Ear Ache vs. Ear Infection: What’s the Difference?

Ear pain can range from a minor nuisance to a major source of agony. Ear pain is a common problem, especially in children, and can have a number of causes – some of which have nothing to do with the ear.

But how to know whether it’s an ear ache or an ear infection? And when is it serious enough to seek medical help? We talked with UH family medicine physician Meredith Hale, DO, to find out.

Ear Infections

Ear infections are the most common cause of ear pain. It’s especially common in children and is the most common reason parents bring their child to a doctor. In fact, five out of six children will have at least one ear infection by their third birthday.

An ear infection happens when fluid in the interior space behind the eardrum becomes infected, usually with bacteria. The tube leading into the body becomes blocked, and fluid builds up behind the eardrum. The increased pressure pushes the eardrum outward, causing pain and fever.

An ear infection often occurs after a sore throat, cold or other upper respiratory infection, Dr. Hale says. Symptoms include hearing loss, fever and feeling unwell.

Most ear infections happen to children before they’ve learned how to talk. Here are a few things parents should look for if they suspect their young child has an ear infection:

• Tugging or pulling at the ear
• Fussiness and crying
• Trouble sleeping
• Fluid draining from the ear
• Clumsiness or balance problems

Ear Ache

Ear aches are not always caused by an ear infection. Other conditions also can cause ear ache or ear pain, especially in adults.

Ear ache is often described as a feeling of pressure in the ear.

“It can begin suddenly or gradually, and it can be quite severe,” Dr. Hale says.

Aside from infection of the inner ear, other causes of ear pain include:

• Injury
• Swimmer’s ear – inflammation and infection in the channel that leads from the eardrum to the outside.
• Cellulitis — infection of the external ear and ear lobe
• Pain caused by irritation of the nerves in the ear
• Pain from a sore throat or a problem with the jaw joints
• Referred pain from infections or inflammation elsewhere in the body such as a toothache
• Allergic reactions from soap, shampoo, earrings or other allergens
• Water trapped in the ear
• Changes in altitude

Many people wonder if ear wax buildup causes ear pain. Normally, your ear canal does not need to be cleaned. But sometimes ear wax does build up, become impacted and cause symptoms, usually a sensation of fullness or muffled sound as if you are wearing ear plugs.

“When too much wax blocks the ear, you may feel pressure, but this usually doesn’t cause pain,” Dr. Hale says.

When To See a Doctor

Ear infections don’t always need to be treated with antibiotics. “Sometimes, we observe and initiate antibiotic therapy if signs and symptoms worsen or fail to improve after 48 to 72 hours,” Dr. Hale says.

If your child has repeated ear infections or trouble hearing, your doctor may suggest meeting with an ear, nose and throat specialist to discuss placing small tubes in your child’s ear to help maintain a healthy environment.

If you experience intense pain, a high fever or a hearing loss, it’s important to seek medical attention immediately, Dr. Hale says.

Related Links

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Symptoms, Causes, Treatments, and Prevention

Earaches usually occur in children, but they can also occur in adults. Injury, infection, irritation in the ear, or referred pain may cause earaches.

An earache may affect one or both of your ears. But most of the time, it’s in one ear. It may be constant or come and go, and the pain may be dull, sharp, or burning.

If you have an ear infection, you may also get a fever, and temporary hearing loss may occur. Young children who have ear infections tend to be fussy and irritable. They may also tug or rub their ears.

Read on for other symptoms, causes, treatments, and more.

Earaches can develop from ear infections or injury. Symptoms in adults include:

• ear pain
• impaired hearing
• fluid drainage from ear

Children can typically show additional symptoms, such as:

• ear pain
• muffled hearing or difficulty responding to sounds
• fever
• sense of fullness in the ear
• difficulty sleeping
• tugging or pulling at the ear
• crying or acting irritable more than usual
• headache
• loss of appetite
• loss of balance

Ear pain is felt somewhere other than the infection or injured site. For example, pain in the jaw or teeth may be felt in the ear.

Causes of earaches can include:

Ear infections

Ear infections are a common cause of earaches or ear pain. Ear infections can occur in the outer, middle, and inner ear.

Outer ear infection can be caused by swimming, wearing hearing aids or headphones that damage the skin inside the ear canal, or putting cotton swabs or fingers in the ear canal.

Skin in the ear canal that gets scratched or irritated can lead to infection. Water softens the skin in the ear canal, which can create a breeding ground for bacteria.

Middle ear infection can be caused by infections that stem from a respiratory tract infection. Fluid buildup behind the ear drums caused by these infections can breed bacteria.

Labyrinthitis is an inner ear disorder that’s sometimes caused by viral or bacterial infections from respiratory illnesses.

Other common causes of earaches

• change in pressure, such as when flying on a plane
• earwax buildup
• a foreign object in the ear
• strep throat
• sinus infection
• shampoo or water trapped in the ear
• use of cotton swabs in the ear

Less common causes of earaches

• temporomandibular joint (TMJ) syndrome
• perforated eardrum
• arthritis affecting the jaw
• infected tooth
• impacted tooth
• eczema in the ear canal
• trigeminal neuralgia (chronic facial nerve pain)

You can take several steps at home to reduce earache pain. Try these options to ease the ear pain:

• Apply a cold washcloth to the ear.
• Avoid getting the ear wet.
• Sit upright to help relieve ear pressure.
• Use over-the-counter (OTC) ear drops.
• Take OTC pain relievers.
• Chew gum to help relieve pressure.
• Feed an infant to help them relieve their pressure.

If you have an ear infection, your doctor will prescribe oral antibiotics or eardrops. In some cases, they’ll prescribe both.

Don’t stop taking the medication once your symptoms improve. It’s important that you finish your entire prescription to ensure that the infection will clear up completely.

If a buildup of wax is causing your ear pain, you may be given wax-softening eardrops. They may cause the wax to fall out on its own. Your doctor may also flush out the wax using a process called ear lavage, or they may use a suction device to remove the wax.

Your doctor will treat TMJ, sinus infections, and other causes of earaches directly to improve your ear pain.

If you or your child has a persistent fever of 104ºF (40 ºC) or higher, seek medical attention. For an infant, seek medical help immediately for a fever higher than 101ºF (38ºC). The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.

You should also seek immediate medical attention if you have severe pain that stops suddenly. This could be a sign of the eardrum rupturing.

You should also watch for other symptoms. If any of the following symptoms appear, make an appointment with your doctor:

• severe ear pain
• dizziness
• bad headache
• swelling around the ear
• drooping of the facial muscles
• blood or pus draining from the ear

You should also make an appointment with your doctor if an earache gets worse or doesn’t improve in 24 to 48 hours.

You can book an appointment with a primary care doctor in your area using our Healthline FindCare tool.

Some earaches may be preventable. Try these preventive measures:

• Avoid smoking and exposure to secondhand smoke.
• Keep foreign objects out of the ear.
• Dry the ears after swimming or bathing.

Avoid allergy triggers, such as dust and pollen.

Read this article in Spanish.

Ear hurts

Arthritis

Otitis

Labyrinthite

Mastoiditis

5731

09 June

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.

Pain associated with labyrinthitis and mastoiditis

Audio and vestibulometric examinations, bacterial culture from the middle ear with the determination of sensitivity to an extended spectrum of antimicrobials, radiography or CT of the temporal bone.

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 guidelines “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.

What to do when your ear hurts – an article on the site Aptechestvo, Nizhny Novgorod

Ear pain in adults or ear pain in a child is simply exhausting. Usually it is accompanied by discomfort, fatigue, sleep disturbance, loud crying. Practice shows that people with ear pain make many mistakes that lead to complications. What to do when your ear hurts? First of all, you need to consult a doctor who will diagnose ear pain and prescribe the appropriate course of treatment.

When an adult’s ear hurts or a child’s ear hurts, discomfort can occur in different departments. We will analyze them in accordance with the generally accepted classification.

Pain in the outer ear

This part of the auditory organ is considered the most unprotected for infections. Why does my ear hurt? Very often, pain occurs due to inflammatory processes caused by bacteria. Another reason is improper cleaning, physical damage, foreign bodies. All this leads to the appearance of boils and even eczema. In such cases, doctors put otitis externa.

Pain in the middle ear

Ear pain can also appear in the middle ear. The department is closely connected with the outer ear and nasopharynx. Therefore, it is also characterized by the appearance of infections. Pathologies in the middle ear are accompanied by shooting pain, pulsation, hearing loss, distortion of the perception of one’s own voice.

Main pathologies:

• inflammatory processes;

• tumors in the tympanic cavity;

• trauma and breach of integrity;

• problems in the auditory tube.

In some cases, severe ear pain may appear after going to the pool. Pain extends both to the outer ear, where the infection could have entered, and to the middle ear, where pain is caused by the strong pressure of water when diving to depth.

Pathologies of the inner ear

The defeat of the inner ear in most cases is not accompanied by pain. Therefore, here, it is best to talk about pathologies. The main symptoms: impaired coordination, periodic nausea, extraneous sounds, headaches, dizziness and rapid hearing loss.