Definition and Overview

Also referred to as otalgia, ear pain is a condition that results in painful or dull ache in the ears. It can be referred, which means the cause is outside of the ears. In this case, the pain is more of a symptom of an underlying disease or infection. It can also be primary, where the pain originates from the inside the ears. Suffering from an earache doesn’t have to result in hearing loss.

The ears are organs responsible for hearing and balance. They are divided into three sections: outer, middle, and inner ear. The outer ear, which includes the pinna (the visible skin cartilage), receives the sound, which then travels through a small tube and into the tympanic membrane or the eardrum, which signals the beginning of the middle ear.

Along with the eardrum are the ossicles (malleus, incus, and stapes, the smallest bone in the body), which also vibrate. These vibrations become louder and proceed to the cochlea, where they are received in fluid form. The cochlea then converts the sound from fluid form into electrical signals that can be understood by the brain. Also parts of the inner ear are semicircular ducts, which are needed to maintain balance. They are filled with fluid. The tube found in the middle ear, called the Eustachian tube, also has to maintain enough fluid by draining it, passing through the back of the nose and then into the throat.

An ear pain can occur or affect any part of the ears.

Causes of Condition

Ear pain can be caused by many factors. Some of the most common ones are:

  • Foreign body – Very small objects and insects can find their way into the canals and may even reach the middle ear.

  • Trauma – Injuries to the ears can include accidents and activities that lead to a tear in the eardrum or irritation of the canals (e.g., applying too much force when using cotton buds or rubbing the ears vigorously).

  • Inflammation – A lot of ear pain cases is caused by inflammation usually due to an infection. Two of the most well-known are otitis media and otitis externa or the swimmer’s ears. Otitis media is currently the most common source of distress for children and infants. It is characterized by the inflammation of the middle ear due to the presence of virus or bacteria. It occurs usually right after the eardrum, which is a space that should be properly ventilated. If the Eustachian tube, where the air coming from behind the nose passes through, is blocked, the area becomes moist or damp, so germs tend to thrive well. In otitis externa, the skin outside of the auditory canal becomes infected with bacteria including Staphylococcus. It usually happens when a person spends too much time in the water.

  • Environment – A very loud sound or sudden change in pressure, such as when one dives underwater, can cause a ruptured eardrum.

  • Balance disorders – Ear pain can be a sign of a balance problem. A classic example is BBPV (benign paroxysmal positional vertigo), where the patient experiences sudden dizziness or loss of balance when in certain positions. Meniere’s disease, meanwhile, can cause hearing loss and shows symptoms of vertigo. Both can affect the inner ear.

  • Problems of the face – Some conditions affecting other parts of the face such as the nose, throat, and jaw can also cause pain in the ears. These include infection of the sinuses, sore throat, TMJ (temporomandibular joint syndrome), facial nerve pain, or a toothache.

  • Cancer – Certain types of cancer such as skin and nasopharyngeal, may lead to recurrent ear infections.

Key Symptoms

  • Low to high fever
  • Restlessness
  • The feeling of fullness in the ear
  • Dull to excruciating pain inside and/or outside the ears
  • Loss of appetite (common among children)
  • Tendency to rub or pull the ears
  • Tendency to lose hearing or difficulty in hearing
  • Balance issues
  • Presence of other conditions such as colds or flu
  • Inflammation
  • Soreness of the ears
  • Itchiness
  • Ear drainage

Who to See and Treatments Available

The doctor who specializes in ear problems is called an otolaryngologist or ENT (ears, nose, throat) doctor. However, in many cases, patients approach their general doctors first. GPs can work on ear problems that are symptoms of another medical condition such as flu or common colds. Once the main cause has been treated, ear pain also goes away. If it continues to persist or only worsens, patients are then referred to an ENT.

An ENT performs several types of tests to diagnose and understand the cause of the ear pain. The patient’s habits, activities such as swimming, and medical history will be discussed before a physical exam is conducted. In this exam, instruments will be used to look into the deeper parts of the ears, such as the canals. Other tests such as acoustic reflectometry (which measures the echo coming from the eardrum) and tympanometry (which assesses the vibrations of the eardrum) can also be conducted, especially if the pain is accompanied by hearing loss or difficulty in hearing.

Depending on the findings, the treatment options can include:

  • Over-the-counter medicines if the ear pain is caused by the build-up of hardened earwax
  • Antibiotics to treat infection
  • Heat application
  • Pain relievers
  • Good rest and sleep

In cases of recurrent or persistent otitis media, myringotomy, which is a surgical procedure that involves draining the fluid build-up in the middle ear, can be performed. This involves making a small incision in the eardrum and placing a tube to improve the ventilation of the space. It may take up to a year before the inserted tube is removed. Regardless, it’s essential that at some point the tube comes off so the eardrum can close up again.

Ear pain should not be taken lightly as it may lead to more serious problems including facial paralysis.

References:

  • Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010:chap 156.

  • O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 19.

  • Lieberthal AS, Carroll AE, Chonmaitree T. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3): e964-e999.

  • Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010 Nov 17;304(19):2161-9.

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