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Ear Pain – Causes, Symptoms and Treatment

Ear pain is a common symptom that can be caused by infections, inflammation, or injury in or around the ear. It affects both children and adults.

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Things worth knowing about "Ear Pain"

Ear pain is a common symptom that can be caused by infections, inflammation, or injury in or around the ear. It affects both children and adults.

What Is Ear Pain?

Ear pain (medically known as otalgia) refers to pain occurring in or around the ear. The pain can be sharp, dull, throbbing, or burning, and may affect one or both ears. Ear pain is one of the most frequent complaints seen in general practice and ear, nose, and throat (ENT) medicine. While it can affect people of all ages, it is particularly common in young children.

Causes

Ear pain can stem from a wide range of causes. It is generally classified as either primary otalgia, where the source of pain is within the ear itself, or referred otalgia, where pain originates from a nearby structure and radiates to the ear.

Common Primary Causes

Middle ear infection (otitis media): One of the most common causes, especially in children. Bacteria or viruses infect the middle ear, often following an upper respiratory tract infection.
Outer ear infection (otitis externa): Inflammation of the external ear canal, frequently triggered by moisture, bacteria, or fungi — often referred to as swimmer's ear.
Earwax blockage (cerumen impaction): A buildup of earwax can create pressure and discomfort in the ear canal.
Eardrum injury: Perforations or tears in the eardrum caused by pressure changes, foreign objects, or infection.
Foreign body in the ear canal: Particularly in young children, objects placed in the ear can cause significant pain.

Common Referred Causes

Dental or jaw problems (e.g., tooth abscess, temporomandibular joint disorders)
Throat or tonsil conditions (e.g., tonsillitis, pharyngitis)
Neuralgias (e.g., trigeminal neuralgia)
Cervical spine disorders

Symptoms

In addition to the pain itself, ear pain may be accompanied by the following symptoms:

A feeling of pressure or fullness in the ear
Hearing loss or muffled hearing
Ringing in the ears (tinnitus)
Discharge from the ear (otorrhea)
Fever, especially when caused by an infection
Dizziness or balance problems
Itching inside the ear canal

Diagnosis

A doctor will diagnose ear pain through a clinical examination using the following approaches:

Otoscopy: The ear canal and eardrum are examined using an otoscope (a lighted instrument for looking into the ear).
Medical history: Detailed questioning about the onset, duration, nature, and associated symptoms of the ear pain.
Hearing tests: If hearing loss is suspected, simple hearing assessments or formal audiometry may be performed.
Ear swab: A swab of the ear canal may be taken if a bacterial or fungal infection is suspected.
Imaging: In rare or chronic cases, a computed tomography (CT) scan of the temporal bones may be required.

Treatment

Treatment depends on the underlying cause of the ear pain:

Medical Treatment

Pain relievers: Paracetamol (acetaminophen) or ibuprofen to relieve pain and reduce fever.
Antibiotics: May be prescribed by a doctor for confirmed bacterial middle ear infections.
Ear drops: Depending on the cause, anti-inflammatory, antibiotic, or antifungal ear drops may be prescribed.
Decongestant nasal sprays: Can help relieve blocked Eustachian tubes and improve pressure equalization.

Non-Medical Measures

Applying gentle warmth (e.g., a warm compress) can help ease discomfort.
Rest and avoiding putting strain on the affected ear.
Keeping water out of the ear canal when suffering from otitis externa.

When to See a Doctor

Medical attention should be sought promptly if ear pain is severe or persistent, if fever exceeds 39 °C (102.2 °F), if there is sudden hearing loss, discharge from the ear, dizziness, or if a child under the age of two is experiencing ear pain.

References

Wai Kuen Chow et al.: Ear pain (otalgia): primary, secondary and referred causes and their management. Current Opinion in Otolaryngology & Head and Neck Surgery, 2020.
World Health Organization (WHO): Ear care and hearing health. WHO World Report on Hearing, 2021. Available at: https://www.who.int/publications/i/item/9789240020481
Rosenfeld RM et al.: Clinical Practice Guideline: Acute Otitis Externa. Otolaryngology-Head and Neck Surgery, 2014; 150(1 Suppl): S1-S24.

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