Earache: Causes, Home Relief and When to See a Doctor

What causes earache

Earache is split into two groups. Primary otalgia comes from the ear itself. Referred otalgia is pain felt in the ear but coming from nearby structures that share the same nerves: the jaw, teeth, throat, neck or tonsils. In adults with ear pain and a normal ear exam, referred pain is common.

Causes inside the ear

Middle ear infection (otitis media)

Otitis media is an infection behind the eardrum, usually following a cold. It is most common between 6 months and 2 years. Clues:

• earache, often worse lying down and at night
• fever, irritability, poor sleep and pulling at the ear in young children
• muffled hearing
• sometimes a sudden discharge as the eardrum bursts, which relieves the pain

Swimmer's ear (otitis externa)

Otitis externa is an infection of the ear canal, often after swimming or cleaning with cotton swabs. The ear hurts when you pull the earlobe or press the flap in front of the canal, and the canal may itch, swell and discharge.

Other ear causes

• Earwax impaction: fullness, muffled hearing and mild discomfort.
• Barotrauma: pressure changes during flying or diving.
• Eustachian tube dysfunction: blocked feeling and popping with colds or allergies.
• Ruptured eardrum: sharp pain after an infection, injury or loud blast, often followed by discharge.
• Shingles of the ear (Ramsay Hunt syndrome): severe pain and blisters in the ear with facial weakness.
• Foreign objects and insects in the ear canal.

Referred causes (normal ear)

• TMJ disorder: jaw joint pain in front of the ear, worse when chewing, with clicking and morning stiffness from teeth grinding.
• Dental problems: a tooth abscess or impacted wisdom tooth.
• Throat infections: tonsillitis, a peritonsillar abscess and pharyngitis cause ear pain when swallowing.
• Neck problems: arthritis of the upper neck.
• Sinusitis.
• Cancer of the throat or tongue: rare, but ongoing one-sided ear pain with hoarseness, trouble swallowing or a neck lump in a smoker or heavy drinker needs checking.

Earache in children vs adults

How doctors diagnose earache

A doctor looks into the ear with an otoscope to check the canal and eardrum. A bulging, red eardrum suggests otitis media; a swollen, red canal suggests otitis externa. If the ear looks normal, the doctor examines the jaw, teeth, throat and neck. A hearing test, tympanometry or, rarely, imaging may follow.

Treatment and relief

• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose for age and weight. Do not give aspirin to children or teenagers.
• Warm or cool compress over the ear for 20 minutes.
• Sleep with the sore ear up and the head slightly raised.
• Antibiotics for middle ear infections: many children improve without them. Doctors often recommend waiting 48 to 72 hours, but prescribe them sooner for babies under 6 months, children under 2 with infection in both ears, severe symptoms or discharge.
• Ear drops for swimmer's ear: antibiotic drops, sometimes with a steroid, for 7 days. Keep the ear dry.
• Earwax: softening drops, or removal by a clinician.
• Referred pain: dental treatment, a night guard for teeth grinding, or treatment of throat infection.

Preventing earaches

• Keep ears dry after swimming, and use earplugs if you get swimmer's ear often.
• Avoid cotton swabs in the ear canal.
• Avoid exposure to cigarette smoke, which raises children's risk of ear infections.
• Keep children's vaccines up to date, including pneumococcal and flu vaccines.
• When flying, swallow, yawn or chew gum during descent.

Frequently asked questions

What causes earache without infection?

Earache with no infection is often referred pain from the jaw joint (TMJ), teeth, throat or neck. Other causes include earwax, pressure changes from flying, and Eustachian tube problems. Ongoing one-sided ear pain with a normal ear exam in an adult should be checked by a doctor.

How long does an earache last?

Earaches from middle ear infections usually improve within 2 to 3 days and settle within a week. Swimmer's ear improves within a few days of using drops. See a doctor if pain is not better after 3 days or is getting worse.

Why does my ear hurt when I swallow?

Ear pain when swallowing is often from a throat infection such as tonsillitis or pharyngitis, because the same nerves supply the throat and ear. It can also come from a blocked Eustachian tube during a cold. Severe pain with trouble opening the mouth needs prompt care.

How do I relieve an earache at home?

Take acetaminophen or ibuprofen following the label dose, apply a warm or cool compress, and rest with the painful ear facing up. Do not put objects or oils into the ear. See a doctor if there is fever, discharge or the pain lasts more than a few days.

Do ear infections always need antibiotics?

No. Many middle ear infections clear without antibiotics within a few days. Doctors often recommend pain relief and watchful waiting for 48 to 72 hours. Antibiotics are used for babies, severe infections, infections in both ears in young children, or when symptoms do not improve.