What are the common causes of outer ear infections. How can you recognize the symptoms of an outer ear infection. What are the most effective treatment options for outer ear pain. How can you prevent outer ear infections.

Understanding Outer Ear Infections: A Comprehensive Guide

Outer ear infections, medically known as otitis externa, are a common cause of ear discomfort and pain. These infections typically affect the visible part of the ear (auricle) and the ear canal leading to the eardrum. While often referred to as “swimmer’s ear,” these infections can occur for various reasons beyond water exposure.

Common Causes of Outer Ear Infections

Outer ear infections can arise from several factors:

• Bacterial infections (most common)
• Fungal infections (less frequent)
• Viral illnesses (e.g., influenza or Zoster oticus)
• Allergic reactions to products like shampoos

Frequent swimming increases the risk of outer ear infections, as water can introduce germs into the ear canal. Additionally, minor injuries to the ear canal, such as those caused by cotton swabs or in-ear headphones, can create an environment conducive to infection.

Recognizing the Symptoms of Outer Ear Infections

Identifying an outer ear infection early can lead to prompt treatment and quicker relief. The most common symptoms include:

• Pain, especially when touching or tugging the earlobe
• Itching in the ear canal
• Redness and swelling of the ear canal skin
• Flaking or oozing of the skin in the ear canal
• Partial hearing loss due to ear canal blockage

For about one-third of affected individuals, the symptoms can significantly impact daily life, with approximately 20% needing to take time off work or school due to the infection.

How severe can outer ear infection symptoms become?

In severe cases, outer ear infections can lead to intense pain, significant hearing impairment, and even spread to nearby tissues. While rare, these complications underscore the importance of proper treatment and monitoring.

Prevalence and Outlook of Outer Ear Infections

Outer ear infections are particularly common among adults, with approximately 10% of people experiencing at least one episode in their lifetime. While most cases are mild and resolve on their own within a few days to weeks, some infections can persist longer or recur frequently.

Do outer ear infections pose long-term risks?

Generally, outer ear infections do not lead to long-term complications when treated properly. However, chronic or recurrent infections may require more intensive management to prevent potential complications such as hearing loss or spread of infection to surrounding tissues.

Effective Prevention Strategies for Outer Ear Infections

Preventing outer ear infections involves maintaining good ear hygiene and avoiding factors that can irritate or damage the ear canal. Here are some effective prevention strategies:

1. Avoid inserting objects into the ear canal, including cotton swabs
2. Allow ears to clean themselves naturally through earwax production
3. Use a snug-fitting swimming cap when swimming or bathing
4. Ensure earplugs fit properly if used while swimming
5. Dry ears thoroughly after water exposure
6. Limit the use of in-ear headphones and earplugs if prone to infections
7. Consider alternative products if certain cosmetics cause ear irritation

How can you safely remove excess earwax?

If excess earwax buildup occurs, it’s best to consult a healthcare professional for safe removal. They may recommend softening the wax with olive oil or use specialized tools to remove it without damaging the ear canal.

Treatment Options for Outer Ear Infections

The treatment of outer ear infections typically involves a combination of pain management and addressing the underlying cause. Common treatment options include:

• Over-the-counter painkillers to alleviate discomfort
• Disinfectant ear drops or sprays available without prescription
• Prescription antibiotic ear drops for bacterial infections
• Professional ear cleaning by a healthcare provider in severe cases

It’s important to consult a doctor if symptoms don’t improve within a few days or if the infection appears severe.

When should you seek medical attention for an outer ear infection?

While many outer ear infections resolve on their own, medical attention is necessary if you experience severe pain, fever, complete hearing loss, or if symptoms persist for more than a week despite home treatment.

The Role of Proper Ear Care in Preventing Infections

Maintaining good ear hygiene is crucial in preventing outer ear infections. This involves understanding the natural cleaning process of the ears and avoiding practices that can disrupt this balance.

Why is it important to avoid using cotton swabs in the ears?

Cotton swabs can push earwax deeper into the ear canal, potentially causing blockages or injury to the delicate skin lining. This can create an environment conducive to infections. Instead, allow the ears to clean themselves naturally and only clean the outer part of the ear with a soft cloth.

The Impact of Water Exposure on Ear Health

While swimming and other water activities are enjoyable and beneficial for overall health, they can increase the risk of outer ear infections. Understanding how to protect your ears during water exposure is essential for preventing infections.

How can swimmers protect their ears effectively?

Swimmers can protect their ears by wearing well-fitting swimming caps or custom-made earplugs designed for water use. After swimming, it’s important to tilt the head to each side to allow water to drain from the ears and to dry the outer ear thoroughly with a towel.

The Connection Between Allergies and Outer Ear Infections

Allergic reactions can sometimes lead to outer ear infections by causing inflammation and irritation in the ear canal. This inflammation can disrupt the ear’s natural defenses, making it more susceptible to bacterial or fungal overgrowth.

How can you identify if an ear infection is allergy-related?

Allergy-related ear infections often coincide with other allergy symptoms such as sneezing, itchy eyes, or a runny nose. If you notice a pattern of ear irritation following exposure to certain products or during specific seasons, it may indicate an allergic component to your ear issues.

Understanding the causes, symptoms, and prevention strategies for outer ear infections empowers individuals to maintain better ear health. By following proper ear care practices and seeking timely medical attention when needed, most people can effectively manage and prevent outer ear infections, ensuring optimal ear health and overall well-being.

Outer ear infection: Overview – InformedHealth.org

Last Update: February 13, 2020; Next update: 2023.

Introduction

Outer ear infections typically lead to redness and swelling in the ear. They are among the most common causes of earache. In many cases they are caused by bacteria. But fungi, viruses or allergies are sometimes to blame too.

The outer ear includes the part of the ear you can see (the auricle) and the outer ear canal. The outer ear canal leads from the eardrum to the auricle. The medical term for inflammations of the outer ear is “otitis externa.” They are usually caused by infections.

Outer ear infection

Symptoms

Outer ear infections are often very painful– especially when you touch or tug on your earlobe. Itching is common too.

The skin in the ear canal is red and swollen, and sometimes also sheds skin flakes or oozes a liquid. The ear might then become blocked, making it difficult to hear properly.

In about 1 out of 3 people the symptoms are so severe that it affects their everyday lives. About 1 out of 5 people have to stay home from work or school for a few days because of the infection.

Causes and risk factors

Outer ear infections are usually caused by bacteria. They are sometimes caused by a fungus, such as a yeast, but that’s less common. Viral illnesses like the flu or a certain type of shingles (Zoster oticus) may also lead to an outer ear infection. And sometimes allergic reactions – for instance, to a shampoo – are to blame.

Outer ear infections are also often called “swimmer’s ear” because germs can easily get into the ear canal while you’re swimming. This means that people who swim a lot are more likely to get outer ear infections.

Minor injuries to the ear – for instance, through the use of cotton ear buds to clean your ear, or regularly wearing headphones that you stick inside your ear (“in-ear headphones”) – can increase the risk too. People who have already had an outer ear infection or are generally prone to infections are also more likely to get outer ear infections.

Prevalence and outlook

Outer ear infections are especially common in adults: About 1 out of 10 people will have one at some point in their life.

The infection is usually mild and clears up on its own after a few days or weeks. But it sometimes lasts longer. In rare cases it may spread to nearby tissue.

Prevention

In order to prevent outer ear infections, it’s important not to irritate or damage the ear canal. Pointed objects should never be inserted into the ear canal.

But simply trying to clean your ears with cotton ear buds can cause damage to the ear canal too. There’s no need to use cotton ear buds anyway because your ears clean themselves by producing earwax. When the earwax comes out of your ears, you can remove it (and the dirt inside it) with a tissue. If larger amounts build up or a hard “plug” develops, the earwax can be softened, for instance with olive oil, allowing it to leave the ear more easily.

It’s important to take care, though. If you are unsure, it might be better to get a doctor to flush out your ear and suck out the built-up earwax or carefully remove it with a thin, hook-like instrument.

The following things can also help to prevent outer ear infections:

• A snug-fitting swimming cap helps to keep water from entering the ear while swimming, showering or having a bath.

• People who use earplugs while swimming should make sure that they are soft and fit properly.

• If water does get into your ear, you usually just need to tilt your head to the side to let the water flow out. Gently pulling your earlobe and jumping up and down a little can help. You can also carefully dry your ear using a hairdryer at a low setting.

• If you often have problems with earwax buildup, it’s a good idea to have your ear cleaned by a doctor before going on any trips where you might do a lot of swimming.

• If you have sensitive ear canals, don’t use earplugs to protect your ears from noise, dust or water too often. That’s also true for the use of in-ear headphones when you listen to music or make phone calls. It might be better to try different headphones if you’re prone to outer ear infections.

If you’ve noticed that certain shampoos, soaps or other cosmetic products lead to ear infections, it’s best to try out other products instead.

Treatment

The medications that are commonly used to treat outer ear infections include painkillers and disinfectant ear drops or sprays. These are available from pharmacies without a prescription. Acute outer ear infections that are caused by bacteria are often treated using special ear drops that have to be prescribed by a doctor. If the symptoms don’t improve within a few days, it’s advisable to see a doctor.

If the infection is severe or lasts for several weeks, your doctor might clean your ear and place a little sponge or a strip of gauze soaked in ear drop fluid into your ear canal. Sometimes other kinds of medication are needed too – for instance, if the ear infection was caused by shingles.

Sources

• Burton MJ, Singer M, Rosenfeld RM. Extracts from The Cochrane Library: Interventions for acute otitis externa. Otolaryngol Head Neck Surg 2010; 143(1): 8-11. [PubMed: 20620612]

• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Ohrenschmerzen (S2k-Leitlinie). AWMF-Registernr.: 053-009. 11.2014.

• Hajioff D, MacKeith S. Otitis externa. BMJ Clin Evid 2015: pii: 0510.

• Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev 2010; (1): CD004740. [PubMed: 20091565]

• Lenarz T, Boenninghaus HG. Hals-Nasen-Ohren-Heilkunde. Berlin: Springer; 2012.

• Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis Externa. Dtsch Arztebl Int 2019; 116(13): 224-234. [PMC free article: PMC6522672] [PubMed: 31064650]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Outer ear infection: Overview – InformedHealth.org

Last Update: February 13, 2020; Next update: 2023.

Introduction

Outer ear infections typically lead to redness and swelling in the ear. They are among the most common causes of earache. In many cases they are caused by bacteria. But fungi, viruses or allergies are sometimes to blame too.

The outer ear includes the part of the ear you can see (the auricle) and the outer ear canal. The outer ear canal leads from the eardrum to the auricle. The medical term for inflammations of the outer ear is “otitis externa.” They are usually caused by infections.

Outer ear infection

Symptoms

Outer ear infections are often very painful– especially when you touch or tug on your earlobe. Itching is common too.

The skin in the ear canal is red and swollen, and sometimes also sheds skin flakes or oozes a liquid. The ear might then become blocked, making it difficult to hear properly.

In about 1 out of 3 people the symptoms are so severe that it affects their everyday lives. About 1 out of 5 people have to stay home from work or school for a few days because of the infection.

Causes and risk factors

Outer ear infections are usually caused by bacteria. They are sometimes caused by a fungus, such as a yeast, but that’s less common. Viral illnesses like the flu or a certain type of shingles (Zoster oticus) may also lead to an outer ear infection. And sometimes allergic reactions – for instance, to a shampoo – are to blame.

Outer ear infections are also often called “swimmer’s ear” because germs can easily get into the ear canal while you’re swimming. This means that people who swim a lot are more likely to get outer ear infections.

Minor injuries to the ear – for instance, through the use of cotton ear buds to clean your ear, or regularly wearing headphones that you stick inside your ear (“in-ear headphones”) – can increase the risk too. People who have already had an outer ear infection or are generally prone to infections are also more likely to get outer ear infections.

Prevalence and outlook

Outer ear infections are especially common in adults: About 1 out of 10 people will have one at some point in their life.

The infection is usually mild and clears up on its own after a few days or weeks. But it sometimes lasts longer. In rare cases it may spread to nearby tissue.

Prevention

In order to prevent outer ear infections, it’s important not to irritate or damage the ear canal. Pointed objects should never be inserted into the ear canal.

But simply trying to clean your ears with cotton ear buds can cause damage to the ear canal too. There’s no need to use cotton ear buds anyway because your ears clean themselves by producing earwax. When the earwax comes out of your ears, you can remove it (and the dirt inside it) with a tissue. If larger amounts build up or a hard “plug” develops, the earwax can be softened, for instance with olive oil, allowing it to leave the ear more easily.

It’s important to take care, though. If you are unsure, it might be better to get a doctor to flush out your ear and suck out the built-up earwax or carefully remove it with a thin, hook-like instrument.

The following things can also help to prevent outer ear infections:

• A snug-fitting swimming cap helps to keep water from entering the ear while swimming, showering or having a bath.

• People who use earplugs while swimming should make sure that they are soft and fit properly.

• If water does get into your ear, you usually just need to tilt your head to the side to let the water flow out. Gently pulling your earlobe and jumping up and down a little can help. You can also carefully dry your ear using a hairdryer at a low setting.

• If you often have problems with earwax buildup, it’s a good idea to have your ear cleaned by a doctor before going on any trips where you might do a lot of swimming.

• If you have sensitive ear canals, don’t use earplugs to protect your ears from noise, dust or water too often. That’s also true for the use of in-ear headphones when you listen to music or make phone calls. It might be better to try different headphones if you’re prone to outer ear infections.

If you’ve noticed that certain shampoos, soaps or other cosmetic products lead to ear infections, it’s best to try out other products instead.

Treatment

The medications that are commonly used to treat outer ear infections include painkillers and disinfectant ear drops or sprays. These are available from pharmacies without a prescription. Acute outer ear infections that are caused by bacteria are often treated using special ear drops that have to be prescribed by a doctor. If the symptoms don’t improve within a few days, it’s advisable to see a doctor.

If the infection is severe or lasts for several weeks, your doctor might clean your ear and place a little sponge or a strip of gauze soaked in ear drop fluid into your ear canal. Sometimes other kinds of medication are needed too – for instance, if the ear infection was caused by shingles.

Sources

• Burton MJ, Singer M, Rosenfeld RM. Extracts from The Cochrane Library: Interventions for acute otitis externa. Otolaryngol Head Neck Surg 2010; 143(1): 8-11. [PubMed: 20620612]

• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Ohrenschmerzen (S2k-Leitlinie). AWMF-Registernr.: 053-009. 11.2014.

• Hajioff D, MacKeith S. Otitis externa. BMJ Clin Evid 2015: pii: 0510.

• Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev 2010; (1): CD004740. [PubMed: 20091565]

• Lenarz T, Boenninghaus HG. Hals-Nasen-Ohren-Heilkunde. Berlin: Springer; 2012.

• Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis Externa. Dtsch Arztebl Int 2019; 116(13): 224-234. [PMC free article: PMC6522672] [PubMed: 31064650]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Ear hurts

Ear hurts – the causes of the appearance, in which diseases it occurs, diagnosis and methods of treatment.

Ear pain can be caused by diseases of different parts of the hearing organ, nearby organs, head injuries, and can also appear due to the spread of pain from other parts of the body. Such pain is caused by inflammatory, skin, neurological, dental, rheumatic, infectious pathologies.

The nature of such pain does not explain the cause of the disease. The doctor should evaluate the results of laboratory and instrumental examinations in order to clarify the diagnosis.

Types of pain in the ears

Most often, these pains are the result of otitis media – a disease of the outer, middle or inner ear.

Mastoiditis, arthritis of the temporomandibular joint, inflammation of the cervical lymph nodes – these are pathologies of nearby organs that often cause ear pain.

Ear pain can occur due to the spread of pain along the cranial nerves. For example, a toothache radiates through the auditory branch of the trigeminal nerve to the ears.

Traumatic rupture of the eardrum is the cause of ear pain due to damage from falls, blows to the head.

We will talk about the diseases that most often cause ear pain.

Possible causes

Mastoid pain

Mastoiditis, that is, purulent inflammation of the bone tissue of the mastoid process of the temporal bone, located behind the auricle, is the most characteristic complication of otitis media and a frequent consequence of its improper treatment.

Pain in otitis externa

Otitis externa is an inflammation of the outer ear, which consists of the auricle, the external auditory canal and the tympanic membrane separating it from the middle ear. The main symptom of the disease is a boil – a purulent inflammation of the hair follicle that captures the sebaceous gland. Sometimes boils can appear after cleaning the ears too hard, when microtraumas form on the skin of the ear canal, through which the infection penetrates.

Pain in otitis media

Behind the tympanic membrane begins the middle section of the organ of hearing. It is a small, air-filled space in the temporal bone between the external auditory meatus and the inner ear.

There are three tiny bones here: the hammer, anvil, and stirrup. The eardrum vibrates under the influence of acoustic waves. The vibrations are transmitted to the bones. Through the oval window separating the middle and inner ear, the stirrup sends a signal to the fluid that fills the inner ear – the perilymph.

Otitis media begins as a complication not of otitis externa, but of acute respiratory infections, influenza, tonsillitis.

With these ailments, an excess amount of mucus is formed, which enters the Eustachian tube. The Eustachian tube connects the middle ear to the nasopharynx and equalizes air pressure in both directions. If this organ becomes inflamed, eustacheitis develops – a frequent companion of otitis media.

Otitis internal pain

Otitis media is also called labyrinthitis, because the inner ear is called a labyrinth because of its peculiar shape. Its main function is to conduct sound waves and convert them into electrical impulses for the brain. The cochlea, which is part of the labyrinth, belongs to the organ of hearing. The other two parts – the vestibule of the cochlea and the semicircular canals – to the organ of balance.

Labyrinthitis is usually a complication of otitis media.

Less commonly, this disease occurs as a result of microtrauma through the tympanic membrane and middle ear with sharp objects, which are sometimes recklessly cleaned ears, or as a result of damage to the temporal bone during head injuries.

What diseases occur

Mastoid pain

Ear pain is very severe, often covering half of the head on the side of the lesion, aggravated at night.

The remaining symptoms of mastoiditis occur in severe otitis media. These are noise in the ear, severe hearing loss, fever, a significant deterioration in the general condition, suppuration from the ear, detected during otoscopy.

Pain in otitis externa

The pain gradually increases as the follicle matures, it can radiate to the jaw, neck, intensify when chewing and pressing on the tragus – a cartilaginous protrusion on the outer ear. The pain is accompanied by itching, a feeling of fullness in the ear. Hearing may deteriorate, body temperature may rise.

Pain in otitis media

Pulsating, aching, shooting, often radiating to the teeth and back of the head, earache usually appears with fever. Ear pain with otitis externa and otitis media is easy to distinguish. In the first case, it intensifies if you press on the tragus, in the second it remains unchanged.

Pain due to labyrinthitis

Such pain in the ear is accompanied by hearing loss, nausea and vomiting, dizziness, headaches, staggering when walking, involuntary twitching of the muscles of the eyeball.

Diagnostics and examinations

Pain in otitis externa

Otoscopy – examination of the external auditory canal and eardrum by an ENT doctor using specialized instruments.

Pain in otitis media

Hearing assessment using an audiometric examination, including tuning fork tests. These are tests with tuning forks, which make it possible to determine whether hearing loss is associated with inflammation in the middle ear or with damage to the auditory nerve. Bacterial culture from the middle ear is performed to determine sensitivity to an extended spectrum of antimicrobials, radiography or CT of the temporal bone, as well as tympanometry, in which the mobility of the tympanic membrane is assessed.

The procedure in which the doctor removes material from the middle ear cavity for analysis is called tympanocentesis. This method, performed after local anesthesia, is also used to pump out pus from the middle ear cavity.

What should be done when pain occurs?

If you experience ear pain, see your doctor right away.

If the pain is accompanied by fever and hearing loss, do not go outside, call a doctor at home.

Which doctors should I contact?

Inflammatory skin diseases that cause otitis externa can be treated by a general practitioner or surgeon, but it is better to consult an ENT doctor. And only this specialist should treat otitis media and mastoiditis. An ENT doctor and a neurologist will help in the treatment of labyrinthitis.

Treatment

Mastoid pain

The basis of the treatment of mastoiditis, as well as labyrinthitis, is antibiotic therapy, which is prescribed only by a doctor. Depending on the severity of the disease, operations are used: puncture of the eardrum to ensure the outflow of pus; mastoidectomy (rarely) – removal of pus from the air cells of the mastoid process.

Pain in otitis externa

The treatment of otitis externa is based on the use of drops, ointments, creams containing antiseptics in combination with anti-inflammatory and analgesic components. According to indications, surgical treatment is used (opening of mature boils).

Pain in otitis media

Drops with anti-inflammatory and analgesic effects are instilled into the ears, vasoconstrictor drops are instilled into the nose, reducing swelling of the nasopharynx and pharyngeal mouth of the Eustachian tube, and reducing the formation of mucus. The doctor may prescribe antibiotics. In the case of advanced otitis media, a puncture of the eardrum is used to free the middle ear cavity from pus.

Pain due to labyrinthitis

Labyrinthitis is treated only in a hospital by an otolaryngologist and a neurologist, and, if necessary, by an infectious disease specialist and a neurosurgeon. In addition to antibiotic therapy, a labyrinthotomy operation is often needed. This is the name of the opening by the surgeon of the semicircular canals of the ear labyrinth to ensure the outflow of pus and stop the infection from entering the cranial cavity.

Sources:

1. Clinical guidelines “Otitis externa” (children). Developed by: Union of Pediatricians of Russia, National Medical Association of Otorhinolaryngologists, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. – 2021.
2. Clinical guidelines “Otitis externa” (adults). Developed by: National Medical Association of Otorhinolaryngologists. – 2021.
3. Clinical recommendations “Otitis media acute”. Developed by: National Medical Association of Otorhinolaryngologists. – 2021.
4. Clinical guidelines “Chronic otitis media”. Developed by: National Medical Association of Otorhinolaryngologists. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Ear pain: causes and treatment

The article was checked by a doctor: Elena Lvovna Kogan

Consultation with a specialist:

Anatomy of the ear

The ear is a paired organ located in the temporal bones of the skull. Its main function is the perception of sound, the position of the body in space and the maintenance of balance.

The ear is made up of three sections:

• Outer ear. Forms the auricle and external auditory canal. Picks up sound vibrations and transmits them to the middle ear.

• Middle ear. It is formed by the tympanic cavity and three auditory ossicles: anvil, stirrup and malleus. Picks up sounds from the outer ear and amplifies them.

• Inner ear. It contains the cochlea, semicircular canals and vestibular apparatus. Perceives sound vibrations, and transmits auditory information to the cortex of the temporal lobe of the brain.

The structure and function of each part of the ear is different. Any pathological processes in all three departments also proceed differently.

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Causes of pain in the ears

Ear pain has a different intensity (from moderate to severe), duration (from short-term to permanent), character (sharp, dull, shooting, spreading to neighboring areas). Separately, there is an acute form of pain, lasting about 10 days, and chronic, which can be permanent or episodic. At the place of occurrence, there is one- and two-sided pain in the ear.

Otalgia occurs for various reasons. In 80% of cases, pain is associated with infectious and inflammatory diseases of the ear, throat and nose. Due to the anatomical proximity, inflammation of one of these organs provokes pain in other adjacent cavities.

Most often, pain inside the ear is a symptom of otolaryngological diseases:

• otitis,

• mastoiditis,

• eustachitis,

• boil,

• sulfur plug,

• ear tumors,

• boil,

• myringitis,

• otomycosis.

The patient experiences pain in the ear with craniocerebral injuries, the ingress of a foreign body into the ear canal. Otalgia can be a non-specific manifestation of mumps, neurological disorders, dental diseases, and nasopharyngeal cancer.

Otitis

This is inflammation in different parts of the ear of an acute or chronic course. It is equally common in children and adults. The disease is provoked by various infections, more often these are influenza viruses and SARS, pneumococcus, candida (fungi). The likelihood of developing otitis media increases after surgical operations in the nasal cavity and nasopharynx, with immunodeficiency states, adenoids.

The first sign is pain in the ear of a different nature: throbbing, shooting, aching. The pain is often unilateral, but there is also bilateral inflammation. Simultaneously with otalgia, there is a general malaise, high temperature, tinnitus, hearing loss.

Pain inside the ear appears different variants of the inflammatory process:

• Otitis externa. The pain is throbbing, intense, gives to the neck, eyes and teeth, intensifies during conversation and chewing. On examination, a reddened auricle and the visible part of the ear canal are found. Hearing, as a rule, is not disturbed.

• Otitis media. The disease begins with a sudden shooting pain in the ear, which periodically worsens. Sometimes the pain is so pronounced that it disrupts the usual way of life and sleep. Painful sensations persist from one to three days, after which the tympanic membrane ruptures, and mucopurulent discharge comes out of the ear canal. At this moment, the patient’s condition stabilizes, body temperature normalizes, and the intensity of otalgia decreases. The eardrum heals slowly without hearing loss.

• Otitis media or labyrinthitis. A typical symptom of the disease is a severe sudden attack of dizziness, nausea, and vomiting. Some patients complain of noise and ringing in the ears. Otalgia is moderate, and is more felt in the temporal zone. Hearing is usually reduced.

With the unfavorable development of otitis media, pus does not pour outward, but inward, which is dangerous with irreversible hearing loss, inflammation of the temporal bone, brain abscess (formation of a purulent cavity), meningitis (inflammation of the membranes of the spinal cord and brain).

A separate place among the causes of otalgia is occupied by diffuse otitis externa (swimmer’s ear). This is an inflammation of the external acoustic canal, with possible damage to the auricle and tympanic membrane, due to water entering the ear.

The main signs of the disease:

• discharge from the ear of different consistency and color;

• itching in the ear canal;

• throbbing pain inside the ear, which spreads to the upper and lower jaw, temporal zone.

Pressure on the ear, pulling on the lobe, chewing increase the pain. The general condition usually does not worsen, there are no signs of intoxication. Sometimes the parotid lymph nodes are enlarged.

Eustachitis or tubo-otitis

This is an inflammatory lesion of the auditory (Eustachian) tube, which leads to a violation or complete cessation of air flow into the tympanic cavity. Eustachitis is characterized by unilateral, rarely bilateral pain, hearing loss, a feeling of pressure and fullness in the ear canal. Some patients feel heaviness in the head, a feeling of overflowing liquid when moving the head, increased perception of one’s own voice. Symptoms of intoxication and high body temperature indicate the development of purulent tubo-otitis.

Mastoiditis

This is an infectious inflammation of the mastoid process of the temporal bone, which is located behind the auricle. Usually, mastoiditis occurs as a complication of otitis media, and develops 7–14 days after its onset. It starts with headache, temperature, intoxication. In parallel, there is pain inside the ear and behind the ear, hearing loss, a feeling of pulsation in the ear canal. On examination, the behind-the-ear area is reddened and edematous, the auricle protrudes, and there is a copious outflow of pus from the ear.

Injuries

Ear injuries occur for various reasons: a blow with a blunt object, a foreign object, a bullet and knife wound, a burn, damage during medical procedures. Often, the outer ear is injured due to its unprotected anatomical position, less often the tympanic membrane, ear canal, middle and inner ear.

Ear pain is the main symptom of any injury. The pain has a different intensity, from minor discomfort to unbearable. Other symptoms depend on the nature and extent of the damage. Trauma of the auricle is accompanied by the formation of a hematoma, bleeding, hearing loss. Damage to the eardrum is characterized by tinnitus, the release of perilymph (a viscous fluid that is involved in the conduction of sound vibrations).

If an ear injury is one of the consequences of a traumatic brain injury, then headache, dizziness, nausea, flushing of the face, tinnitus and coordination disorder come to the fore. The pain is felt not only inside the ear, but also radiates to the temporal part, the mastoid process. Possible external bleeding.

Diseases of the teeth

Running inflammation of the tissues surrounding the tooth (pulpitis, periodontitis, periodontal disease), deep caries of chewing teeth provoke painful sensations inside the ear. The pain is intense, constant, throbbing, radiating to the neck and temple. Patients simultaneously experience nasal congestion, headache.

Help! A characteristic sign of otalgia against the background of dental diseases is an increase in pain inside the ear when pressing on the diseased tooth.

Sulfur Plug

With an increase in the amount of earwax formation, it accumulates and thickens in the bone part of the external auditory canal. The presence of sulfur plug leads to blockage of the ear canal. For a long time, there are no symptoms, until the auditory canal is completely blocked. Clinically, this is manifested by hearing loss, ear congestion, noise and pain inside the ear. If the sulfur plug puts pressure on the eardrum, then the general condition is complicated by dizziness, headache and nausea.

Mumps (mumps)

This is an infection of the salivary glands and nervous tissue. Has a similar clinic with otitis media and eustachitis. A typical symptom is inflammation of the salivary glands, their swelling and soreness. There is pain and swelling in the parotid region. Unpleasant sensations are aggravated at night, when chewing, pressing behind the earlobe. Disturbs the noise inside the ear, sometimes hearing is reduced.

Concomitant symptoms – general weakness, chills, malaise, dry mouth, fever. The oval of the face is deformed, pear-shaped.

Neurological disorders

Neuralgia of the ear node is characterized by bouts of otalgia in the parotid region and inside the ear from the side of the lesion. The pain is intense, burning, throbbing, spreading to the back of the head, ear, shoulder girdle and lower jaw, sometimes even to the arm and upper chest. Hearing is not broken.

The attack of pain lasts from several minutes to an hour, and even more. During an attack, increased salivation is observed, which is not observed in the interictal period. Reception of hot food, stress, hypothermia increase painful sensations.

With neuralgia of the glossopharyngeal nerve, pain is felt at the root of the tongue, but often also radiates to the ear. Chewing, coughing, taking cold and hot food, drinks provoke a painful attack.

Tumors of the ear

Neoplasms are benign and malignant. Predominantly occur in the outer and middle ear. For a long time they do not manifest themselves clinically. For the first time, painful sensations in the ear occur at the time of active growth of the neoplasm, which puts pressure on the surrounding tissues.

A tumor in the tympanic membrane compresses the vestibule of the ear, which causes neurological disorders: dizziness, lack of coordination, involuntary oscillatory eye movements.

Malignant tumors of the ears are characterized by burning and baking pain, similar to a burn. At first, the pain is episodic, but as the neoplasm grows, it becomes permanent and radiates to the temple. Another characteristic sign of oncopathology is purulent bloody discharge from the ear.

Foreign body in the ear

The presence of a foreign object in the ear canal is accompanied by bursting pain. The pain is constant, not stopped by painkillers, ear drops. A foreign body interferes with the ventilation and pressure of the auditory tube, which leads to a feeling of pressure and congestion, and a decrease in hearing acuity.

Injury to the ear canal with a sharp object can provoke bleeding. Rarely, patients experience dizziness and headache.

Long-term presence of a foreign body in the ear canal is complicated by the inflammatory process. In this case, the intensity of pain increases, acquires a pulsating character, mucopurulent discharge from the ear appears.

Furuncle

This is a purulent inflammation of the sebaceous gland or hair follicle of a part of the outer ear, the auricle. The disease begins with itching and discomfort inside the ear. Then there is a feeling of fullness, pressure, and only then does pain appear. The pain is pulsating, is of a constant nature, spreads to the temporal and occipital zone, neck and head. Any touch, chewing increases the intensity of pain.

The skin of the auricle and the visible part of the auditory canal is swollen and reddened. The purulent-inflammatory process disrupts the ventilation of the auditory canal, which causes hearing loss. There is also an intoxication syndrome, fever, febrile temperature. Relief brings a breakthrough of the abscess, which on average occurs 5-7 days after the onset of the disease. After that, suppuration appears, a decrease in the severity of pain, an improvement in hearing and general condition.

Myringitis

This is an acute or chronic inflammation of the eardrum. It often occurs as a complication of other ear diseases. The first symptom is severe unilateral throbbing pain inside the ear. It intensifies when chewing, is practically not stopped by painkillers, disturbs sleep.

In some patients, instead of otalgia, discomfort and a feeling of heaviness in the ear canal are felt. In parallel, hearing acuity decreases, ear congestion occurs. There is a small amount of serous discharge from the ear canal.

Otomycosis

This is a fungal infection that most often affects the middle and outer ear. Pathology has no specific signs, and is manifested by otalgia, noise and congestion in the ear, expiration of secretions, and a decrease in the quality of hearing. Puffiness of the skin of the outer ear develops, partial or complete overlap of the auditory lumen, the temporomandibular joint and the parotid gland become inflamed.

Help! At risk for the occurrence of otomycosis are those who go in for swimming, have undergone organ surgery or surgical treatment of mastoiditis.

Cancer of the nasopharynx

This is a malignant tumor of the nasal part of the pharynx. Usually the disease debuts at the age of over 50 years. The reasons are not exactly clear. Risk factors include alcohol abuse, smoking, chronic rhinosinusitis, infection with the Epstein-Barr virus (herpesvirus type 4), and hereditary predisposition.

In the nasopharyngeal region, sarcoma, carcinoma and other types of malignant neoplasms can occur. The clinical picture depends on the stage of cancer and the presence of metastases. In the early period, asymptomatic course is possible.

As the disease progresses, signs from the ear, throat and nose appear:

• nasal congestion,

• nasal bleeding,

• nasality,

• the presence of painful compaction in the nasopharynx,

• Ear ache,

• hearing loss,

• noise and ringing in the ears.

Ear pain is more often unilateral from the side of the localization of the tumor, it is felt simultaneously in the zone of the lower jaw and tongue. There is a gradual violation of the perception of speech and surrounding sounds.

The patient’s condition is aggravated by neurological disorders: headache, dizziness, chewing and speech disorders, paralysis of the facial muscles. Usually, in cancer of the nasopharynx, metastases affect the lungs, liver, and bones.

Diagnosis of causes of ear pain

Get expert advice:

• ENT (otolaryngologist)
• ENT for children (otolaryngologist)

A person who has an earache needs to consult an otolaryngologist. Children under 18 are under the supervision of a pediatrician or pediatric otolaryngologist.

A preliminary diagnosis is made after examining the external auditory canal, nasopharynx, oropharynx, paranasal sinuses visually and using endoscopic equipment. From a conversation with the patient, the doctor specifies the conditions for the onset of pain and frequency, a possible antecedent factor, and other accompanying symptoms.

To study the cause of otalgia and choose further treatment tactics, laboratory and instrumental diagnostics is carried out:

• Otoscopy. Examination of the external auditory canal and tympanic membrane with the help of special instruments and a lighting device. With the destruction of the tympanic membrane, the middle ear is available for examination.

• Audiometry. This is the definition of hearing acuity and auditory sensitivity in different ways: speech, computer, tonal.

• X-ray of the temporal bone. The study makes it possible to study in detail the structure of all structures of the ear, to identify inflammation, tumors, bone fractures.

• bacteriological analysis. The biological material from the ear canal is examined for the presence of infection, the resistance of the pathogen to antibacterial drugs is determined.

• General and biochemical analysis of blood. The results reflect the presence of infection, allergies, inflammation in the body.

• CT scan of the skull, MRI of the brain. Assign after traumatic brain injury, fracture of the skull, to clarify the localization of the tumor and foreign object.

If necessary, a consultation of other specialists is prescribed – a traumatologist, neurologist, oncologist, dentist, and additional studies.

Ear pain treatment

The choice of treatment tactics depends on the underlying disease, the severity of the symptoms. In the acute period of infectious and inflammatory diseases, rest, half-bed and bed rest, plenty of fluids, and a sparing diet are recommended for all patients.

First aid before diagnosis

Self-treatment is unacceptable, because due to the anatomical proximity of the ear, the brain and skull bones are quickly involved in the pathological process. With unbearable intense pain before a visit to the otolaryngologist, it is permissible to use drops with an anesthetic effect or painkillers in tablets.

Important! Drops are contraindicated if ear pain occurs after an injury.

Conservative treatment

As a symptomatic treatment to reduce the intensity of pain, different drugs are used:

• Non-steroidal anti-inflammatory drugs. They have anti-inflammatory and analgesic effects, normalize body temperature.

• Ear drops. Anti-inflammatory and antiseptic agents are prescribed. They well disinfect the mucous membranes, eliminate the sensation of a foreign body in the ear canal, relieve inflammation.

• Antiallergic drugs. They are necessary for infectious and inflammatory diseases, as they inhibit the production of mediators of inflammation and pain. These are first-line drugs for allergic diseases. Assign in the form of tablets and drops.

• Antibiotics. It is used for bacterial infections, and is not effective for treating complications of viral diseases. Take a course of 5-10 days. After cancellation, a control bacteriological culture is made to monitor the effectiveness of treatment. With candidiasis, antifungal drugs are needed.

• Vitamins and immunomodulators. They help to fill the deficiency of vitamins, micro- and macroelements, stimulate the protective mechanism, accelerate the recovery time.

If ear pain is a symptom of neurological diseases, then neurometabolic stimulants, metabolic drugs are needed. In the presence of external or otitis media, an ear toilet is performed. Cotton is wound around the probe and pus is collected from the ear canal, after which the passage becomes clean and dry.

In the process of treating infection, inflammation of the ear, throat and nose, physiotherapy methods are effective:

With otitis, sensorineural hearing loss at the stage of recovery, pneumomassage of the tympanic membrane is performed – the supply of pulses of different amplitudes and frequencies.

Surgical treatment

With purulent otitis media, myringotomy is performed to create conditions for the outflow of pus, eliminate inflammation and the consequences of a purulent process. In various ways (with a radio wave knife, a laser scalpel), a small incision is made in the eardrum, the purulent contents are removed, and washed with antibacterial drugs.

The ineffectiveness of drug therapy, chronic otitis media are indications for atticoanthrotomy. This is an opening of the mastoid process of the temporal bone and the epitympanic space in order to remove pathological tissues in the middle ear region.

The consequences of middle ear injuries are eliminated with the help of reconstructive operations:

• myringoplasty – restoration of the integrity of the tympanic membrane with a piece of skin that is taken behind the auricle;

• mastoidoplasty – overlapping of the defect of the mastoid process with a muscular-fascial flap, bone or cartilage tissue;

• tympanoplasty – closing the perforation hole with a thin skin flap.

In case of violations and purulent processes in the inner ear, a number of operations are performed:

• decompression – drainage through the middle ear;

• laser destruction – destruction of vestibular receptors by laser pulses;

• labyrinthectomy – opening of the semicircular canals of the labyrinth.