Earache
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Earache is a very common condition in both adults and children. In children, the cause is often a cold or ear inflammation. In adults, it is more commonly caused by otitis externa, which is also called “swimmer’s ear”. Problems will often get better by themselves, but in certain cases some form of treatment may be necessary.

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This text provides information on the most common causes of earache, what you can do yourself and when to seek medical care.

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Different types of earache

Different types of earache

  • The ear has three sections. More information.

    The ear has three sections. More information.

    Mer information
    The ear

    The ear has three sections: the outer ear, the middle ear and the inner ear. At the far end of the ear canal is the eardrum. Behind the eardrum is the middle ear, which is a tiny cavity that is normally filled with gas.

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.

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When should I seek medical care?

When should I seek medical care?

Earache often clears up on its own and most people do not require treatment.

You should seek medical care at a health centre or local emergency clinic if you or your child

  • has earache and pain that has not eased after 24 hours
  • has a discharge of fluid from the ear
  • has an irritated or swollen ear canal for more than 48 hours.

You should seek medical care immediately at an emergency department if you or your child

  • has earache and also a stiff neck and feels very tired and weak
  • has earache, a high temperature and feels seriously ill
  • has redness and swelling behind the ear or if the ear has started to stick out.

Contact a health centre again if you or your child still has earache or a discharge of fluid from the ear two to three days after seeing a doctor about the problem.

Contact a health centre if you or your child has had inflammation of the ear and the ear feels blocked or hearing is impaired or there is a ringing or whistling in the ear that persists for more than three months. Seek medical care sooner if there is a lot of discomfort.

You can always get medical advice by calling 1177.

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What can I do myself?

What can I do myself?

Earache often clears up on its own. There are some things you can try to alleviate the symptoms.

Keep your head raised

Both adults and children feel better if they keep their head raised while they have earache. The swelling in the nose and ears is reduced, easing the pain. It can be a good idea to keep your head raised as you sleep as well. You can do this by using some extra thick pillows. You can also raise your head and neck in bed by putting a pillow under the mattress.

For children aged less than one year, you can try using a baby carrier. You can also have your child sit on your lap or in a baby bouncer. You can also raise your child’s head as they sleep by, for example, putting some thick books under the legs of their cot or bed at the head end.

Nasal spray will not help to reduce ear inflammation, but it will make it easier to breathe

Decongestant nasal drops and nasal spray will ease a blocked nose, making it easier to breathe if you have a cold. However, this does not help to reduce ear inflammation. This is the case for both adults and children. Do not use decongestant nasal spray for more than ten days. If you do, you may develop a blocked nose that is hard to get rid of.

Flush your nose with salt water solution

You can also try rinsing your nasal passages with salt water solution. It is possible to buy prepared saline drops or saline spray at a pharmacy. You can also make your own salt water solution by mixing a pinch of salt into 100 ml of water. The solution should be boiled and left to cool. You can use a special neti pot or a small plastic syringe to rinse your nose with the salt water solution. Both items can be purchased at a pharmacy.

Over-the-counter medicines alleviate pain

Adults can take over-the-counter pain-relieving medicines containing paracetamol or ibuprofen. Paracetamol is used in, for example, Alvedon and Panodil. Ibuprofen is used in, for example, Ipren and Ibumetin.

If your child is less than six months old, you must always consult a doctor or a nurse before giving your child medicine. From the age of six months you can give your child medicine containing ibuprofen. Some examples are Ipren or Ibuprofen Apofri. It is important to follow the instructions on the packaging carefully to ensure that your child gets the correct dose.

Avoid certain medications

Children up to the age of 18 years who have a temperature should not take medicines containing acetylsalicylic acid (aspirin), for example Treo and Bamyl, without you, the adult, first having spoken with a doctor.

Tips on ways to alleviate otitis externa

Otitis externa often clears up on its own in adults and children, but it can itch a lot. To alleviate discomfort, it is a good idea to keep the ear dry by using cotton wool, earplugs or a shower or swimming cap while showering or bathing. This can make the discomfort go away. It is also a good idea to avoid scratching the ear, as this can make the problem worse. As an adult you can also try an ear spray for otitis externa, which you can buy at a pharmacy. The spray can also be used by children over the age of five.

Pressure equalisation can help with ear problems

A person’s hearing may be impaired temporarily following ear inflammation if the pressure in the middle ear has changed. Equalising the pressure again can help. You can do this by holding your nose while trying to blow air out through your nose. The air is instead pushed up through the Eustachian tube. Equalising the pressure is a bit easier if you use nasal drops or nasal spray to reduce swelling of the mucous membranes. You can help young children to equalise the pressure in their ears by getting them to suck on something, such as a dummy, or to drink from a feeding bottle. You can also buy things from a pharmacy that will help.

If you have problems with your ears, it is also a good idea to equalise the pressure in your ears if you fly somewhere.

Ear conditions and bathing

You should avoid bathing if you have ongoing ear problems with pain and fluid being discharged from the ears. If you have had ear inflammation that has caused a burst eardrum, you should avoid getting water in your ears for a week or so after any discharge from the ear has stopped. You can use cotton wool or earplugs when you shower or take a bath.

If you or your child has had an operation to insert a tube (grommet) into the ear, avoid getting water in the ear immediately afterwards. You should be able to bathe properly again after a few weeks, provided you do not put your head more than one metre underwater.

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Treatment

Treatment

Earache often clears up on its own. Earache with a cold or glue ear is not treated with antibiotics.

Certain cases of ear inflammation are treated with antibiotics

All adults and some children require treatment with antibiotics if the ear inflammation is caused by bacteria. Ear inflammation is treated differently at different ages because the risk of complications varies with age. 

People who should always be treated with antibiotics are:

  • Children under a year old.
  • Children under the age of two who have ear inflammation affecting both ears.
  • Children over the age of twelve years and adults.
  • All children and adults who have suffered a burst eardrum.

Ear inflammation usually heals without the need for antibiotics in children between the ages of 1 and 12. However, ear inflammation in children must be treated if:

  • The child has a high temperature.
  • The child has severe earache, despite treatment with over-the-counter pain-relieving medicines.
  • There are indications that the infection may spread or that the child has another serious illness.

Otitis externa is treated with eardrops

The most important thing when treating otitis externa is to clean the ear canal. Sometimes cleaning the ear canal is treatment enough. In some cases, you can get eardrops by prescription. These often contain a combination of antibiotics, cortisone and anti-fungal ingredients. Antibiotics will help if you have a bacterial infection and cortisone helps to reduce the inflammation that causes itching and swelling.

If the ear canal is very swollen, you can insert a small compress soaked in an anti-inflammatory preparation into the ear canal. This is called a tamponade. Once the swelling has subsided, you can start treatment with the eardrops.

In some cases, the inflammation can spread to the outer ear. If this happens, you may need antibiotics in the form of tablets.

Tubes in the ear

Children and adults who have a lot of problems with fluid in the ears or repeated ear inflammation may need to have tubes inserted into their ears. In adults surgery can be performed under local anaesthetic, but children usually always need a general anaesthetic. Children can sometimes develop an enlarged gland behind the nose that can be removed at the same time. This is done if the gland causes the Eustachian tube to become too narrow or causes the child to snore.

During the operation a tiny plastic tube (grommet) is inserted through the eardrum, which allows air to enter the middle ear. This enables the eardrum to move more easily and for less fluid to collect behind the eardrum. As well as improving hearing, it can also reduce the risk of new ear inflammation.

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Examination

Examination

A doctor will use an otoscope, also known as an auriscope, to examine your ears. This looks like a handle with a small funnel and light at the end. Sometimes the doctor will use an ear microscope, which looks like a pair of binoculars.

The doctor examines the appearance of the eardrum, whether there is any fluid behind the eardrum, the appearance of any fluid and how the eardrum moves.  With the aid of a balloon, the doctor blows air on to the eardrum to see if it moves. Sometimes the doctor uses something called a tympanometer instead to check how the eardrum moves and the pressure in the middle ear. To do this, the doctor inserts a small soft plug into the opening of the ear canal before connecting a device to the plug. The device emits a beeping sound. The examination is not painful.

Otitis externa can make it difficult to see the eardrum. It can also make it difficult for the doctor to see whether there are any other problems affecting the ears. If this is the case, the first course of action is to treat the otitis externa. You will then be asked to return a few days later for another examination.

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Is earache contagious?

Is earache contagious?

Ear infections such as ear inflammation and glue ear are not contagious. However, they often develop in connection with a cold. The cold virus spreads very easily. It can be spread by shaking hands or other direct contact. You can try to avoid infecting others by coughing or sneezing into the inside of your elbow and washing your hands frequently. 

Otitis externa is not contagious but the gritty substance that can form inside the ear can support bacteria that are.

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How can I prevent earache?

How can I prevent earache?

It is difficult to avoid children and adults being infected with the cold virus, which is often the cause of earache.

Difficult to avoid ear inflammation

As an adult the risk of developing ear inflammation is fairly low. It can be difficult to avoid ear inflammation completely in children. The following things may help:

  • Continue to breastfeed your child, if you are already breastfeeding. Breastfeeding offers some protection during a child’s first year of life.
  • Avoid smoky environments, which cause a child’s mucous membranes to become more susceptible to infections.

Children and adults who suffer frequent ear inflammation can have a tiny tube inserted into their ears. This can reduce the risk of future bouts of ear inflammation.

How to avoid otitis externa

Do not poke things into your ears. This disrupts the ear canal’s natural cleaning mechanism and increases the risk of bacteria entering the ear. You can also develop otitis externa if you wash or clean your ears frequently.

It is a good idea to use hearing protection or earphones that go over your ears instead of into the ear canal.

If you wear earrings, try ones that have been tested and recommended for allergy-sufferers. Allergies and eczema that affect the outer part of the ear can spread to the ear canal. It is also a good idea to use shampoo and soap that have been allergy-tested.

It is important to let air circulate in the ear canal if you wear a hearing aid

If you do wear a hearing aid, think about taking it out when you are not using it to let air circulate in the ear canal. It is also important to clean the earpiece to stop bacteria entering the ear canal. 

If you frequently suffer from otitis externa, it may be better to use a hearing aid that sits behind the ear instead of one that is inserted fully into the ear.

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Complications

Complications

Earache will often clear up on its own after a few days. Sometimes fluid may remain behind the eardrum for a little while after the ear inflammation has cleared up. This can cause your hearing to deteriorate temporarily. It is a good idea to contact your doctor if the problem persists for several weeks or gets worse. Children less than four years old who have had inflammation in both ears must always have a checkup after three months. The checkup is performed by a doctor at a health centre. If the doctor discovers that your or your child’s hearing has not completely returned or if the eardrum looks unhealthy, a referral to an ear, nose & throat clinic will be arranged.

Mastoiditis and other complications

In rare cases involving ear inflammation, the infection spreads and causes complications. Mastoiditis means that the ear inflammation has spread to the mastoid bone behind the ear. Symptoms include severe pain in and behind the ear, a temperature and the ear sticking out.  In young children this complication can develop so quickly that you do not have time to spot the ear inflammation. This is a serious condition. Seek medical care immediately at an emergency department if you think that you or your child has mastoiditis. People with mastoiditis have to stay in hospital and be given intravenous antibiotics. Most people recover following treatment, but sometimes surgery is required.

Ear inflammation can also cause facial paralysis and meningitis, for example, if it spreads. If this happens, you or your child must be treated quickly.

Repeated otitis externa

It is common to get repeated bouts of otitis externa. Keep your ears dry and use shampoo and soap that has been allergy-tested, because otitis externa is sometimes caused by an allergy. This can reduce the risk of developing the condition. Avoid poking things into your ears. It is better to use headphones than earphones that fit in your ears when listening to music or for hearing protection.

You can also develop an infection in a sebaceous gland

You can also develop an infection in one or more sebaceous glands in the ear canal in the same way as you can get spots on your face. This tends to be quite painful and sometimes causes swelling and discharge from the ear. Often treatment is needed to reduce the swelling and sometimes the abscess needs to be lanced by a doctor. Do not touch the pus, as this can cause the infection to spread.

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Senast uppdaterad:
2016-10-12
Redaktör:

Editors: Jenny Andersson, Maud Cordenius, 1177 Vårdguiden.

Granskare:

Reviewer: Ann Hermansson, associate professor, ear, nose & throat clinic, Skåne University Hospital in Lund.

Illustratör:

Illustrator: Kari C Toverud

Fotograf:

Photographer: Jenny Hallström 1177 Vårdguiden