All of us have had an earache or otalgia, at some point in our lives. Most of us think of only children suffering from ear pain, but earaches never discriminate based on age alone.
The problem can vary from mild to debilitating. Many of us take our ears for granted. We never think twice about our hearing or balance, since we expect our ears to be trustworthy. But when things go wrong, we want immediate answers.
Why does your ear hurt?
Before figuring out a remedy, it is important to understand why the ear is hurting. There are always hints. Often, determining the cause of an earache takes some detective work and this involves learning about other associated signs or symptoms, including:
- Ear drainage.
- Tinnitus (ringing).
- Hearing loss.
- Dizziness or balance problems.
- Teeth or jaw pain.
The first step is to determine if the earache is coming from the ear itself or because of pain from something nearby, also called “referred pain.” Everyone insists that the ear is the primary cause because the ear is what hurts. Unfortunately, the reason our ear hurts is not always clear.
Ear pain causes
The best clues to determine the basis of the ear pain are the patient history, including associated signs and symptoms, and the physical exam. Even when something seems unrelated, it can still be a cause of ear pain.
It may be a good idea to get a hearing test as well. Hearing tests reveal much more than just our hearing. They can provide valuable information regarding the health of our ears by showing if our eardrum is intact or if there is abnormal pressure or fluid behind the eardrum.
An easy example of an earache is when the person has been swimming. There is drainage from the ear, fullness, and redness. The reason the ear hurts may be obvious. The diagnosis is an outer ear infection known as otitis externa, or as we all know it well, “swimmer’s ear.” Treatment involves ear drops and dry ear precautions.
Another cause of an earache can be a result of a recent trip that included air flights. The earache is persistent because of changes in air pressure. There may be a negative pressure persisting behind the eardrum or fluid. The eustachian tube is the real culprit, but the cause of the pain is still the ear because of the way the ear works. Treatments can vary and include merely equalizing the pressure with coughing or bearing down (a Valsalva maneuver).
There are three main parts of the ear: the outer ear, the middle ear, and the inner ear. Each area can have its own set of problems that can provide hints as to why the ear is hurting.
Examples of causes of ear pain can be divided into these categories:
- Infection (outer, middle, or inner ear).
- Inflammation (outer, middle, or inner ear).
- Foreign body (insects are a common one).
- Earwax (cerumen).
- Trauma (eardrum perforation).
Ear pain due to other issues
There are many instances when we feel pain in our ears because of other reasons. This is when a careful evaluation of all the signs and symptoms and history is necessary.
When the ear is not the culprit, it is often difficult to diagnose and even more difficult, in many cases, to convince a person that the reason their ear hurts is not their ear at all. It is essential to understand that the head and neck region has one of the most complicated and compact designs. No other area of the body has a greater network of interconnected structures. Everything relates to everything nearby.
The ear is either adjacent to or interrelated to the following:
- Sinuses (paranasal).
- Eustachian tubes.
- Temporomandibular joint (jaw or TMJ).
- Mouth/Throat (including tonsils, tongue, teeth, gums, palate, voice box, pharynx).
Ear pain can manifest from or is “referred” from many sources, including:
- Sinus, nasal, or allergy issues.
- Eustachian tube dysfunction (air pressure changes).
- Dental (tooth infection) or TMJ problems (arthritis).
- Throat problems (tonsillitis, pharyngitis, swallowing problems).
- Headaches, neurologic problems.
Treatment depends on the origin of the earache. Sometimes, the diagnosis is easy, as with a “swimmer’s ear” or even eustachian tube dysfunction, but often identifying the source of the ear pain is more elusive.
In many cases, it takes some trial and error and sleuthing skills to alleviate the ear pain. Earaches can disappear as quickly as they arrive or hang on for days or longer.
If the person has a history of something new and recent, there may be reasons to investigate. Some examples may include:
- A recent cold, sinus infection, or flu.
- A recent airplane flight with high altitude.
- Earwax impaction.
- Ear infections (history).
- Recent injury.
- Sore throat.
- TMJ arthritis.
- Dental problems.
Treatment can be initiated at home first. Cold compresses, anti-inflammatory medicines, rest, chewing, and keeping upright, are some of the best initial steps.
Prevention includes avoiding water, controlling allergies and nasal congestion, and OTC medications such as ear drops or nasal sprays. One should be cautious in using ear drops or systems to remove suspected earwax since the ear canal can be extremely sensitive. In general, using ear drops that lower the pH of the ear canal can be helpful, but using harsh chemicals such as alcohol or hydrogen peroxide can cause more harm.
Seek help from your health care provider if these home remedies do not work, and the signs and symptoms worsen. Symptoms to watch out for include:
- Ear drainage.
- Ear swelling or redness, particularly behind the ear (mastoid bone).
- Intractable pain and tenderness.
- Worsening nasal or sinus pain and congestion or visual problems.
- Facial weakness (the facial nerve travels through the inner ear).
When in doubt, always seek the help of qualified health professionals.
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