Ear pain or earache (otalgia) is a very common problem, particularly in children, and because the pain is often caused by a build-up of pressure inside the middle ear, normal (and even prescribed) painkillers are often not effective. Only reducing the pressure will ease the pain.
It is often difficult to tell if a child has an ear infection, but this trick may help. If moving the outer ear causes pain, a middle ear infection is a possibility. If pressure on the tragus (the firm lump of cartilage immediately in front of the ear canal) causes pain, an outer ear infection is possible. If neither causes pain, an ear infection is unlikely.
A direct injury to the ear from a blow or fall may cause bleeding, bruising, swelling and pain to the ear and surrounding tissues.
Wax is normally produced in the ear canal by specialised glands, and slowly moves out of the canal to keep it clean. If excess amounts of wax are produced, dirt or dust gets into the canal, water swells the wax in the canal, or attempts are made to clean the canal with a cotton bud or other implement, the wax may become swollen, hard and tightly packed in the canal to cause pain and deafness.
Otitis externa (swimmer’s ear) is a bacterial or fungal (tropical ear) infection of the ear canal. The ear becomes very painful, and as the infection progresses, a smelly discharge usually develops.
Middle ear infections (otitis media) are a very common cause of temporary deafness in children that if left untreated, may progress to a permanent partial loss of hearing. The ear is painful, the child is feverish, and when a doctor examines the ear, a red bulging eardrum can be seen.
If phlegm from the nose enters the middle ear cavity through the Eustachian tube, or other secretions accumulate in the cavity, it is difficult for them to escape back through the Eustachian tube to the back of the nose, particularly if the adenoids which surround the opening of the tube into the nose are swollen. This is glue ear, and may be responsible for recurrent infections in the ear, deafness and low-grade ear discomfort.
A Eustachian tube blocked with phlegm will prevent pressure equalisation between the middle ear and the outside if there is an altitude change (e.g. taking off in an aircraft) or pressure change (e.g. scuba diving). Intense pain will be felt in the ear because of distortion of the sensitive eardrum with the pressure difference. In the worst cases, the eardrum will burst, the pain will ease, but the ear will be deaf until the ear drum heals.
If bacteria or viruses enter the sinuses, an infection (sinusitis) may result and thick pus is produced. The sinuses becomes very painful and tender, then waste products from the infection enter the blood stream, and cause a fever, headaches and the other unpleasant sensations of any major infection. It is quite easy for the infection to spread through the Eustachian tube from the back of the nose to the middle ear.
The sensory nerves that supply the teeth run along the top and bottom jaws to a point just in front of the ear where they enter the skull. Any infection or disease of a tooth can inflame the nerve running from that tooth, but the pain may be felt in the ear because of the course the nerve follows to the brain. Babies who are teething often pull at their ears because of this phenomenon.
Less common causes of earache include a foreign body in the ear canal (e.g. a small toy, nut, insect), mastoiditis (infection in the bone behind the ear), a furuncle (boil in the ear), a cholesteatoma (foul smelling growth in the ear canal) and parotitis (infection of the parotid salivary gland). There are many uncommon and rare causes of ear pain.