Pain in one or both ears can be caused by a variety of things. You may have a viral infection, a bacterial infection or inflammation of the ear canal. It is often difficult to know why you have earache.
Earache caused by a cold
With a viral cold, the nose and throat tend to become inflamed. Your throat will look red and irritated and you may have a sore throat. It is also common with a cold to have a temperature and to cough and sneeze. Colds can also cause earache. This may be due to pressure in the ear caused by swelling of the mucous membranes.
The cold also makes it harder for the mucous membranes in the nose and ears to fight off the bacteria that can cause ear inflammation. Healthy people too can carry these bacteria at the back of their nose. Young children are more prone to these problems than adults. It may be the case that the bacteria only makes you ill once a viral infection has cleared the way for them.
Earache caused by ear inflammation
Ear inflammation is very common in children and often develops in connection with a cold. Adults can also develop inflammation of the ear, but it is a less common problem. With ear inflammation, pus forms in the middle ear and the eardrum becomes red and swollen. The eardrum may bulge and be less mobile.
Ear inflammation causes earache because the mucous membrane is swollen, pressure has increased in the middle ear and the eardrum is inflamed. As a result, you usually experience more pain when you are lying down and pressure in the middle ear increases. Both adults and children may also feel that their ears are blocked and may experience impaired hearing while the ear is inflamed. You may also have a temperature. A temperature is common in children under one year of age, but it is less common in older children and adults.
Sometimes the pressure in the middle ear becomes so great that the eardrum bursts. Until this happens it can be very painful, but the pain usually then subsides quickly. When the eardrum bursts, pus runs out into the ear canal. The eardrum usually heals on its own and there are not normally any problems afterwards. If the eardrum bursts, you should always seek medical care as the inflammation needs to be treated with antibiotics. This is because if the eardrum has burst, it means that the ear inflammation is very likely severe.
Earache caused by glue ear
Glue ear develops when clear fluid builds up in the middle ear. This is caused by swelling of the mucous membrane in the Eustachian tube in your ear, which prevents the tube from opening and equalising the pressure. This creates a slight vacuum and fluid can collect that completely or partially fills the middle ear. This means that the eardrum is less mobile, sound waves are dampened and your hearing may be impaired for a while. It feels as though your ears are blocked and that sounds are muffled.
It is common for children to develop glue ear after a cold or ear inflammation. The condition will often clear up on its own and does not need to be treated with antibiotics. As an adult, you may experience problems with fluid in the middle ear if you cannot equalise the pressure in your ears while flying or diving, for example. Adults also tend to experience problems in connection with a cold, but these usually clear up quickly on their own. Equalising the pressure can help to speed up recovery. As an adult, if the problem does not clear up within a week, always seek medical advice. Particularly if you are having problems with just one ear.
Earache caused by otitis externa
Adults and children can also suffer from earache that is caused by inflammation of the ear canal itself. This is called otitis externa. In this case it is the skin of the ear canal that has become irritated and inflamed.
With otitis externa the ear is unable to clean itself as it normally would. This can lead to the ear canal becoming irritated and itching. Sometimes the inflammation is more severe. The ear canal can then become swollen and painful, and there may be a foul-smelling, sticky discharge from the ear. In some cases a gritty substance forms that may encourage fungi or bacteria to grow. Hearing may be impaired temporarily if the ear canal becomes completely or partially blocked by eczema, swelling, fluid or skin cells. This is because it is more difficult for sound to reach the eardrum.
Mild otitis externa is very common, particularly among people who swim a lot. It is also a common problem if you use cotton buds to clean the ear canal. Otitis externa develops more easily in a warm, moist climate. It is therefore more usual for the problem to develop in the summer in Sweden or when you travel to warmer countries.
Other causes of earache
In rare cases earache can be caused by objects that have entered the ear canal. Young children can insert beads, stones and other small objects into their ears. Insects can also get into the ear canal.
A blow to the ear, such as a ball hitting you on the ear, can burst the eardrum and cause pain, bleeding, hearing loss and sometimes dizziness. The same thing can happen during diving or flying if you are unable to equalise the pressure in your ears quickly enough.