Symptoms
Pain in the ear (technical term: otalgia) can be unilateral or bilateral and persistent or intermittent. They vary in intensity and nature, can be extremely uncomfortable, and sometimes go away on their own. Ear pain is often accompanied by other symptoms, such as a discharge from the ear canal, difficulty hearing, a feeling of pressure, fever, runny nose, sore throat, tinnitus, or dizziness.
Causes
Pain that originates in the ear itself is more common in children and is called primary otalgia. On the other hand, if the origin is outside, it is called secondary otalgia. Secondary otalgias occur more often in adults. The actual source of the pain can sometimes be far away from the ear. Thus, even a heart attack can cause ear pain. This is a result of the complex sensory nerve supply to the ear. Ear pain is often triggered by inflammation, infection, from injury or physically. The most common causes include:
- Acute otitis media occurs primarily in children and is caused by bacteria that enter the middle ear from the nasal cavity. Viruses can also be involved in the development.
- Inflammation of the external auditory canal (otitis externa) is also usually caused by bacteria and occurs, for example, after swimming. Possible accompanying symptoms include itching, redness, swelling and discharge. Herpes viruses and fungi are also possible pathogens.
- Sore throat, for example, in the context of a cold, can radiate to the ear. The viruses involved can also lead to tubal catarrh, an inflammation of the Eustachi tube.
- In a plug of earwax, the external auditory canal is displaced with cerumen, which manifests itself in a feeling of pressure and hearing difficulties.
- Diseases, inflammations and infections of the teeth or jaw can also very often cause ear pain.
- Foreign bodies such as insects, pellets or Lego bricks (in children).
- Injuries to the ear, in the ear canal, perforation of the eardrum, for example, by cotton swabs.
Other causes (selection):
- Frostbite, burns
- Infectious diseases, for example, of the eardrum (myringitis), mumps.
- Muscle tension
- Noise and bang trauma
- Barotrauma during diving or during landing in an airplane
- Cancers
- Cellulitis of the auricle
- Sinusitis
- Mastoiditis
- Craniomandibular dysfunction
- Trigeminal neuralgia
Diagnosis
The diagnosis is made on the basis of the patient’s history, physical examination (including otoscopy) and, if necessary, laboratory methods and imaging techniques. Not only is the ear examined, but also the pharynx, oral and nasal cavities, lymph nodes, and surrounding skin, among other areas. It is especially important to ask patients about possible accompanying symptoms, because these can provide clues to the cause.
Drug treatment
Treatment depends on the cause. The following are the main drug treatment options. Ear drops:
- Ear drops containing local anesthetics such as procaine and analgesics such as phenazone are instilled mainly for irritation and inflammation of the external auditory canal. Ear drops with antibiotics or glucocorticoids are also available, which are used for infections and skin diseases. Important: Ear drops should not be administered to a perforated eardrum!
Diver drops:
- Diver drops are ear drops with acidic, antiseptic and nourishing properties. They are mainly administered for the prevention of otitis externa, but are also partially suitable for treatment.
Cerumenolytics:
- Cerumenolytics are ear drops that soften an ear plug and facilitate its removal. They are combined with a subsequent ear irrigation. For this purpose also exist cleansing and nourishing sprays.
Painkillers:
- Non-steroidal anti-inflammatory drugs, such as ibuprofen or diclofenac, and other analgesics, such as acetaminophen or metamizole, may be taken for short-term symptomatic treatment of pain if there are no contraindications.
Antibiotics:
- Oral antibiotics such as penicillins may be indicated for otitis media and other bacterial infections. They are now prescribed more cautiously for otitis media because of the high spontaneous cure rate. Superficial infections can also be treated locally.
Decongestant nasal sprays:
- Sympathomimetics such as xylometazoline or oxymetazoline are used as sprays or drops for decongestion of the nasal mucosa and the eustachian tube, for example, in case of tubal catarrh. Systemic sympathomimetics, such as those containing phenylephrine, are also available. Other nasal medications, such as humidifying nasal sprays or expectorants, may also be administered.
Non-drug treatment
- Heat, e.g. warm compresses, ear candles.
- Inhalations
- Nasal rinses
- Onion compresses
- Cleaning the external auditory canal
