An earache can be a sharp, dull, or burning pain. The pain may be temporary or constant.

The symptoms of an ear infection may include:

• Ear pain
• Fever
• Fussiness
• Increased crying
• Irritability

Many children will have temporary and minor hearing loss during, and right after, an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has.

Ear pain in children is often caused by a buildup of fluid and pressure behind the eardrum, in the area called the middle ear. The middle ear is connected to the nasal passages by a short narrow tube, the Eustachian tube. The Eustachian tube allows normal fluids to drain out of the middle ear, and helps keep the pressure in your ear equalized.

A cold or allergy can block the Eustachian tube due to inflammation and the buildup of secretions. This is especially likely in small children, because their Eustachian tube is shorter and more horizontal. Closing of the Eustachian tube prevents the normal flow of fluid from the middle ear. The fluid begins to build up, which can cause stuffiness, pain, hearing loss, and an ear infection.

Ear pain in adults is less likely to be from an ear infection. What you perceive as ear pain may actually be coming from another location, such as your temporomandibular joint, your teeth, throat, or other location. This is called "referred" pain.

Causes of earache:

• Arthritis of the jaw
• Ear infection
  • Middle ear infection - acute (short and severe episode)
  • Middle ear infection - chronic (does not go away or recurs)
  • Outer ear (canal) infection - acute
  • Outer ear (canal) infection - chronic
  • Outer ear (canal) infection - malignant
• Ear injury from pressure changes (from high altitudes and other causes)
• Object stuck in the ear or severely impacted ear wax
• Ruptured or perforated eardrum
• Sinus infection
• Sore throat with referred pain to the ears
• Temporomandibular joint syndrome (TMJ)
• Tooth infection

Ear pain in a child or infant is not always from infection, however. Other causes include:

• Ear canal irritation from cotton-tipped swabs
• Soap or shampoo staying in the ear
• Water from bathing

The following steps may help an earache:

• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position can help reduce pressure in the middle ear.
• Olive oil or over-the-counter ear drops are gentle and effective, as long as the eardrum has not ruptured. Prescription drops, such as Auralgan, are also effective for pain relief.
• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give aspirin to children.)

You can relieve ear pain caused by rapidly descending from high altitudes by swallowing or chewing gum. Allowing infants to suck on a bottle while the plane is descending can help.

Call your child's doctor if:

• At the start, the child seems sicker than just an ear infection
• New symptoms appear, especially
  • Dizziness
  • Severe headache
  • Swelling around the ear
  • Weakness of the face muscles
• Severe pain suddenly stops (this may indicate a ruptured eardrum)
• Symptoms (pain, fever, or irritability) do not improve within 24 - 48 hours, or worsen
• Your child has a high fever or severe pain

The doctor will do a physical examination, which may include examination of the:

• Ear
• Mastoid (bony part behind the ear)
• Nose
• Throat

Pain, tenderness, or redness of the mastoid often indicates a serious infection.

During the examination, the doctor will ask questions about the ear pain, such as:

• When did it begin?
• Is it getting better, worse, or staying the same?
• Is the pain constant?
• What other symptoms are present?
• Is there ear pressure?
• Is there drainage from the ear?
• Are there unusual ear noises?
• Is there a fever?
• Is there pain in the bone behind the ear?
• Is there hearing loss?

Because most ear infections improve within 24 hours of seeing a doctor, physicians are less likely to prescribe antibiotics immediately. They will often wait to see if symptoms continue or worsen. This strategy has been shown to reduce antibiotic usage.

If antibiotics are prescribed, it is important to take ALL of the prescribed antibiotics on schedule. Ear tubes may be inserted for children who have persistent or recurring ear infections, to re-establish the proper functioning of the middle ear. Inserting ear tubes is a simple and effective surgical procedure.

The following steps can help prevent earaches:

• Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
• Prevent outer ear infections by not putting objects in the ear, and drying the ear after bathing or swimming.
• Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.

Ely JW, Hansen MR, Clark EC.Diagnosis of ear pain.Am Fam Physician. 2008 Mar 1;77(5):621-8. Review.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.