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Symptoms and Signs of Earache (Ear Pain)

Doctor's Notes on Earache and Ear Pain

Eye pain is pain or discomfort that originates within the structures of the eye or the surrounding structures, including the eyelids, conjunctival membranes, cornea, or muscles and nerves that control the eye. There are a number of different causes of eye pain, which can include corneal infections, corneal abrasions, conjunctivitis (pink eye), blepharitis (inflammation of the eyelids), glaucoma, optic neuritis, and sinusitis, among others. A foreign object in the eye is also a source of eye pain, along with trauma or injury to the eye area.

Signs and symptoms associated with eye pain vary depending on the exact cause of the pain. These can include redness, swelling, bleeding, excessive tearing, vision disturbances, headache, nausea, and vomiting. Other associated symptoms can include the sensation of something in the eye, such as a gritty or irritated feeling.

Medical Author:
Medically Reviewed on 3/11/2019

Earache and Ear Pain Symptoms

Aside from pain symptoms of an earache depends upon the underlying cause

Outer ear (helix, auricle) inflammation include:

  • Redness
  • Swelling
  • Fever
  • Auricle trauma causes a well-defined hematoma or clot in the outer ear

Otitis externa or swimmer's ear symptoms include:

  • Pain, fullness or pressure
  • Itching
  • Drainage
  • Decreased hearing
  • Tinnitus or ear ringing

Otitis media (middle ear infection) symptoms include:

  • Deep pain
  • Decreased hearing
  • Fever
  • Fullness
  • Ear drainage if there is associated ear drum perforation
  • Inner ear inflammation (labyrinthitis, vertigo)
  • Vertigo (a sense of the room or surroundings spinning)
  • Loss of balance
  • Nausea and vomiting
  • Decreased hearing, tinnitus (these may be symptoms of Meniere's disease or acoustic neuroma)

Myringitis symptoms include:

  • Pain
  • Decreased hearing
  • Ear fullness
  • Drainage that may be bloody

Other symptoms associated with other causes of earache:

  • When ear pain occurs because of an illness or injury from a structure adjacent to the ear, the specific symptoms will be related to that structure. For example, TMJ inflammation may lead to earache, but most often is associated with pain when opening the mouth or with chewing. Dental issues may cause ear pain, but most likely involve tooth or gum pain.

Earache and Ear Pain Causes

The ear has many parts to it, and each may cause ache, pain or other discomfort. Pain may come from one or many parts of the ear, depending on the situation.

The helix and auricle form the outer part of the ear cartilage and may become inflamed and infected. Inflammation may be due many reasons including:

  • Skin infection or cellulitis
  • Sunburn
  • Chronic skin irritations, like atopic dermatitis
  • Trauma. An injured auricle is a common wrestling injury. If a hematoma (bruise/blood clot) forms, it can be very painful and may cause damage to the underlying cartilage, resulting in a cauliflower ear.
  • The ear canal may be a source of pain due to infection or trauma.

Otitis externa is inflammation of the ear canal, and is often referred to as "swimmer's ear."

  • Irritation to the skin that lines the canal may be due to minor trauma, like trying to clean ear wax with a sharp object and causing a scratch that becomes inflamed or infected.
  • swimmer's ear describes inflammation caused by retained water in the ear canal. The dark, warm, moist area may promote bacterial growth and predispose to infection.
  • Cerumen (ear wax) impaction. Ear wax is part of the body's protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds excessively, it may cause significant pain. This is especially true if the wax presses against the eardrum.
  • Foreign body. When a foreign body is inserted in the ear and cannot be removed, pain and inflammation may occur. These may include Q-tips, hair pins, and other narrow objects that are often used to scratch an itch or to remove ear wax. This is never safe, and nothing should be inserted into the ear canal. In addition to irritation of the external canal, the ear drum may also be perforated or damaged.

Otitis externa is inflammation of the ear canal, and is often referred to as "swimmer's ear."

  • Irritation to the skin that lines the canal may be due to minor trauma, like trying to clean ear wax with a sharp object and causing a scratch that becomes inflamed or infected.
  • swimmer's ear describes inflammation caused by retained water in the ear canal. The dark, warm, moist area may promote bacterial growth and predispose to infection.
  • Cerumen (ear wax) impaction. Ear wax is part of the body's protective mechanism to lubricate the ear canal and prevent infection. If the wax hardens and builds excessively, it may cause significant pain. This is especially true if the wax presses against the eardrum.
  • Foreign body. When a foreign body is inserted in the ear and cannot be removed, pain and inflammation may occur. These may include Q-tips, hair pins, and other narrow objects that are often used to scratch an itch or to remove ear wax. This is never safe, and nothing should be inserted into the ear canal. In addition to irritation of the external canal, the ear drum may also be perforated or damaged.
  • The inner ear is adjacent to the middle ear. The inner ear is the site of the labyrinth system that sends messages to the brain to help with balance. Inflammation of the inner ear is associated with vertigo but not necessarily pain.
  • The inner ear is adjacent to the middle ear. The inner ear is the site of the labyrinth system that sends messages to the brain to help with balance. Inflammation of the inner ear is associated with vertigo but not necessarily pain.

Ear discomfort may be due to pain from a nearby structure that that radiates to the ear:

  • TMJ pain. The temporomandibular joint, where the jaw attaches to the skull, is located adjacent to the external ear canal, and inflammation of this joint may be associated with ear pain. TM joint pain may be due to trauma or arthritis. Teeth grinding may cause irritation and ear pain as well.
  • Sinusitis may be associated with increased pressure within the middle ear, causing pain.
  • Dental problems and toothaches may radiate pain to the ear area.
  • Mastoiditis. The mastoids are bony prominences of the skull filled with air cells and are located behind the ear. Infection of these areas may cause ear pain.
  • Pharyngitis (throat inflammation) and tonsillitis may cause pain that radiates to the ear. A peritonsillar abscess will often result in ear pain in addition to difficulty opening the mouth and difficulty swallowing.
  • Thyroid inflammation and carotid artery pain (carotidynia) may also be associated with ear pain
  • Trigeminal neuralgia. Inflammation of the fifth cranial nerve may cause significant facial pain including ear pain.
  • Tinnitus. While not truly pain, ringing in the ear may cause significant discomfort
  • Barotrauma describes injury to the ear because an acute change in pressure within the middle and inner ear. This may include changing pressures from flying in an airplane, scuba diving or snorkeling, or trauma due to a blast injury. Damage may occur to any or all of the eardrum, middle and inner ear.

Ear discomfort may be due to pain from a nearby structure that that radiates to the ear:

  • TMJ pain. The temporomandibular joint, where the jaw attaches to the skull, is located adjacent to the external ear canal, and inflammation of this joint may be associated with ear pain. TM joint pain may be due to trauma or arthritis. Teeth grinding may cause irritation and ear pain as well.
  • Sinusitis may be associated with increased pressure within the middle ear, causing pain.
  • Dental problems and toothaches may radiate pain to the ear area.
  • Mastoiditis. The mastoids are bony prominences of the skull filled with air cells and are located behind the ear. Infection of these areas may cause ear pain.
  • Pharyngitis (throat inflammation) and tonsillitis may cause pain that radiates to the ear. A peritonsillar abscess will often result in ear pain in addition to difficulty opening the mouth and difficulty swallowing.
  • Thyroid inflammation and carotid artery pain (carotidynia) may also be associated with ear pain
  • Trigeminal neuralgia. Inflammation of the fifth cranial nerve may cause significant facial pain including ear pain.
  • Tinnitus. While not truly pain, ringing in the ear may cause significant discomfort
  • Barotrauma describes injury to the ear because an acute change in pressure within the middle and inner ear. This may include changing pressures from flying in an airplane, scuba diving or snorkeling, or trauma due to a blast injury. Damage may occur to any or all of the eardrum, middle and inner ear.

The middle ear is separated from the external ear canal by the eardrum, and this is the location of nerves involved with hearing. It is a relatively closed space and anything that increases pressure in the middle ear will cause pain.

  • Middle ear infections are a common cause of otitis media especially in children. These are commonly caused by a virus or bacteria that invades and infects stagnant fluid in the middle ear.
  • Serious otitis media describes fluid collection within the middle ear and is usually due to Eustachian tube dysfunction. This is the tube that drains fluid and equalizes pressure between the middle ear and the back of the throat. Increased pressure may cause pain and fullness but usually resolves over time. However, this fluid may also become infected, causing pain and fever.

The middle ear is separated from the external ear canal by the eardrum, and this is the location of nerves involved with hearing. It is a relatively closed space and anything that increases pressure in the middle ear will cause pain.

  • Middle ear infections are a common cause of otitis media especially in children. These are commonly caused by a virus or bacteria that invades and infects stagnant fluid in the middle ear.
  • Serious otitis media describes fluid collection within the middle ear and is usually due to Eustachian tube dysfunction. This is the tube that drains fluid and equalizes pressure between the middle ear and the back of the throat. Increased pressure may cause pain and fullness but usually resolves over time. However, this fluid may also become infected, causing pain and fever.

A health-care professional usually diagnoses the cause of an earache by talking to the patient, parent, or caregiver (taking history) and performing a physical examination. In general, X-rays and other tests are unnecessary.

Otoscope

The health-care professional may use an otoscope to look into the ear canal to evaluate the canal and the ear drum.

  • If otitis externa is the cause of the earache, the ear canal will look swollen and inflamed. There may be thick drainage visible. Sometimes, the canal may be so swollen and painful that the canal cannot be seen.
  • Bullous myringitis is diagnosed by using the otoscope to visualize the ear drum. The tissue will look inflamed and fluid blisters can be seen.
  • Otitis media causes inflammation and swelling of the middle ear. The health-care practitioner cannot see the middle ear directly but instead, uses the otoscope to look at the ear drum. Initially, fluid fills the middle ear (serous otitis media), and there may be air and fluid bubbles seen behind the drum. As pressure builds, the ear drum may not move if a small puff of air is pushed through the otoscope. If the eardrum looks red and inflamed, the diagnosis of acute otitis media is made. The presence of fluid is called an effusion and may persist for two to three months after the acute infection has resolved.
  • The eardrum may appear scarred if there have been previous infections.
  • If tubes have been placed in the ear drum to treat chronic ear infection, these may be seen, if they are still in place.

The health-care professional also may evaluate other parts of the body including the throat (looking for sore throat or tonsillitis), the neck (feeling for swollen lymph nodes and assessing stiffness), and the lungs (looking for signs of pneumonia). This is especially important if the earache persists and there is no apparent reason for ear pain on examination. Referral to an ear, nose, and throat specialist may be necessary to evaluate the structures deeper in the throat with an endoscope (flexible camera) or a mirror.

Hearing tests

  • Hearing tests may be recommended if there have been recurrent infections or if there has been a delay in speech development.
  • Patients with vertigo may undergo hearing tests.

Laboratory tests

  • Laboratory testing is usually not indicated in caring for routine ear infections.
  • Rarely, a sample of drainage from the ear is sent to the laboratory in an attempt to identify the specific bacteria causing the infection. Sending the sample to the laboratory is not necessary in most cases and usually is reserved for infections that do not respond to normal treatment.

Imaging

X-ray, CT and other imaging studies are not usually needed for most cases of ear pain. They may be considered if there is concern for tumors or other structural problems in or adjacent to the ear.

A health-care professional usually diagnoses the cause of an earache by talking to the patient, parent, or caregiver (taking history) and performing a physical examination. In general, X-rays and other tests are unnecessary.

Otoscope

The health-care professional may use an otoscope to look into the ear canal to evaluate the canal and the ear drum.

  • If otitis externa is the cause of the earache, the ear canal will look swollen and inflamed. There may be thick drainage visible. Sometimes, the canal may be so swollen and painful that the canal cannot be seen.
  • Bullous myringitis is diagnosed by using the otoscope to visualize the ear drum. The tissue will look inflamed and fluid blisters can be seen.
  • Otitis media causes inflammation and swelling of the middle ear. The health-care practitioner cannot see the middle ear directly but instead, uses the otoscope to look at the ear drum. Initially, fluid fills the middle ear (serous otitis media), and there may be air and fluid bubbles seen behind the drum. As pressure builds, the ear drum may not move if a small puff of air is pushed through the otoscope. If the eardrum looks red and inflamed, the diagnosis of acute otitis media is made. The presence of fluid is called an effusion and may persist for two to three months after the acute infection has resolved.
  • The eardrum may appear scarred if there have been previous infections.
  • If tubes have been placed in the ear drum to treat chronic ear infection, these may be seen, if they are still in place.

The health-care professional also may evaluate other parts of the body including the throat (looking for sore throat or tonsillitis), the neck (feeling for swollen lymph nodes and assessing stiffness), and the lungs (looking for signs of pneumonia). This is especially important if the earache persists and there is no apparent reason for ear pain on examination. Referral to an ear, nose, and throat specialist may be necessary to evaluate the structures deeper in the throat with an endoscope (flexible camera) or a mirror.

Hearing tests

  • Hearing tests may be recommended if there have been recurrent infections or if there has been a delay in speech development.
  • Patients with vertigo may undergo hearing tests.

Laboratory tests

  • Laboratory testing is usually not indicated in caring for routine ear infections.
  • Rarely, a sample of drainage from the ear is sent to the laboratory in an attempt to identify the specific bacteria causing the infection. Sending the sample to the laboratory is not necessary in most cases and usually is reserved for infections that do not respond to normal treatment.

Imaging

X-ray, CT and other imaging studies are not usually needed for most cases of ear pain. They may be considered if there is concern for tumors or other structural problems in or adjacent to the ear.

Ear Infection Symptoms, Causes, and Treatment Slideshow

Ear Infection Symptoms, Causes, and Treatment Slideshow

Sometimes it seems like kids are always getting ear infections. Ear infections are very common in children. Children get ear infections about two out of every three times they have a cold. Children are more prone to ear infections because their small ears do not drain fluid as well as adult ears. Kids’ immune systems are also immature, and this increases the likelihood of certain infections.

There are three types of ear infections. Each type is defined according to where they occur in the ear canal. An ear infection may take place in the inner, middle, or outer ear. Each type of ear infection may exhibit different symptoms.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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