What is really behind that pesky earache?
Earaches are often associated with children, yet many adults suffer frequently from ear pain, as well. So what causes earaches? Can they be avoided?
Dr. Betty Tsai, assistant professor of otorhinology at the University of Oklahoma Health Science Center and otolaryngologist with OU Physicians, says the first step to managing earaches comes directly from determining the source of the pain.
“It’s important to pay attention to what is causing the pain or making it worse,” explains Tsai.
Spencer Voth, otololaryngologist with the Warren Clinic at Saint Francis Health System, agrees, saying, “The best treatment for an earache is, of course, going to depend on the source of the pain.” He suggests answering the following questions.
“When did your earache start? Is the pain intermittent, or is it constant, dull and achy or sharp and stabbing?” asks Voth. “Are you having any ear drainage, hearing loss, ringing in the ears, balance issues, a sore throat, nasal congestion, facial pain, runny nose or post-nasal drainage? Do you grind your teeth at night, wake up with a sore jaw, chew gum frequently or find yourself clinching your jaw when stressed?”
Or, more seriously, “Do you have any voice changes, difficulty swallowing, difficulty breathing or weight changes?” adds Voth.
These answers will help you and the doctor determine the root cause of an earache and the best course of action to remedy the pain.
While some ear pain can be treated at home with anti-inflammatories, such as ibuprofen or acetaminophen, Voth offers other home remedies that may offer some relief from the discomfort. A warm washcloth, heating pad or even warm liquids in the ear canal can help relieve pain.
“Hot fluids or organic matter, such as garlic, should not be placed in the ear canal,” cautions Voth. “Any earache lasting beyond 24 hours should certainly be discussed with a physician.”
Dr. Austin Sibley, a family medicine physician with St. John Medical Center, takes this one step further.
“If the pain is something that is concerning to you, it’s always acceptable to have it evaluated by your doctor,” encourages Sibley.
Tsai says that most ear pain results from Eustachian tube dysfunction. The Eustachian tubes are small passageways that connect the most inner part of your throat, nose and ears. Eustachian tubes open, allowing air to flow in and out. These tubes usually get blocked by swelling or fluids and often cause pain.
“Allergies or colds are the most common causes of Eustachian tube dysfunction,” comments Tsai.
The positive side to this common dysfunction is that it can be easy to treat. Sibley says simple over-the-counter allergy medicine or a decongestant can work wonders. Voth suggests Afrin or oxymetazoline.
“Over-the-counter nasal decongestants can offer some immediate relief,” says Voth. “But, these should not be used for more than three days.”
Still no relief? Sidley suggested talking to your doctor about a nasal steroid.
Tsai agrees that nasal steroids are often very effective, but adds, “It may take some time to see results.”
“Improvement may not be seen for several days, possibly weeks,” confirms Voth.
“You’ve got stay up on (your doses),” adds Tsai. “It’s really the only way to prevent this kind of ear pain.”
Poorly controlled Eustachian tube dysfunction can lead to serious complications, like cholesteatomas, which are benign lesions in the ear.
Cholesteatomas are very serious and can lead to hearing loss, dizziness, facial paralysis and encephaloceles, a condition where the brain falls into the middle ear, says Tsai.
“Sometimes these can cause bad ear infections that can get into the neck, requiring emergency surgery,” warns Tsai. “The most common complication is hearing loss. The rest are far less common.”
Ear infections, another common cause of ear pain, can develop in the outer, middle or inner ear.
Outer ear infections, sometimes called Swimmer’s Ear, are classically very painful with any movement of the external ear and can be accompanied by drainage from the ear canal, says Voth. An outer ear infection is typically caused by two culprits: moisture or over-cleaning.
Consequently, proper ear care is extremely important in preventing an outer ear infection. Contrary to popular belief, cotton swabs aren’t necessary and can be harmful.
“Don’t ever stick anything into your ears,” advises Tsai.
Instead, simply use a washcloth to clean the wax that makes its way out, suggests Sidley.
Voth agrees, explaining that using cotton swabs can irritate the ear canal.
“Removing the protective earwax leaves the ear canal dry, which can lead to cracking, itching, and pain,” says Voth.
If your outer ear infection is caused by moisture in the ear, a simple at-home remedy can help.
Tsai recommends a few drops of a mixture of equal parts water and vinegar. Sidley, too, has his own recipe.
Voth says a severe outer ear infection might need to be treated with antibiotic eardrops.
Inner ear infections are more commonly found in children under the age of 7 due to the positioning of their still-developing Eustachian tubes.
“Their Eustachian tubes are more horizontal, so pressure and fluids build up easier,” explains Tsai. “If an adult has a one-sided inner ear infection, I would recommend seeing an ear, nose and throat specialist to see if something else is wrong.”
Typically, adults suffer from middle ear infections more often.
“(Middle ear infections are) typically associated with a dysfunctional Eustachian tube, which frequently happens after recent traveling, illness or allergies,” says Voth.
Both inner and middle ear infection are often treated with antibiotics. The concern with ear infections is the frequency they occur.
“If you have chronic ear infections, you need to see your primary care physician to ward off any complications,” recommends Sibley.
“When no obvious source is noted by your physician, evaluation by an otolaryngologist is generally recommended,” says Voth. “Though the chances of your earache being cancer or a tumor are low, this diagnosis cannot afford to be missed.”
“Chronic infections of the ear in adults can be a sign of diabetes or underlying low immune system,” adds Voth.
Ear pain can also be a result of other problems with the mouth, nose and throat.
“The nerve endings (in that area) are connected, so sometimes the brain confuses (other issues) as ear pain,” explains Tsai.
Medical professionals term this as referred otalgia.
“Referred otalgia is most commonly associated with temporomandibular joint dysfunction (TMJ), tonsillitis, dental infections, sinusitis and ulcers of the mouth,” says Voth. “Many head and neck cancers may also present in this way.”
As Sibley said before, if the pain concerns to you, talk to your doctor.