Earache
Earache is one of the commonest reasons parents lose a night's sleep. It is unfair but explicable: in a small child the tube linking ear and nose is short…
On this page
- How to tell that a baby's ear is the problem
- What is actually hurting inside
- Signs that cannot wait until morning
- When the ear is healthy and still hurts
- What to do at home in the first few days
- What must not be done to an ear
- Are antibiotics needed?
- When to see a doctor even though it is not urgent
- Online consultation
Medicines commonly prescribed for Earache
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 1 g paracetamolActive substance: paracetamolManufacturer: Laboratorios Combix S.L.U.Prescription not requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Combix S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mgActive substance: ibuprofenManufacturer: Nutra Essential Otc S.L.Prescription not required
Earache is one of the commonest reasons parents lose a night's sleep. It is unfair but explicable: in a small child the tube linking ear and nose is short and almost horizontal, so any cold reaches the middle ear easily, and lying down raises the pressure inside it, which is why the pain builds up at night. In an adult the story runs differently: the ear hurts less often, and far more frequently the ear itself turns out to be perfectly healthy while something else is doing the hurting. The two scenarios are dealt with separately below.
How to tell that a baby's ear is the problem
A child who cannot yet talk will not complain of an ear. It is worth suspecting when several signs come together:
- pulling, rubbing or pressing the ear, and rolling the head on the pillow;
- crying the moment they are laid down and settling when held upright;
- sleeping badly at night specifically, while by day they seem almost themselves;
- refusing the breast, the bottle or food: sucking and swallowing make the pain worse;
- irritable, listless, not responding to quiet sounds;
- a temperature, often on the second or third day of a runny nose;
- something coming out of the ear — clear fluid, cloudy fluid or fluid streaked with blood.
That last one, oddly enough, often comes with relief: the pain stops abruptly. It usually means the eardrum has burst and the pus has escaped; the pressure has dropped, so it no longer hurts. That is not a catastrophe in itself and the drum generally heals within a fortnight, but the child must be seen by a doctor, and from that moment on nothing is dripped or poured into the ear.
It is also worth knowing that pulling gently on the outer ear is a simple test to do at home. If that sends the pain sharply up, it points to inflammation of the outer canal; in middle-ear infection the same manoeuvre is usually painless.
What is actually hurting inside
- Middle-ear infection. The classic picture after a cold: the tube swells, the cavity behind the drum stops being ventilated, fluid collects and the pressure rises. The pain is deep and bursting, worse lying down, often with a temperature and muffled hearing. It usually lasts two or three days and goes.
- Outer-ear infection. Inflammation of the skin of the canal, known as swimmer's ear. It follows the pool, the sea, diving, poking about in the ear or wearing in-ear headphones. The pain is superficial, the ear hurts on being touched and on chewing, there may be a scanty discharge and the canal opening looks narrowed. Swimming and getting the ear wet are out.
- Pressure changes. Aircraft, a fast lift, diving: the tube fails to equalise pressure in time and the drum is drawn inwards. The pain is sharp but brief; swallowing, yawning and sucking help, and in babies the breast or bottle during take-off and landing.
- Fluid behind the drum without infection. After an ear infection a thick fluid can sit in the middle ear for weeks. It barely hurts, but hearing is muffled: the child asks you to repeat things, turns the volume up and seems inattentive. This is glue ear, and it needs following up, because speech suffers from it.
- Wax and foreign bodies. A hard plug of wax gives blockage and a dull ache; small objects and insects give a sharp one. Neither is removed at home.
Signs that cannot wait until morning
Straight away, by calling an ambulance or going to hospital:
- the child is listless and drowsy, hard to rouse, does not recognise you, or conversely screams non-stop on one note;
- the temperature comes with a rash that does not fade when pressed with the side of a glass;
- the neck will not bend, light hurts the eyes, there is repeated vomiting or a fit;
- the face has dropped on one side, an eye will not close, the corner of the mouth has fallen;
- severe dizziness with vomiting, the child veers to one side, the eyes flick;
- a blow to the head or the ear, followed by pain, blood from the ear or loss of hearing.
The same day, not left until tomorrow:
- redness and swelling behind the ear, with the ear pushed forward and sticking out. This is the main sign of mastoiditis, infection of the bone behind the ear and a complication of middle-ear infection. The skin behind the ear is tender, smooth and shiny, and the child has a high temperature. It is treated in hospital;
- a baby under six months with earache or with a temperature and no obvious cause;
- a high temperature that persists, a child refusing to drink and wetting fewer nappies;
- severe pain that painkillers do not touch;
- pus or blood coming from the ear;
- earache in someone with diabetes, on treatment that suppresses immunity or after chemotherapy: in such people an outer-ear infection can burrow deeper and reach bone;
- hearing lost suddenly in one ear, even without pain: sudden deafness responds better the sooner treatment starts.
When the ear is healthy and still hurts
In adults this accounts for half of all cases. The ear shares its nerve supply with the teeth, the throat, the jaw joint and the neck, so pain arising in those places is genuinely felt in the ear; it is called referred pain. Suspecting it is easy: the ear hurts, but there is no cold, hearing is unchanged, nothing is discharging, and examining the ear finds nothing. The search then moves elsewhere:
- the teeth, most often the lower molars and the wisdom tooth, with decay or an abscess at the root. The pain throbs and worsens with heat and at night;
- the jaw joint: it clicks on opening the mouth, is tender to press just in front of the ear, worsens through the day and after chewing, and is common in people who clench their teeth in their sleep;
- the throat: tonsillitis, and — with severe one-sided pain, a mouth that barely opens, a muffled voice and drooling — a quinsy, which needs seeing urgently;
- the neck: the cervical spine and the neck muscles;
- neuralgia and shingles: burning pain, with blisters appearing in and around the ear a day or two later.
There is one combination that deserves saying plainly. Pain in one ear in an adult lasting more than a few weeks, with a settled nose and a normal ear on examination — and all the more so if hearing on that same side has dropped or the ear feels blocked — is a reason to look at the back of the nose and the larynx. Particularly in smokers and heavy drinkers over forty: in them a blocked feeling in one ear can be the first sign of a tumour at the back of the nose obstructing the opening of the tube. The examination takes minutes and should not be put off.
What to do at home in the first few days
- Pain relief. Children are given two classes of medicine, paracetamol and ibuprofen, each by age and weight and strictly according to the leaflet for the particular preparation. Children and teenagers are not given aspirin. Pain relief in earache is not a «just in case» measure but the main treatment of the first days: it lets the child sleep and eat while the inflammation settles on its own.
- Dry warmth against the ear — a warmed cloth or a hot water bottle through fabric, for a short while. Some children prefer something cool instead. Be guided by the child.
- A raised head end of the bed and an upright position by day: lying flat makes it worse.
- Drinks in small amounts. Swallowing helps ventilate the middle ear, and dehydration makes everything worse.
- Saline nasal rinses if there is a runny nose: a clear nose means a clear tube.
- Keeping the ear dry: in the bath, plug it with cotton wool smeared in petroleum jelly, and keep away from swimming pools and diving.
What must not be done to an ear
- Put nothing in if anything is discharging, if there has been an injury, or if you do not know whether the eardrum is intact. With a perforation, drops go straight into the middle ear, and some preparations in that contact can damage hearing irreversibly. Ear drops are prescribed by a doctor after looking at the drum, and this rule has no exceptions.
- Warm oil, onion juice, garlic, spirit solutions and boric alcohol. Home remedies burn the skin of the canal and, with a burst drum, get inside.
- Cotton buds. They do not clean the ear: they push the wax deeper and pack it into a plug, they scratch the skin of the canal — which is how outer-ear infection starts — and one clumsy movement or a nudge from someone passing is enough to pierce the drum. Nothing smaller than your own elbow goes into the canal, hairpins, matches and keys included.
- Ear candles. No benefit has been shown, while burns and wax dropped into the ear are on record.
- Trying to syringe or pop the ear yourself, or to pull out a plug of wax or a stuck object.
- In-ear headphones and a hearing aid in the affected ear while the inflammation lasts.
- Smoking near the child: second-hand smoke is a proven cause of repeated ear infections and of fluid in the middle ear.
Are antibiotics needed?
Most of the time, no. The majority of middle-ear infections are caused by viruses or settle on their own within two or three days, and an antibiotic does not speed recovery while it does produce side effects. So the usual approach in an uncomplicated ear infection in a child over two is pain relief and watching, with the decision on an antibiotic taken if there is no improvement in two or three days or if things get worse.
An antibiotic is started earlier and without waiting when the child is very young, when both ears are affected, when the ear is discharging, when the child is seriously unwell or has other conditions. That decision belongs to a doctor who has looked at the eardrum: from the outside there is no telling one situation from another. A course once started is finished, even if the pain went on the second day. Antibiotics left over from a previous occasion are not used.
When to see a doctor even though it is not urgent
- the pain lasts more than two or three days, or climbs again after starting to ease;
- hearing has not come back weeks after the infection: the child asks you to repeat things, turns the volume up, seems distracted at school or is behind with speech;
- ear infections keep recurring several times in a season;
- the ear keeps discharging, particularly if it has gone on for months and the discharge smells unpleasant: long-standing discharge from one ear is investigated in its own right, because destruction of bone can lie behind it;
- an adult has earache with no cold and no change in hearing — the cause is to be looked for outside the ear;
- a constant buzzing or ringing has appeared in the ear, or dizziness;
- you are not confident you are managing at home.
Online consultation
More can be settled remotely than people expect, above all at night, when the choice lies between setting off now and holding out until morning. From your account the doctor will work out whether this looks like an ordinary middle-ear infection, an outer-ear one, or something needing to be seen at once, and will check separately for the signs of mastoiditis and meningitis. They will tell you which painkiller and which preparation suits the child by age and weight, and how to space the doses overnight. They will explain why nothing goes into the ear at this point. For an adult they will work through the referred-pain possibilities — teeth, jaw joint, throat — and say which specialist to see and whether the back of the nose needs looking at. And they will name the signs that mean breaking off the consultation and heading for hospital.
This material is for information only and does not replace medical advice.
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