Most of us would have at some point had a severe ear ache or seen someone else (usually a child) crying out in severe ear pain. The article will provide you with some information on the common causes and what you can do if you have someone with a earache to look after. Of the common causes for ear ache the first 4 conditions are more common in children and the last few ones are commoner in adults. Before that, lets have a quick look at the anatomy of the ear to get a better understanding of the problem.

The external ear or the Pinna behaves like a funnel collecting the sound waves from outside the body and directing it inside the ear where they hit the eardrum and make it vibrate. The portion of the ear upto the eardrum (from the outside) is called the External ear. Touching the eardrum are bones that sequentially transmit the vibration to the snail like Cochlea which is the organ that converts the sound vibration to electrical impulse which is conducted by the auditory nerve to the brain where the electrical impulse is interpreted as meaningful sound/voice/music or noice. In the diagram above, the 3 bones that conduct sound waves to the cochlea (i.e., Malleus Incus and Stapes) lie in the middle ear and this chamber is connected to the back of the throat by the Eustachian tube (in pink). The Eustachian tube maintains equal pressure on both sides of the ear drum permitting free undampened vibrations of the ear drum to incident sound. The inner ear (found deep inside the bone) also contains the organs of balance – Utricle and saccule and the semicircular canals.

Therefore the ear has 2 functions – hearing and balance!

Conditions causing Ear ache

1. Otitis externa (External ear infection) – is usually caused by trauma or injury caused by over enthusiastic ear cleaning with the finger or the ear bud. Less frequently it can happen after a swim in the pool. The tissues of the outer ear are tightly attached to the underlying bone and therefore any infection or boil, produces severe pain. The ear lobe could be red and swollen. Looking into the ear with a torch may show the boil or if pressing on the tragus (the small prominence just in front of the opening into the ear) or pulling the ear give severe pain – this would also indicate external ear infection. This would need antibiotic ear drops prescribed by your doctor.

2. Shining a light into the ear may also show an insect that can be the cause for pain. Shining a bright light may draw the insect out. Please don’t put oil into the ear (especially if you know that the ear drum is perforated)

3. Eustachian tube dysfunction – When the person has a mild cold, the excess mucous secreted may occlude the Eustachian tube. The air in the middle year then get absorbed and this negative pressure would draw the eardrum insides and reduce its vibrations to sound. Therefore people may have a feeling of reduced hearing. This is very common during a aeroplane flight. Sudden changes in altitude can even cause rupture of the ear drum (Barotrauma). The ear could pop open on yawning or blowing out with a pinched nose giving some relief. Using a nasal decongestant drop or using Vicks inhaler might help. Eustachian tube dysfunction commonly occurs in those with respiratory allergies, dust exposure and infections. If this condition doesn’t resolve, persisting negative pressure may draw out the fluid into the middle ear from the blood vessels causing serous otitis media. If bacteria invade and proliferate here, it becomes Acute suppurative (pus producing) Otitis media (middle ear infection).

4. Acute Suppurative Otitis media (ASOM) – this often presents with severe ear pain, reduced hearing and often with fever. Pulling on the ear or looking into the ear would not give severe pain. Sometimes there could be a spontaneous rupture of the ear drum and release of copious pus from the ear, also relieving the pain to an extent. This condition requires specific antibiotics and requires you to go to the local ENT surgeon for advice. If inadequately treated, the infection could become chronic (CSOM) and also spread inwards to the bone and the brain.

5. Herpes Zoster Oticus – relapse of the chicken pox virus affecting the ear could be a cause for severe earache with a rash around the ear. It may also cause hearing loss, ringing in the ear, vertigo, difficulty in closing the eye and a dry mouth.

6. TMJ Dysfunction – Temperomandibular joint is formed between the jaw bone and the undersurface of the skull. People who have a habit of biting only on one side or grinding their teeth can develop pain around the ear. This pain would be worse on opening the mouth widely and on chewing.

7. Pain referred to the ear due to stimulation of commonly innervated body parts- The tonsil and the ear may be supplied by the same nerve (the glossopharyngeal Nerve) Therefore irritation of the nerve due to Tonsillitis would cause pain to be referred to the ear. Similarly other nerves such as the Trigeminal, Facial, Vagal and somatic cervical nerves may also in certain conditions cause an earache.

Take home points:

Any medicine that you have taken for pain before would work to relieve an ear ache. Paracetamol or any other anti-inflammatory medicine can be given until you see the doctor.