Earache (otalgia) is the term used to describe feelings of discomfort, including pain, pressure or blockage, in one or both ears.

(Note: this article is intended to provide an overview of adult earaches.)

When an earache presents, the pain may be coming from the ear itself - for example, from local inflammation - the pressure between the middle ear and outside air, or a combination of these (Kaylie 2022).

Alternatively, earache can be the result of referred pain, which is an issue in a nearby area that shares the same nerves with the brain as the ear (Kaylie 2019).

The most common reason for ear-related earache pain is a blockage of the passageway between the middle ear and the back of the throat. This passage is known as the Eustachian tube (Harvard Health Publishing 2019).

Most earaches resolve within a few days. Even in the case of prolonged ear infections, the prognosis is usually favourable (Havard Health Publishing 2019).

Causes of Earache

Earaches may be caused by an infection or any of the following:

• Injury
• Inflammation or infection within the ear canal - often referred to as ‘swimmer’s ear’
• Infection in the external ear and ear lobe - ‘cellulitis’
• Allergies or irritation
• Pain caused by nerve irritation in the ear - ‘neuralgia’
• An abrupt change in air pressure
• An object stuck in the ear
• Ear wax build-up
• Loud noises
• Referred pain, such as from a throat infection
• Issues with the jaw
• Dental problems, such as an abscess.

(Healthdirect 2022; Harvard Health Publishing 2019)

Earache Symptoms

Earache is most commonly associated with a feeling of obstruction or blockage in the ear. It may begin gradually or suddenly, and the pain may feel very intense (Harvard Health Publishing 2019).

Often, an earache will clear up after a few days without intervention. If it doesn’t, however, it’s wise to see a general practitioner (GP).

A patient should be advised to seek help if they:

• Notice that the pain is getting worse
• Are feeling generally unwell
• Are experiencing hearing loss or muffled hearing
• Are experiencing fever
• Are experiencing discharge
• Are concerned.

(Healthdirect 2022; Harvard Health Publishing 2019; Southern Cross Medical Library 2019)

Clear or bloody fluid accompanied by severe ear pain may signal a ruptured eardrum. A ruptured eardrum is a hole or perforation in the membrane that separates the inner or outer ear (Masters & Laube 2021).

If the eardrum ruptures because of a middle ear infection, the pain often decreases because the pressure is reduced (Harvard Health Publishing 2019).

A ruptured eardrum can be caused by injury to the neck and head area, changes in air or water pressure (for example, from diving), inner ear infections, and, less commonly, as a result of very loud noises (Masters & Laube 2021).

If pain is chronic and is accompanied by a ringing or buzzing sound, it may be tinnitus.

Earache Diagnosis

If the earache is severe and/or if other symptoms are present, it’s recommended that the person seeks out advice from a health professional.

Usually, a general practitioner (GP) will examine the ears, nose and throat of a person with an earache. This will be carried out with an otoscope to look inside the ears and investigate redness and fluid buildup. The GP may also test for any hearing loss (Harvard Health Publishing 2019).

Earache Treatment

If pain is the result of a blocked Eustachian tube, a decongestant or antihistamine may help to relieve this (Harvard Health Publishing 2019).

Until the underlying problem is treated or clears up, pain-relief medicines will usually be enough to control the pain of earache (Harvard Health Publishing 2019).

Non-medicinal methods of easing the pain include holding a warm cloth or heat pack to the ear or covering the ears in cold weather or rainy conditions (Healthdirect 2022).

If symptoms last for more than two to three days, antibiotics may be recommended in some cases (Harvard Health Publishing 2019).

If a patient is concerned or believes medication is required for the earache, they should seek information from a doctor and/or pharmacist.

Earache Prevention

The following is advised for preventing earaches:

• Avoid allergy triggers as they may irritate sinuses
• For people prone to ear pain, loud music, concerts, and environmental noise (such as construction sites) should be avoided. If these scenarios cannot be avoided, earplugs or noise-cancelling headphones should be worn
• Earplugs and a swimming cap should be worn while swimming, and ears should be properly dried after any immersion in water
• Keep all foreign objects out of the ear.

(Masters & Laube 2021)