EARACHE

Symptom Definition

  • Pain or discomfort in or around the ear

General Information

  • Ear pain can be primary or referred.
  • Primary ear pain originates from the ear itself. Examples include otitis media and otitis externa.
    • Otitis media is an infection of the middle portion of the ear behind the tympanic membrane. It is very common in children but less common in adults.
    • Otitis externa is also called Swimmer's Ear and it is an infection of the external ear canal. Swimmers and people who frequently use Q-tips are more likely to get it. Otitis externa is more common than otitis media in adults.
  • Referred ear pain means that the pain originates from a disease process outside of the ear. Because of the manner in which the nerves run in the head, the pain may be perceived as being in the ear. Examples of referred ear pain include dental abscess, TMJ Syndrome, and tonsillitis.

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WHEN TO CALL YOUR DOCTOR FOR EARACHE

Call Your Doctor Now (night or day) If:

  • You feel weak or very sick
  • Earache is severe
  • Pink or red swelling behind the ear
  • Stiff neck (unable to touch chin to chest)
  • Fever of 103 F (39.4 C) or higher
  • Pointed object was inserted into the ear canal (e.g., a pencil, stick or wire)
  • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)

Call Your Doctor Within 24 Hours (between 9am and 4pm) If:

  • Earache lasting longer than 1 hour (suspected ear infection)

Self Care at Home If:

  • Earache lasting less than 1 hour and you don't think you need to be seen
  • Earache occurring only during air travel and you don't think you need to be seen
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HOME CARE ADVICE FOR EARACHE

  1. Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug.
    • Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  2. Local Cold for Pain: Apply a cold pack or a cold wet washcloth to the outer ear for 20 minutes to reduce pain while the pain medicine takes effect.  (Note: Some individuals prefer local heat instead of cold for 20 minutes)
  3. Avoid Earplugs: If pus or cloudy fluid is draining from the ear canal, wipe the pus away as it appears. Avoid plugging with cotton. (Reason: retained pus causes irritation or infection of the ear canal.)
  4. Contagiousness: Ear infections are not contagious.
  5. Earache during Air Travel: Ear pain and stuffiness can occur during air travel. This results from too rapid changes in air pressure.
  6. Treatment - Earache During Air Travel: There are a number of different maneuvers that you can use to reduce the pressure and pain, including yawning, chewing gum, or swallowing. You can also try to exhale while pinching your nose and keeping your lips closed.
  7. Prevention of Earache During Air Travel: Using a nasal decongestant approximately one hour before take-off can sometimes help. Decongestants shrink the swollen nasal passages and open up the tube connecting the nose and the ear (eustacian) to help normalize ear pressure. They can be taken as pills by mouth or as a nasal spray.
    • Pseudophedrine (Sudafed): is available in pill form. Typical adult dosage is two 30 mg tablets every 6 hours. Read package instructions.
    • Phenylephrine nasal drops (Neo-Synephrine): are available over the counter. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.
    • Do not take these medications if you have high blood pressure, heart disease or prostate enlargement. Do not use these medications for more than 3 days. (Reason: excessive use can cause rebound nasal congestion.)
    • Read the package instructions thoroughly on all medications that you take.
  8. Call Your Doctor If:
    • You become worse or develop any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2003 David Thompson, M.D. FACEP

Reviewed 8/2003

Revised 7/2002

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