What causes ear pain?
Ear pain most often originates from the ear itself: outer ear canal infections, middle ear infections, impacted earwax, eardrum injuries and pressure changes (air travel, diving) are the most common causes. In children the leading cause is middle ear infection, while in adults — especially in summer — outer ear canal infections come to the fore.
Referred ear pain
An important point: not all ear pain comes from the ear. The ear shares its nerve supply with the throat, teeth, jaw joint and larynx. Tonsil infections, dental and gum problems, jaw joint disorders and diseases of the throat and larynx can therefore project pain to the ear. When the ear looks entirely normal on examination, the source is sought in these regions. In particular, persistent one-sided ear pain in older individuals who smoke — especially with difficulty swallowing or hoarseness — must always be evaluated in detail.
When should you see a doctor?
Short-lived, mild pain often resolves on its own. However, pain lasting more than a day or two or getting worse, fever, ear discharge, reduced hearing, redness and swelling of the outer ear, tenderness behind the ear, or accompanying dizziness all require examination. In babies and small children, irritability, ear pulling and fever can herald a middle ear infection.
Diagnosis and treatment
The ear canal and eardrum are examined with an otoscope/endoscope; hearing tests and middle ear pressure measurement (tympanometry) are performed when needed. Treatment is entirely cause-directed: drops and canal cleaning for outer ear infection, antibiotics where indicated for middle ear infection, removal of impacted wax, and treatment of the source in referred pain. Self-treating with drops — especially when there may be a hole in the eardrum — can be harmful; starting with an examination is the safest approach.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.