Earache

Earache is pain felt in or around your ear, which can be sharp, dull or burning, and may come and go or stay constant. It's very common, especially in children, and while it can be uncomfortable, it's not usually a sign of anything serious.

Symptoms of earache

Earache can affect one or both ears, and the amount of pain you feel doesn't always match how serious the cause is. In babies and young children, who can't always describe pain, look out for:

• rubbing or pulling at the ear
• not reacting to some sounds
• a temperature of 38°C or above
• being irritable, restless or off their food
• losing their balance more than usual.

If the earache comes from an infection, you might also notice a general feeling of being unwell, a feeling of pressure or fullness in the ear, itching, or fluid discharge from the ear.

Causes and risk factors

Earache often comes from a problem within the ear itself, but it can also be 'referred' pain from a problem somewhere nearby, since your ear shares nerves with other structures in your head and neck. Common causes of earache include:

• outer, middle or inner ear infections
• a build-up of earwax, or an object stuck in the ear
• a hole (perforation) in the eardrum, often after a loud noise or injury
• changes in air pressure, for example when flying or diving
• referred pain from a sore throat, tonsillitis, a tooth infection, sinusitis, or a problem with your jaw joint (TMJ).

In children, ear infections are especially common because their eustachian tube, the passage that drains the middle ear, is shorter and more horizontal than in adults, making it easier for it to become blocked. Being around cigarette smoke also raises a child's risk of ear infections.

Types of ear infection

Since infection is the most common cause of earache, it helps to know that ear infections come in three main types, depending on which part of the ear is affected:

• outer ear infection (otitis externa), affecting the ear canal, often caused by water, irritation from earplugs, or a skin condition such as eczema
• middle ear infection (otitis media), affecting the eustachian tube behind the eardrum, usually caused by a cold or flu virus and most common in children
• inner ear infection (otitis interna), affecting the deeper labyrinth and balance system; this can affect both adults and children and may also cause dizziness.

Diagnosing earache

Your GP or pharmacist can usually identify the cause of earache by asking about your symptoms and examining your ear with an otoscope, an instrument with a small light and magnifying lens. Some otoscopes also puff a small amount of air into the ear to check how well your eardrum moves, which can reveal a blockage or fluid build-up.

If there's tenderness, pain or redness over the bone just behind your ear, this can be a sign of a more serious infection, so your doctor may examine this area too.

Treating earache

Most earaches get better on their own within a few days, so treatment often starts with simple things you can do at home:

• take paracetamol or ibuprofen (children under 16 should not take aspirin)
• hold a warm flannel, or a cold pack, against the affected ear
• rest in an upright position rather than lying flat, to ease pressure in the middle ear
• chew, or, for babies, breastfeed or suck on a bottle, if the pain is related to a change in air pressure, such as during a flight.

Don't put anything inside your ear, including cotton buds, don't try to remove earwax yourself, and don't let water get into your ear while it's healing.

If home treatment isn't enough, a pharmacist or GP may prescribe antibiotic, antifungal, steroid or painkilling ear drops, or antibiotic tablets, depending on the cause. Ear drops shouldn't be used if you have a perforated eardrum. If there's a build-up of pus, a GP may refer you to an ENT specialist to pierce and drain it with a needle.

When to see a doctor

See a pharmacist first if you or your child, aged 1 to 17, has earache; they can offer the same treatments as a GP for an ear infection. See a GP if your child is under 12 months old and you think they have an ear infection, if earache doesn't improve after 2 to 3 days, or if you keep getting earache or ear infections.

Get an urgent GP appointment or call NHS 111 if you or your child have earache along with:

• feeling generally unwell, a very high temperature, or feeling hot, cold or shivery
• swelling around the ear, or fluid coming from the ear
• a change in hearing or new hearing loss
• feeling or being sick, dizziness, or a severe sore throat
• an existing condition such as diabetes, or a heart, lung, kidney, neurological or immune condition.

Contact your doctor straight away, too, if severe pain suddenly stops, since this can be a sign of a ruptured eardrum, or if something is stuck in the ear; don't try to remove an object yourself.