Earache

and Carola Felchner, science journalist

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015.Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Earache can have many causes. Mostly they are triggered by inflammation. However, there can also be other causes, such as an eardrum injury or an occlusion of the ear canal. (Small) children are particularly prone to earache. Find out here what can cause ear pain, how it can be treated with conventional medicine and home remedies, and how earache can be prevented!

Brief overview

What is an earache? Pain in the outer, middle, or inner ear. They can persist continuously or appear like seizures and feel differently (stabbing, pounding, dull, etc.). Sometimes they get stronger as you chew.
Possible accompanying symptoms: feeling of pressure or itching in the ear, ringing in the ears, hearing problems, dizziness, fever, etc.
Causes: Inflammations and infections (such as otitis media), blockage of the ear canal, injuries (such as perforation of the eardrum), jaw or dental problems, tumors
Treatment: depending on the cause and severity. Decongestant nasal drops or sprays, pain relievers, antibiotics and antimycotics are available. An operation may be necessary. Foreign bodies in the ear are carefully removed by the doctor (e.g. with fine forceps).
Home remedies: onion wrap, mustard wrap, cold compress, ear steam, oil wrap, infrared light, etc.

Earache: causes and possible diseases

The ears are particularly sensitive organs that contain many nerve endings. Even small disturbances can therefore trigger ear pressure or ear pain. The complaints can be located in the outer, middle or inner ear, persist continuously or occur like attacks. The pain can be sharp, throbbing or dull, for example, and be accompanied by other symptoms (uncomfortable ear pressure, dizziness, hearing problems, etc.).

Very often inflammation and infection are the causes of ear pain. Other possible causes are, for example, a blockage of the ear canal and injuries.

Earache can arise here

Earache occurs particularly often in the ear hang (outer ear) or in the middle ear. Bacterial inflammation is the most common cause.

Inflammations and infections

Inflammation is very often the cause of ear pain. They are usually the result of an infection, for example with bacteria or viruses. In the area of the auricle and the external auditory canal, allergies or sunburn are also possible triggers.

The following inflammations and infections are common causes of ear pain:

acute or chronic otitis media. It can cause ear pain in particular.
Inflammations in the area of the external auditory canal such as ear canal inflammation, ear and ear canal furuncles, sore throat (erysipelas) or shingles (herpes zoster)
Inflammation of the mastoid process (mastoiditis): The mastoid process is a highly aerated bony process on the temporal bone, directly behind the ear canal.
Inflammation of the teeth
Tonsillitis (tonsillitis)
Inflammation of the parotid gland (e.g. in mumps or measles)

When infected, the earache is often accompanied by a fever.

Closure of the ear canal

Even if the ear canal becomes clogged, it can cause ear pain and impaired hearing. A closure can result from:

a plug of ear wax (cerumen)
Foreign bodies, for example when children stick something in their ears while playing

Injuries

External ear pain is often the result of cuts, bruises, and abrasions. If there is pain in the ear after a more serious accident, there may also be a broken bone in the skull area behind it.

An eardrum injury (eardrum perforation) is also possible. A short, sharp pain in the middle ear may be associated with the tissue injury. The earache can then be felt in the area of the middle ear. The eardrum can tear, for example, if a sharp object enters the ear canal or if the ears are improperly cleaned with cotton swabs. Pressure waves or pressure fluctuations can also result in a tear in the eardrum. Such a barotrauma can occur, for example, when diving or on air travel. Loud noise, an explosion, and a blow to the ear can tear the eardrum, and it can also be painful and cause dizziness, ringing in the ears (tinnitus), and hearing loss.

Other causes of ear pain

The ear is close to the jaw. Therefore, problems with the temporomandibular joint (e.g. TMJ osteoarthritis) or dental problems can also make the ears ache. Sometimes tumors on the auricle, in the external auditory canal or in the middle ear become noticeable with pain. Ear herpes (herpes zoster oticus) can also trigger ear pain, especially in older people: the herpes viruses cause blisters and pain in the area of the auricle and / or in the external auditory canal.

Earache: treatment

If you experience mild pain or uncomfortable pressure in your ear after a walk in cold weather, a visit to the swimming pool or a flight, it is usually not a cause for concern. The symptoms usually subside quickly on their own. You can help a little with some home remedies such as the onion sachet.

But see a doctor if the earache persists and / or is accompanied by other symptoms, for example fever, hearing problems, dizziness, or blood or other secretions leaking from the ear canal. Pain in the ear that is triggered by a foreign body or occurs after an accident (such as a fall on the head) must also be clarified by a doctor!

What does the doctor?

The treatment of earache by the doctor depends on the location and cause of the symptoms. For example, in the case of an inflammation of the ear canal, the doctor can depending on the causative agent

Antibiotics (against bacteria)
Prescribe antifungal drugs (for fungi).

The drugs are usually applied locally, for example in the form of ointments or drops. In severe cases, it may also be necessary to use the medication systemically, for example in the form of tablets or infusions.

Nasal drops or sprays

If you have an otitis media, your doctor will prescribe decongestant nasal drops or sprays. They also work in the ear trumpet, the connecting channel between the middle ear and throat. This way the middle ear is well ventilated again. In addition, secretion that forms in the middle ear due to inflammation can then flow away better. The doctor may also prescribe antibiotics for an otitis media.

Alcoholic strips

If the earache is caused by a boil in the external ear canal, strips containing alcohol are usually inserted into the ear canal. In addition, the patient is given painkillers and - in severe cases - sometimes antibiotics.

Remove the plug and foreign bodies

If the earache is caused by a plug of wax or foreign objects in the ear canal, the doctor will carefully remove it. A small teat or other medical instrument can help.

surgery

Injuries to the eardrum usually heal on their own. In some cases, however, an operation is necessary. For example, an injury to the edge of the eardrum usually does not heal as well. As a support, the doctor can splint the injured eardrum with paper or silicone. An artificial eardrum may also have to be used.

Earache: home remedies

There are several home remedies for earache. However, they should only be used if a serious cause for the symptoms can be excluded. The following home remedies have proven effective:

Onion for earache

An onion sachet has an analgesic, anti-inflammatory effect and loosens phlegm for earache. The reason for this is the mustard oils contained in the onion.

To do this, peel an onion, cut it into small pieces and wrap it in a cloth. Warm the parcel between two hot water bottles, over steam, in the microwave or on the heater. Wring out if necessary. Place the package on the ear and the bone behind the ear and secure with a cap or a cloth. Let it work for 20 minutes. Use once or twice a day.

Onion ear drops: To do this, squeeze out a raw onion. Bring a few drops of the juice into the ear canal and seal the ear with a cotton plug.

Table salt nasal drops

Saline nasal drops relieve a stuffy nose when you have a cold and can reduce the pressure in the ear when you have an earache. To do this, dissolve exactly 9 grams of table salt in one liter of boiled water.

Fill this saline solution into a pipette bottle or a vial with a spray attachment (rinse with hot water beforehand). Put three to five drops or two sprays into each nostril several times a day. Renew the saline solution every two days.

Tea for pain

Some medicinal plants have a slight pain-relieving effect and are therefore also used as home remedies for earache. This includes:

Lemon balm
Meadowsweet
Willow bark

The preparation can be found in the respective medicinal plant texts.

Warmth for earache

Warmth can have a beneficial effect on milder, more common earache. It increases the blood circulation and improves the metabolism in the diseased ear. There are several ways to warm the ear:

Steam: With a spout and a rubber hose, direct the warm steam from a tea kettle to the sore ear with a little space. Caution: only heat the water moderately, do not let it boil!
Oil wrap: Oil stores heat particularly well. Oil wraps are also suitable as home remedies for earache. Soak a compress in warm cooking oil and place it behind the ear as an envelope.
Infrared light: The warmth of an infrared heater can also have a soothing effect on chronic earache.

Acute bacterial infections of the sinuses or the middle ear can be aggravated by heat. In this case, cold is the better remedy. When choosing a home remedy, seek advice from a doctor or pharmacist.

Cold for earache

In acute inflammation of the ear, cold can relieve earache. These compresses and wraps are suitable:

Cold compress: wrap a squeezed compress soaked in cold water in a cloth and place it over the ear. Fix them with a woolen hat.

Cold clay wrap: wrap a cold mush of healing earth or clay in a damp cloth and leave the wrap on your ear until the mush has dried.

Cold application is only advisable if the patient finds it more pleasant than heat treatment.

Home remedies for earache in children

The onion sachet is also suitable as a home remedy for children or babies with earache. If your child finds the smell of the onion unpleasant, you can instead wrap chamomile flowers in the sachet and place them on their ears. They too have anti-inflammatory effects and can relieve ear pain.

Home remedies have limits. If the symptoms persist over a longer period of time and do not get better or even worse despite treatment, you should always consult a doctor.

Earache in babies and toddlers

Babies and young children are particularly likely to have earache. Most children develop otitis media at least once in the first three years of life. The problem: from the outside, earache can usually not be detected with the naked eye - and very young children cannot tell exactly where it hurts. Therefore, parents need to watch out for tell-tale signals:

Does the child often reach for his ear, is he restless and easily irritable? Then it could be plagued by an earache. An otitis media can indicate fever, chills and diarrhea, vomiting and refusal to eat. When the eardrum ruptures, a purulent, bloody secretion often runs out of the ear. In addition, parents should take a look into the ear canal if their child has (suspected) ear pain. Perhaps there is a foreign body in it that the child put in their ear while playing.

Causes of earache in babies and toddlers

Often a cold or flu is to blame for an earache. Such acute respiratory infections are often accompanied by an otitis media - just like a measles infection: The germs can get from the pharynx through the ear trumpet into the middle ear and cause a painful inflammation there.

In children, the ear trumpet is so narrow that it can be completely closed if the mucous membrane swells. Pus and inflammatory fluid can then no longer flow out of the middle ear - a pressure is created that can trigger severe ear pain.

In mumps, a common childhood disease, the parotid gland becomes inflamed and swollen. Those affected have severe pain in the ear area.

Treating earache in children

Ear pain in children is very often due to otitis media and this should always be evaluated and treated by a doctor. Depending on your needs, the doctor will then, for example, prescribe decongestant nasal drops, pain relievers (such as paracetamol), expectorants and possibly antibiotics. Parents can support the treatment by, for example, giving their child an onion wrap. It relieves the pain in the ear.

When children complain of earache on the plane, the ear trumpet is usually blocked. It can often be opened again by holding your nose and mouth closed and exhaling against the resistance. It is also helpful to chew gum, yawn or drink a lot (in small sips).

Earache: examinations and diagnosis

The doctor will talk to you first to take a medical history (medical history). He asks about:

Duration, severity and course of the complaints
Type of earache (e.g. stabbing, dull)
previous or current infections
Treatments that have already taken place (including the use of home remedies)
possible underlying diseases (e.g. diabetes mellitus, skin diseases, HIV) or recent accidents

Also, tell your doctor about any pool visits and diving vacations - they could have something to do with your earache.

The anamnesis interview can give the doctor initial clues as to the cause of the earache. For a reliable diagnosis, various examinations are carried out as required:

The doctor takes a look inside the mouth and throat and feels the lymph nodes in the neck. He also performs an otoscopy: the doctor takes a closer look at the external auditory canal and eardrum with the help of a small, illuminated magnifying lens. If, for example, an otitis media is causing the pain, the eardrum is reddened or bulging with fluid in the middle ear. A foreign body or a plug of ear wax can also be detected during an otoscopy.

A tube function test can be used to test whether the Eustachian tube (ear trumpet) is continuous. This connecting channel ensures the pressure balance between the middle ear and the nasopharynx. The test can be carried out, for example, using the Valsalva test. The doctor asks the patient to exhale forcefully with his mouth closed and his nose closed. Often a previously "closed" ear trumpet opens again.

In some cases, imaging tests are needed to clarify earache. If the doctor suspects the cause of the pain in problems in the temporomandibular joint or in changes in the bony ear canal or in the mastoid process, he can order an X-ray examination or computed tomography (CT).

Hearing tests are also often done. They can help to narrow down the cause of the complaints, as the various disturbances in sound conduction or sound processing often show typical resonance and frequency patterns.

Blood tests and the analysis of secretions from the ear canal can show whether the earache is due to an inflammation or infection.

If these tests do not result in a satisfactory diagnosis, referral to another specialist (e.g. a dentist) can help to get to the bottom of the pain in the ear.

Earache: tips to prevent it

You can also do something preventive against earache. For example, drink enough. This helps the body to form secretions and to flush germs from the mucous membranes. It should be two to three liters of fluid per day for an adult.

Avoid drafts - especially if you are sensitive - and protect your ears with a hat if necessary. This is also recommended in cold weather.

If you have a cold, the secretion should be able to drain away. Decongestant nasal drops may help in such cases. But please only use it for a limited period of time!

When swimming, special plugs or ear drops can help hold or get the water out of your ears. Because water in the ear can be painful and also lead to an otitis media.

Anyone who sleeps with earplugs should change them regularly so that no germs can multiply on them and get into the ear.

If pressure-related earache occurs on a flight, it can help if you consciously swallow, move your jaw, chew gum, or close your nose and mouth and exhale.