Earache

Definition

An earache is a commonly used term for ear pain or discomfort that is a symptom of disease or injury.

Description

An earache itself is not a disease, but it is a symptom of disease or injury in the external or middle ear. It may also be a symptom of problems in the mouth, nose, or throat. Infants or very young children may be unable to say that they are in pain. Increased irritability or pulling at the ears is often a sign of ear pain in infants.

Causes & symptoms

The most common cause of an earache is a buildup of pressure in the eustachian tube. Among other functions, the eustachian tube drains fluids out of the middle ear via the back of the throat. A cold, allergy, or sore throat can cause the eustachian tube to swell shut. Infants and young children are especially susceptible to earaches caused by problems with the eustachian tube, since the structure is still underdeveloped in that age group. When the normal drainage of fluid is prevented, it can accumulate in the middle ear, causing pressure, pain, stagnation, and possibly infection.

An earache may be due to a perforated, or broken, eardrum. The eardrum can be broken as a result of a blow to the head, infection in the inner ear, suction applied to the ear, or the insertion of a foreign object into the ear. Infections of the middle and outer ears are often associated with earaches. Other causes of an earache may be the obstruction of the ear canal with a foreign object or excessive ear wax, boils in the ear canal, a herpes zoster infection of the ear, keratosis of the ear, tumors, an infection of the mastoid process, "swimmer's ear," and the aftermath of surgical procedures. Ear pain can also be caused by a rapid descent from high altitudes, during air travel or travel in the mountains. A sinus infection, arthritis of the jaw, sore throat, tonsillitis, and dysfunction of the temporomandibular joint (TMJ) may be the source of referred pain to the ears.

Diagnosis

A history of the illness should be obtained, including information about the symptoms accompanying the earache. A physical exam should be performed, which may include an examination of the ears, the nasal passages and sinuses, and the throat. An otoscope may be used to see more deeply into the ears, nose, and throat. In addition, the teeth, tongue, tonsils, salivary glands, and TMJ should be examined for problems that might be causing referred pain to the ears. A culture and sensitivity test should be done if there is any discharge from the ears. X rays or a computed tomography (CT) scan may be required to diagnose the problem. Hearing and balancing tests are important to the diagnosis of an earache.

Treatment

Three to five drops of the warmed oil extract of mullein flowers (Verbascum thapsus), garlic (Allium sativa), or St. John's wort (Hypericum perforatum), or a combination of any of the three should be placed into the affected ear. The oil of Calendula officinalis may be used in the same manner. If there is a persistent ear infection, goldenseal (Hydrastis canadensis) salve or tincture can be placed directly onto the outer ear or into the ear canal three to four times per day. Glycerin can be introduced into the ear if it is suspected that excessive earwax or water in the ear is causing the problem.

Food and environmental allergies should be considered as contributors to the development of ear pain and infections, especially if the earache is chronic or recurrent. Allergy testing should be done, and then the allergens should be avoided. Alcohol, dairy products, smoking, caffeine, sugary foods, and processed foods should also be avoided to keep from stressing the immune system. One or two cloves of raw garlic daily may help end chronic episodes of earache, since garlic can kill many of the pathogens that cause earaches. If there is trouble tolerating raw garlic, a daily garlic supplement can be taken instead. Daily supplementation of vitamin C, bioflavonoids, zinc, and beta carotene is recommended to treat some of the underlying conditions causing ear pain and bolster general immune function.

Several homeopathic remedies may also be helpful in treating earaches. Depending upon the symptoms, a 6C or 12C dose of Pulsatilla, Mercurius, or Hepar sulphuris, or a 30C dose of Belladonna can be taken for up to four doses. If there is no symptom relief, a homeopath or other healthcare practitioner should be consulted.

Hydrotherapy treatment for earaches includes the use of hot compresses. To make a compress, a large cloth soaked in hot water should be placed over both ears and the throat for about five minutes. A hot water bottle or smaller compress can also be used. A new hot compress can be used every three to five minutes until the earache is relieved for a maximum of 30 minutes. This treatment is best when the feet are in a hot footbath while the compresses are being applied. Hot water can be added as needed to keep the water comfortably hot. The soak can be repeated two or three times a day as needed.

Massage such as tui na or reflexology can be helpful in clearing up ear pain, congestion, and TMJ dysfunction. A knowledgeable practitioner should be consulted.

Allopathic treatment

If an earache is accompanied by any of the following symptoms, a healthcare provider should be consulted as soon as possible:

severe pain
discharge from the ear
a fever of 102°F (38.8°C) or higher
a sudden change in hearing
a sudden onset of dizziness
an inability to concentrate
facial muscle weakness
earache lasts for more than a few days
earache is worse during chewing
sudden or severe ear pain without any other accompanying symptoms
does not respond to home treatment
appears to be getting worse
pain, tenderness, or redness of the over the area of the mastoid process, which often indicates a serious infection

Antibiotics, decongestants, and antihistamines are often prescribed to halt the infection and inflammation that may be the cause of ear pain. The insertion of ear tubes may be recommended for children who have persistent ear infections to reestablish proper functioning of the middle ear. However, the effectiveness of this treatment is still widely debated. Repeated swallowing or gum-chewing can relieve ear pain caused by changes in pressure secondary to changes in altitude. Allowing infants and young children to suck on a bottle during descent can help relieve popping and ear pain. TMJ dys-function should be evaluated by a dentist. Anti-inflammatory medication, tranquilizers, or muscle relaxants may be prescribed for temporary relief. Other treatments for TMJ problems include braces to correct the bite or a bite plate to wear when sleeping.

Expected results

Earaches can generally be relieved by attending to the underlying problem. Untreated problems may lead to serious ear damage and possible hearing loss. Most children with chronic earaches due to infections tend to out-grow the condition.

Prevention

A hair dryer or other method should be used after swimming if there is a tendency for the ears to retain water. Earplugs should be worn while swimming and cotton or wool should be loosely inserted into the outer ear canal during showers or when the hair is being washed. Objects such as cotton swabs should not be inserted into the ear canal. A healthy immune system should be maintained to reduce the opportunity for infections.