gum can sometimes spread to the nearest ear. See a dentist as soon as possible if you think you may have a dental abscess, as the pus from the abscess should be drained and the infection treated.
Wax is produced naturally in the ears to help protect the ear canals. Wax normally moves out of the ears on its own. But when too much wax builds up inside the ear, it can form a plug that blocks the ear canal, making your hearing dull and sometimes also causing pain. To remove built-up wax, never use cotton buds, as they can push the wax further into the ear. Instead, try over-the-counter ear drops designed to soften excess ear wax, which helps it to fall out naturally.
An alternative to over-the-counter ear drops is to put a couple of drops of warmed olive oil in the affected ear twice a day for a few days (this too helps to soften any built-up wax plugs).
If your ears are affected when you’re travelling by plane, the condition is known as barotrauma of the ear. This happens when the air pressure in the middle ear is different to that outside the ear, and can cause dulled hearing – as if you want to make your ears ‘pop’ – and sometimes can be painful. People who are particularly susceptible to this may want to try using a decongestant nose spray while they’re flying and before the plane is due to land. Using ear plugs may also help. Changes in air pressure can also affect your ears while scuba diving.
Caused by a reactivation of the virus that causes chickenpox (varicella-zoster virus), shingles can sometimes affect the nerve that supplies the ear, and can cause pain inside the ear or on the outer ear.
Temporomandibular joint pain
Earache can also by caused by a jaw problem called temporomandibular disorder (TMD), which can be a result of grinding your teeth or arthritis. According to the National Institute of Health and Care Excellence (NICE), it’s difficult to say how many people experience TMD, as most don’t get any treatment for their symptoms. However it’s thought that women may be more effected by TMD than men (v). Other symptoms include muscle pain around the jaw, clicking noises while chewing, eating difficulties (you may find it hard to open your mouth), headache, migraine, neckache and backache. If you think you may have TMD, see your GP as you may need specialist treatment.
Trauma or injury to the ear caused by cotton buds, sharp objects or even a punch to the ear can damage the ear canal and sometimes tear or make a hole in the eardrum. Other things that may lead to a perforated eardrum include middle ear infections, sudden loud noises and barotrauma of the ear (see above).
The main symptom of a perforated eardrum is hearing problems. If the tear or hole is very small you may only have minimal hearing loss. But larger tears can affect your hearing more seriously.
Ear pain and discomfort is another possible symptom, as is a discharge from the ear and a high temperature. Some people with a perforated eardrum also experience tinnitus noises, while others develop middle ear infections, since the eardrum is a natural barrier to germs that may invade and infect the middle ear.
The good news is a perforated eardrum isn’t usually serious and often heals on its own within six to eight weeks. It’s usually advisable to take over-the-counter painkillers to soothe any pain or discomfort. But if the problem doesn’t resolve itself you may need to see your GP, especially if there’s a chance you may develop an infection (also see your GP if a middle ear infection was the cause of your perforated eardrum).
If the tear in your eardrum is particularly big or doesn’t heal, you may need surgery – called myringoplasty – to repair it. This may help improve any hearing problems you’ve developed as a result of having a perforated eardrum, as well as reduce your risk of getting ear infections.
The operation is usually performed under general anaesthetic, which means you’ll be asleep while it’s being carried out. You should be able to go home from hospital the same day or the day after, but you may need a couple of weeks off work or away from school to recover.
Natural relief for earache
One of the common causes of ear pain is excess mucous in the ear when you have a cold. Decongestant remedies may be helpful in such cases, but if you prefer a more natural alternative, try a steam inhalation. This can help to soften and thin the mucous, which may allow it to drain from your ears more effectively.
Try putting hot – but not boiling – water in a bowl and add several drops of eucalyptus oil, friars’ balsam or a pinch of menthol crystals. Inhale the steam for up to 15 minutes at a time, but take care not to scald yourself.
Meanwhile, taking a herbal supplement that contains echinacea may not directly affect ear pain, but there is some evidence it may shorten the duration of a cold (vi).
You may also want to make sure your immune system is being supported effectively while it’s fighting a cold or an ear infection by taking nutritional supplements such as vitamin C (take 500 - 1000mg daily) or a good-quality general multivitamin and mineral.
Although managing constant ear pain can be worrying, this guide should help to ease some of the symptoms. If you’d like to discover more information on a range of other common health conditions, our health library has a number of helpful articles.
Available online: https://www.nhs.uk/conditions/tonsillitis/
Hoheisel. O, Sandberg. M, Bertram. S, et al. Echinagard treatment shortens the course of the common cold: a double-blind, placebo-controlled clinical trial. Eur J Clin Res. 1997;9:261-268..
Draves AH, Echinacea and the Common Cold: Evidence Suggests That it Can Treat – But Not Prevent – The Common Cold. Candian Pharmacists Journal. 2005 Mar;138(2):Review Article.Available online: https://journals.sagepub.com/doi/abs/10.1177/171516350513800207
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.