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Earache is best organised by where it comes from. This overview helps you place your symptoms roughly, but it does not replace a medical examination.
| Area | Typical causes | Typical clue |
|---|---|---|
| Middle ear | Middle ear infection, blocked ventilation during a cold, pressure damage from flying or diving | Dull pressure, often with fever, common in children |
| Ear canal | Ear canal infection (swimmer's ear), wax plug, foreign body | Pain when pulling on the ear, itching |
| Referred | Throat and tonsil infection, dental and jaw problems, jaw joint, cervical spine | Ear itself normal, pain when swallowing or chewing |
| Rarer | Shingles of the ear (zoster oticus) | Blisters on the ear or face, sometimes with paralysis |
Most earaches come down to a few well-known causes. Here are the most important ones with their typical features.
In a middle ear infection, the air-filled space behind the eardrum becomes inflamed, usually during a cold. Typical are sudden, throbbing pains, often with fever and a dull pressure, especially in children. If fluid leaks from the ear, the eardrum has usually torn under the pressure, which relieves the pain suddenly. Many cases improve under pain treatment on their own, and an antibiotic is not always needed. When it is useful, you can read in the article on middle ear infection.
Very often there is no full-blown inflammation behind earache, only a blocked Eustachian tube. During a cold the mucous membranes swell, pressure equalisation between the throat and the middle ear no longer works properly, and a dull pressure or a clicking in the ear develops. Hearing feels muffled, as if there were cotton wool in the ear. Such symptoms usually settle on their own once the cold clears. Decongestant nose drops and deliberate pressure equalisation by swallowing, yawning or chewing gum can clear the Eustachian tube faster and relieve the pressure.
The ear canal infection (otitis externa) affects the skin of the outer ear canal. It often arises from moisture, hence the name swimmer's ear, or from irritation, for example after cleaning with cotton swabs. Typical is a pain that gets worse when pulling on the ear or pressing on the small cartilage in front of the canal, plus itching and sometimes a thin discharge. Important: keep the ear dry, and treatment is usually with prescription ear drops, not home remedies.
Ear wax protects the ear canal and is completely normal. Sometimes, however, it builds up into a plug that presses, muffles hearing and can be unpleasant, especially after showering or swimming, when the wax swells. You should never dig with cotton swabs, as this only pushes the plug deeper and can injure the canal. Softening drops from the pharmacy or a professional irrigation at the practice solve the problem safely and painlessly.
Especially in small children, small objects such as beads, peas or pieces of foam sometimes get stuck in the ear canal, and occasionally an insect finds its way in. This causes sudden pain, sometimes with restlessness, a feeling of pressure or discharge. Do not try to remove the foreign body yourself with tweezers or cotton swabs, as this usually only pushes it deeper and can injure the ear canal or the eardrum. Safe removal belongs in medical hands, usually with an ENT doctor.
When flying or diving, the surrounding pressure changes quickly. If the Eustachian tube cannot equalise the pressure, a so-called barotrauma develops, with pain and a feeling of pressure. You can prevent it by swallowing, yawning or chewing gum, and when flying also with the careful Valsalva manoeuvre: hold the nose closed and gently breathe against it. With a cold, decongestant nose drops before the flight help. You should postpone a dive entirely with a blocked nose, as pressure equalisation underwater will otherwise fail.
In adults, the pain often does not come from the ear at all. An inflammation in the throat, a diseased tooth or a dysfunction of the jaw joint can send pain into the ear via shared nerve pathways. Clues for this: the ear is normal on examination, and the pain gets worse when chewing, swallowing or grinding the teeth at night. Tension in the cervical spine can also radiate into the ear. More on this under toothache and neck pain.
How the pain feels often gives a first clue. A throbbing, pounding pain with fever suggests an acute inflammation in the middle ear. A stabbing pain that increases when pulling on the ear points more to the ear canal. A dull pressure, like cotton wool in the ear, fits a ventilation problem during a cold or a wax plug. And a pain that mainly occurs when chewing or swallowing, while the ear itself stays quiet, is typical of referred pain from the jaw or throat. This mapping is an orientation, not a diagnosis, but it helps prepare the conversation with the doctor.
What occurs in addition often gives the decisive clue to the cause:
| Accompanying symptom | Suggests |
|---|---|
| Fever and pressure | middle ear infection |
| Pain when pulling on the ear | ear canal infection |
| Sore throat, pain on swallowing | referred pain from the throat |
| Discharge from the ear | torn eardrum or ear canal infection |
| Hearing loss or dizziness | always have it checked |
The middle ear is very often affected by a respiratory infection, and a blocked nose makes the symptoms worse. With referred pain, sore throat and earache often occur together. Persistent hearing loss, ear noises or dizziness should always be assessed, as the inner ear may be involved. Blisters with paralysis point to shingles.
The most important step is the ear examination (otoscopy). With a small lighted device, the doctor looks into the ear canal and at the eardrum. This directly reveals a middle ear infection, an ear canal infection or a wax plug. If nothing is found at the ear, the doctor specifically looks for referred causes, feeling the jaw joint, teeth and lymph nodes or looking into the throat. If a hearing loss is suspected, a hearing test may follow, and for recurring or unclear symptoms a referral to an ENT doctor. You are well prepared if you have the duration, severity, accompanying symptoms and possible triggers at hand. Typical questions are: since when has the pain been there, is it one-sided or on both sides, was there a cold, a flight or water contact, and is there fever, discharge or hearing loss? The more precisely you can describe this, the faster the doctor finds the right track.
Many tips circulate online, but not all of them help, and some can cause harm. This overview sorts the common options by what is actually supported:
| Remedy | Rating | Note |
|---|---|---|
| Painkillers | Well supported | Ibuprofen also reduces inflammation, paracetamol is a good alternative |
| Warmth | May ease | A warm cloth or red light, pleasant with cold-related pain |
| Cooling | May ease | Some find cold more pleasant, simply try it out |
| Onion compress | Weak evidence | Applied from the outside it is harmless, do not put anything in the ear |
| Decongestant nose drops | Useful with a cold | Xylometazoline clears the Eustachian tube, for no more than a few days |
| Dripping oil into the ear | Better avoided | Dangerous with a damaged eardrum, hardly any evidence |
| Cotton swabs | Avoid | Push ear wax deeper and can injure |
For many cases of earache, for example during a cold or a mild middle ear infection, painkillers and some patience are enough, as the symptoms often improve on their own. Three common myths persist here: that oil in the ear dissolves the pain (dangerous with a torn eardrum), that an antibiotic is always needed (usually not, as many causes are not bacterial) and that cotton swabs clean the ear (they only push the wax deeper).
Not every earache needs to be checked by a doctor straight away. With a mild, cold-related pain and no warning signs, you can usually wait one to two days with painkillers and some patience, as many symptoms improve on their own in that time. Watch the course: if the pain slowly eases, that is a good sign. A doctor visit makes sense, however, if the pain does not ease after two to three days, keeps coming back, affects only one ear or comes with fever, discharge or hearing loss. With the warning signs listed below, do not wait at all. When in doubt, and especially with small children, the rule is: better to have it checked once too early than too late.
Not every cause can be prevented, but a few simple rules clearly lower the risk. Avoid cotton swabs, because the ear canal cleans itself. Dry the ears carefully after swimming, and use suitable ear protection if you get swimmer's ear repeatedly. Treat a cold and a blocked nose early, so the Eustachian tube stays clear and no pressure builds up in the middle ear. Actively equalise the pressure when flying by swallowing or yawning. And have recurring, one-sided or stubborn symptoms checked early so that nothing is missed.
When to see a doctor immediately
Most earaches are harmless. With these signs you should not wait but seek medical help right away, in an emergency via 112: redness, swelling or tenderness behind the ear (a sign of mastoiditis), high fever or a stiff neck, facial paralysis or a drooping corner of the mouth, sudden hearing loss or severe dizziness, and any fever in an infant under six months. Blisters on the ear or face should also be checked promptly.
Children get earache particularly often, because their Eustachian tube is shorter and flatter and infections reach the middle ear easily. Small children often cannot name the pain. Watch for indirect signs: frequent grabbing of the ear, crying when lying down, poor feeding, restlessness and fever. For infants under six months, high fever or a clearly reduced general condition, the child should always be examined by a doctor. Use home remedies and painkillers only at the right age and, if in doubt, after medical advice, and never insert anything into the child's ear.
Keep track of the course
If earache does not improve within two to three days or warning signs appear, it is time to see a doctor. brite helps you document fever and symptoms and reminds you of prescribed medicines.
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This article is for general information only and does not replace medical advice, diagnosis or treatment. For severe or persistent earache, for warning signs or in infants, please contact a medical practice, and in an emergency call 112. Take medicines only at the appropriate dose and, if in doubt, after medical advice.
