An earache can be sharp, dull, or burning pain. The pain may be temporary or constant.

Ear pain in children is often caused by a build-up of fluid and pressure behind the eardrum, in the area called the middle ear. The middle ear is connected to the nasal passages by a short narrow tube, the Eustachian tube. The Eustachian tube allows normal fluids to drain out of the middle ear, and helps keep the pressure in your ear equalized.

A cold or allergy can block the Eustachian tube due to inflammation and the build-up of secretions. This is especially likely in small children, because their Eustachian tube is shorter and more horizontal. When the Eustachian tube closes, the normal flow of fluid from the middle ear is prevented. The fluid begins to accumulate, which can cause stuffiness, pain, hearing loss, and an ear infection.

The symptoms of an ear infection may include fever, ear pain, fussiness, increased crying, and irritability. Many children will have temporary and minor hearing loss during and right after an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has.

Ear pain in a child or infant is not always from infection, however. Other causes include water from bathing, soap or shampoo retention, or ear canal irritation from cotton-tipped swabs.

Ear pain in adults is less likely to be from an ear infection. What you perceive as ear pain may actually be coming from another location, such as your temporomandibular joint, your teeth, throat, or other location. This is called "referred" pain.

• An object stuck in the ear or severely impacted ear wax
• An ear infection
  • Middle ear infection - acute (short and severe episode)
  • Middle ear infection - chronic (does not go away or recurs)
  • Outer ear (canal) infection - acute
  • Outer ear (canal) infection - chronic
  • Outer ear (canal) infection - malignant
• Ear injury from pressure changes (from high altitudes and other causes)
• Ruptured or perforated eardrum
• Tooth infection
• Sinus infection
• Arthritis of the jaw
• Sore throat with referred pain to the ears
• Temporomandibular joint syndrome (TMJ)

The following steps may help an earache:

• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give aspirin to children .)
• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• Olive oil or over-the-counter ear drops are gentle and effective, as long as the eardrum has not ruptured. Prescription drops, such as Auralgan, are also effective at pain relief.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position may help reduce pressure in the middle ear.

Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help.

For children, call your child's doctor if:

• The child's symptoms (pain, fever, or irritability) do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or weakness of the face muscles

The doctor will perform a physical examination, which may include examination of the ear, nose, mastoid (bony part behind the ear), and throat. Pain, tenderness, or redness of the mastoid often indicates a serious infection.

During the examination, the doctor will ask questions about the ear pain, such as:

• When did it begin?
• Is it getting better, worse, or staying the same?
• Is the pain constant?
• What other symptoms are also present?
• Is there ear pressure?
• Is there drainage from the ear?
• Are there unusual ear noises?
• Is there a fever?
• Is there pain in the bone behind the ear?
• Is there hearing loss?

Because most ear infections improve within 24 hours of seeing a doctor, physicians are less likely to prescribe antibiotics immediately, often waiting to see if symtpoms persist or progress. This strategy has been shown to reduce antibiotic usage.

If antibiotics are prescribed, it is important to take ALL of the prescribed antibiotic on schedule. Ear tubes may be inserted for children who have persistent or recurring ear infections, to re-establish the proper functioning of the middle ear. Inserting ear tubes is a simple and effective surgical procedure.

The following steps may help prevent earaches:

• Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
• Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.
• Outer ear infections can be prevented by not putting objects in the ear, and drying the ear after bathing or swimming.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004 May;113(5):1451-65. Review.