Ear pain in older adults

Overview

Ear pain in older adults is discomfort or soreness in one or both ears. It can be caused by many things, such as infection, a buildup of earwax, or problems in nearby areas like the jaw or teeth. The pain may be sharp, dull, or a feeling of pressure.

Yes, ear pain is a common complaint among older adults. Age-related changes in the ear, immune system, and chronic health conditions can make older people more prone to ear problems.

This condition primarily affects adults aged 65 and older, especially those with hearing aids, diabetes, or a history of ear infections.

Symptoms

Common symptoms

• Pain or discomfort in one or both ears
• Feeling of fullness or pressure in the ear
• Trouble hearing or muffled hearing
• Itching inside the ear
• Drainage of fluid or pus from the ear

Symptoms in children

• Tugging or pulling at the ear
• Fussiness or crying more than usual
• Fever
• Trouble sleeping
• Loss of balance

Symptoms in older adults

• Mild or dull ear pain that may be hard to describe
• Hearing loss or a feeling that sounds are muffled
• Balance problems or dizziness
• Confusion or changes in behaviour (especially in people with dementia)
• A sensation of something moving or blocked in the ear

Causes

Main causes

• Earwax buildup (cerumen impaction) blocking the ear canal
• Middle ear infection (otitis media), often after a cold
• Outer ear infection (otitis externa or swimmer's ear), from water or irritation in the ear canal
• Referred pain from the jaw joint (temporomandibular joint disorder), teeth, or throat
• Shingles in the ear (herpes zoster oticus), a reactivation of the chickenpox virus

Risk factors

• Age-related changes in the immune system making infections more likely
• Use of hearing aids or earplugs that can trap moisture and bacteria
• Chronic health conditions like diabetes or heart disease
• Smoking or exposure to secondhand smoke
• Previous ear surgery or ear infections

When to see a doctor

See a doctor urgently if:

• Severe ear pain that comes on suddenly
• Sudden hearing loss
• Drainage of blood or pus from the ear
• Dizziness, vertigo, or loss of balance
• Fever with ear pain
• Swelling behind the ear or redness spreading from the ear

Book a routine appointment if:

• Mild ear pain that lasts more than a day or two
• A feeling of fullness or pressure in the ear that does not improve
• Muffled hearing that comes and goes
• Itching in the ear that does not go away
• Concerns about earwax buildup

Diagnosis

Your doctor will ask about your symptoms, medical history, and any recent illnesses. They will examine your ear using an otoscope, a small tool with a light, to see the ear canal and eardrum. They may also check your hearing and look for signs of infection or blockage.

Tests that may be done

• Otoscopy: visual exam of the ear canal and eardrum
• Hearing test (audiometry) if hearing loss is present
• Tympanometry: a test of how well the eardrum moves, useful for detecting middle ear problems
• Imaging tests (CT or MRI) rarely, if a more serious cause is suspected

What to expect at your appointment

The diagnosis is usually quick and painless. Your doctor may gently clean out excess earwax to see the eardrum better. If an infection is found, they may prescribe treatment. In most cases, you will have a clear answer and a plan to relieve your pain.

Treatment

Treatment for ear pain depends on the cause. The goal is to relieve pain, treat any infection, and address underlying issues like earwax or referred pain. Your doctor will recommend options based on your specific situation.

Self-care at home

• Apply a warm cloth or heating pad on low heat to the affected ear for 10-15 minutes at a time
• Sleep with your head elevated on two pillows to reduce ear pressure
• Avoid putting anything in your ear, including cotton swabs or fingers
• Chew gum or yawn if the pain is related to pressure changes (like during flying)
• Use over-the-counter pain relievers like paracetamol or ibuprofen (check with your doctor first if you have other health conditions)

Medical treatments

If an infection is present, your doctor may prescribe antibiotics (by mouth or as ear drops) or antifungal ear drops for fungal infections. Pain may be managed with prescription-strength pain relievers. Earwax removal may be done in the clinic using irrigation or special tools. For referred pain, treating the underlying cause (such as a dental problem or TMJ disorder) often resolves the ear pain.

When is surgery considered?

Surgery is rarely needed for ear pain in older adults. It may be considered for chronic middle ear infections that do not respond to standard treatments, or for severe earwax impaction that cannot be removed safely in the office. Your doctor will discuss the risks and benefits if surgery is an option.

Living with this condition

Managing ear pain day-to-day involves following your doctor's treatment plan, taking any medications as directed, and using home remedies to ease discomfort. Keep your ears dry during showers or swimming by using a shower cap or earplugs designed for water protection.

Lifestyle tips

• Avoid smoking and exposure to smoke, as it can worsen ear problems
• If you use hearing aids, clean them regularly and remove them at night to let your ears air out
• Protect your ears from cold wind or drafts by wearing a hat or ear muffs
• Manage chronic conditions like diabetes or high blood pressure, which can affect ear health

Diet and exercise

A balanced diet rich in fruits, vegetables, and whole grains supports your immune system. Regular exercise, as advised by your doctor, can improve blood flow and overall health, which may help prevent infections. Avoid excessive alcohol, as it can affect balance and ear health.

Mental health and emotional wellbeing

Ear pain can be frustrating and may affect your mood, sleep, and daily activities. Chronic pain or hearing loss can lead to feelings of isolation or depression. It is important to talk to your doctor if you feel down or anxious. Support from family and friends also helps.

Prevention

Not all ear pain can be prevented, but you can lower your risk by keeping your ears dry, cleaning them gently (never with objects), and managing chronic health conditions. Avoid inserting anything into your ear canal.

Vaccines

Getting vaccinated against the flu and pneumococcal disease can help reduce your risk of ear infections. Ask your doctor if these vaccines are recommended for you.

Screening programmes

Regular hearing check-ups can help detect early problems. If you have diabetes or other conditions that affect the ears, your doctor may recommend more frequent ear exams.

Complications

If left untreated

• Hearing loss, which may be temporary or permanent
• Spread of infection to nearby structures, such as the mastoid bone (mastoiditis)
• Chronic ear infections that are harder to treat
• Balance problems leading to falls
• Rarely, infection can spread to the skull or brain

Long-term outlook

With proper care, most cases of ear pain in older adults improve within a few days to a couple of weeks. Even when hearing loss occurs, it can often be managed with hearing aids or other devices. Following your doctor's advice and taking care of your ears gives you the best chance for a full recovery and good quality of life.

Find support

Local organisations

• Your local NHS hearing services · UK

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