When to seek care for ear pain

Overview

Ear pain (also called earache) is a common problem. It can feel sharp, dull, or burning, and may come from inside the ear or from nearby areas like the jaw or teeth.

Yes, ear pain is very common, especially in children. Most people will have an earache at some point in their life.

Ear pain can affect people of all ages. It is most common in young children because their eustachian tubes (the small tubes that connect the ear to the throat) are shorter and more easily blocked.

Symptoms

Common symptoms

• Pain in one or both ears, which may be worse when lying down.
• A feeling of pressure or fullness in the ear.
• Muffled hearing or temporary hearing loss.
• Fever (especially in children).
• Irritability or trouble sleeping.

Symptoms in children

• Tugging or pulling at the ear.
• Fussiness, crying, or difficulty feeding.
• Fever (often higher than in adults).
• Trouble hearing or responding to sounds.
• Fluid draining from the ear (sometimes with blood).

Symptoms in older adults

• Ear pain may be less intense, but dizziness or balance problems can occur.
• Hearing loss may be more noticeable.
• Ear pain can sometimes be a sign of shingles or referred pain from the jaw or teeth.

Causes

Main causes

• Middle ear infection (otitis media) – often starts after a cold or flu, when fluid builds up behind the eardrum and becomes infected.
• Outer ear infection (otitis externa or swimmer's ear) – caused by water trapped in the ear canal, leading to bacterial or fungal growth.
• Eustachian tube dysfunction – when the tubes that drain fluid from the ear become blocked, causing pressure and pain.
• Earwax buildup – hardened wax can press against the eardrum and cause discomfort.
• Injury – like a scratch inside the ear canal, or a sudden change in pressure (airplane ear).

Risk factors

• Young age (especially between 6 months and 2 years).
• Attending daycare or having siblings in school (more exposure to infections).
• Frequent colds or allergies that block the eustachian tubes.
• Swimming or spending time in water (increases risk of outer ear infection).
• Exposure to cigarette smoke (can irritate the eustachian tubes).

When to see a doctor

See a doctor urgently if:

• If you or your child has severe ear pain with a high fever, sudden hearing loss, or discharge from the ear.
• If the ear pain follows an injury or an object stuck in the ear.
• If there is swelling, redness, or tenderness behind the ear.

Book a routine appointment if:

• If you have mild ear pain that lasts more than a few days.
• If you have hearing loss that does not improve after the pain goes away.
• If ear infections keep coming back (more than 3 in 6 months).

Diagnosis

A doctor or nurse will look inside your ear with a handheld tool called an otoscope. This shows the eardrum and ear canal to check for signs of infection or fluid.

Tests that may be done

• Otoscope exam – to see if the eardrum is red, bulging, or has fluid behind it.
• Pneumatic otoscope – a puffer of air to see how the eardrum moves (reduced movement suggests fluid).
• Tympanometry – a small probe placed in the ear to measure how well the eardrum responds to sound and pressure.

What to expect at your appointment

The examination is quick and usually painless. The doctor will ask about your symptoms, when they started, and any recent colds or swimming. For children, the doctor may also check the throat and listen to the lungs.

Treatment

Treatment for ear pain depends on the cause. Many middle ear infections get better on their own within a few days. The main goal is to relieve pain and treat any infection if needed.

Self-care at home

• Apply a warm (not hot) cloth or heating pad to the outside of the ear.
• Rest and sleep with the painful ear elevated on a pillow if possible.
• Over-the-counter pain relievers like paracetamol or ibuprofen can help reduce pain and fever. Always follow the label and ask your pharmacist if you are unsure.
• Avoid getting water in the ear if you have an outer ear infection – use a shower cap or cotton ball with petroleum jelly.

Medical treatments

Your doctor may suggest eardrops for an outer ear infection or prescribe antibiotics for a bacterial middle ear infection. If the pain is severe, stronger pain relief may be offered. Always take medicines exactly as directed by your healthcare provider.

When is surgery considered?

Surgery is rarely needed. In children who have many ear infections (more than 3 in 6 months), a doctor may recommend small tubes (grommets) placed in the eardrum to help drain fluid. For adults, surgery is uncommon.

Living with this condition

While recovering from ear pain, avoid exposing your ears to cold wind or water. If you have hearing loss, speak slowly and face people when talking. Most ear pain improves within a week.

Lifestyle tips

• Keep ears dry after swimming or bathing – tip your head to let water out, and use a towel gently.
• Do not insert cotton swabs or any object into the ear – this can damage the ear canal or push wax deeper.
• If you have allergies, manage them to reduce fluid buildup in the ears.

Diet and exercise

No special diet is needed. Staying hydrated and eating well can help your immune system fight infection. Gentle exercise is fine if you feel up to it.

Mental health and emotional wellbeing

Chronic or recurring ear pain can be frustrating and affect sleep, causing tiredness or irritability. Talk to your doctor if pain or hearing loss is affecting your mood or daily life.

Prevention

Not all ear pain can be prevented, but you can lower the risk. Keep your child's vaccinations up to date (especially the pneumococcal and influenza vaccines). Avoid exposure to tobacco smoke. Treat colds and allergies promptly. After swimming, dry ears gently.

Vaccines

The pneumococcal conjugate vaccine (PCV) and the annual flu vaccine can help prevent some ear infections by reducing common infections that lead to ear problems.

Screening programmes

There is no routine screening for ear pain. If you have frequent ear infections or hearing loss, your doctor may recommend regular hearing checks.

Complications

If left untreated

• A hole in the eardrum (perforation) that usually heals on its own, but sometimes requires treatment.
• Temporary or permanent hearing loss, especially if infections are severe or repeated.
• Spread of infection to the bone behind the ear (mastoiditis) – a serious condition that needs antibiotics.
• Very rarely, infection can spread to the lining of the brain (meningitis).

Long-term outlook

The outlook for ear pain is very good. Most ear infections clear up without lasting problems. With proper care and treatment when needed, hearing usually returns to normal. For people with recurring infections, there are effective treatments to prevent future problems.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.