Pain in the ear

Ear pain is very common in both children and adults. In children, the cause is often cold or ear inflammation. In adults, it is more common than it is due to auditory eczema. Often the problems go away by themselves but in some cases some kind of treatment may be needed.

This text is about the most common causes of ear pain, what you can do yourself and when to seek care. 

Different types of ear pain

Pain in one or both ears may be due to many different causes. You may have a viral infection, infection with bacteria, or an inflammation of the ear canal. It is often difficult to know why one has ear pain. 

Ear pain when cold

In the case of a virus cold, the nose and throat tend to be inflamed. It usually looks red and irritated in the throat and it can hurt the throat. It is common to also have problems such as fever, sniffing and coughing during a cold. It can also hurt the ears. It may be due to pressure in the ear as the mucous membranes are swollen.

The cold also makes it harder for the mucous membranes of the nose and ear to defend against the bacteria that can cause ear inflammation. Even healthy people can carry these bacteria behind the nose. Small children often do this, adults more rarely. The bacteria are given the opportunity to make you sick only when, for example, a viral infection paved the way for them.

Ear pain due to ear inflammation

Ear inflammation is very common in children and often comes with a cold. Even adults can get ear infections, but this is not as common. In the case of an ear infection, it was formed in the middle ear and the eardrum becomes red and thick. The eardrum can bend outward and move worse.

It hurts the ear in case of ear inflammation. This is because the mucous membrane is swollen and the pressure in the middle ear increases and the eardrum is inflamed. Therefore, it usually hurts more when you lie down and the pressure in the middle ear increases. Both children and adults can also have ear lids and poor hearing during ongoing inflammation of the ear. You can also get a fever. Fever is common in children under one year, but in older children and adults it is more uncommon.

Sometimes the pressure in the middle ear becomes so great that the eardrum breaks. It can hurt very much before it bursts, but then the pain usually diminishes quickly. When the eardrum breaks, it usually runs out into the ear canal. Most often, the eardrum heals itself by itself and you do not usually get any trouble afterward. If the eardrum breaks, one should always seek care because the inflammation needs to be treated with antibiotics. This is because ear inflammation is usually severe if the eardrum has burst.

Ear pain at ear catheter

At an ear catheter, clear fluid has been collected in the middle ear. This is because the mucous membrane of the ear trumpet swells so that it cannot open and even out the pressure. Then there will be suppression and fluid can be formed that completely or partially fills the middle ear. This means that the eardrum does not become as moving, the sound waves are attenuated and the hearing can become worse for a while. It feels like having a lid on the ear and the sound is muted.

It is common for children to get an ear catarrh after a cold or an ear infection. The symptoms of pain in the ear often go away on their own and should not be treated with antibiotics. As an adult, you may experience fluid in the middle ear, for example, if you are unable to equalize during flight or diving. Often, adults also experience problems with colds, but the problems usually go away quickly by themselves. Pressure equalization can make the problems go over faster. If the trouble does not go on for a week, you as an adult should always seek care. This is especially true if you only have trouble on one page.

Ear pain during ear canal eczema

Ear pain may also be due to the fact that you as an adult or your child have had inflammation in the ear canal itself. It is called auditory eczema or external otitis. Then it is the skin of the ear canal that has become irritated and inflamed.

In the case of ear canal eczema, the ear’s own cleaning does not work properly. This can cause the ear canal to become irritated and itchy. Sometimes the inflammation becomes more severe. Then the ear canal can become swollen, it can hurt and it can start to drain a smelly and sticky liquid from the ear. In some cases, a grainy mass is formed where fungi or bacteria can begin to grow. Hearing can be temporarily impaired if the ear canal is completely or partially blocked by eczema, swelling, fluid or skin cells. This is because the sound from outside makes it harder to reach the eardrum.

Mild eczema is very common, especially among people who swim and swim a lot. It is also common to use cotton swabs in the ear canal. It is easier to get ear canal eczema in a hot and humid climate. Therefore, it is more common to have problems during the summer many countries or when traveling to warmer countries.

Pain in the ear for other reasons

In rare cases, ear pain may be due to things getting into the ear canal. Small children can put beads, stones and other small things in the ear. Insects can also enter the ear canal.

Stroke to the ear or, for example, a ball to the ear can burst the eardrum and cause pain, bleeding, hearing loss and sometimes dizziness. The same thing can happen when diving or flying if you cannot get pressure equalized fast enough.

What can I do for myself?

Often, the ear pain goes over by itself. There are some things you can try to relieve the symptoms.

Keep your head high

Both children and adults feel better about holding their heads high when they have ear pain. Then the swelling in the nose and ears decreases and it hurts less. It can be good to also have your head high when sleeping. You can do this by bedding with extra thick pillows. You can also raise the head end of the bed by putting an extra pillow under the mattress.

Children under one year can try wearing a baby harness. You can also have them sit on your lap or in a babysitter. You can also raise the head end of the bed when the child is going to sleep, for example, by putting thick books under the bed legs at the head end.

Nasal spray does not help with ear inflammation but makes it easier to breathe

Decomposing nasal drops and nasal spray reduce nasal congestion and can make it easier to breathe in a cold. But they do not help against the inflammation of the ear itself. This applies to both children and adults. Do not use the nasal spray for more than 10 days. It can make you have nasal congestion that is difficult to get rid of.

Rinse nose with saline solution

You can also try rinsing your nose with a saline solution. There are ready-made saline drops and saline spray to buy at pharmacies. You can make saline yourself by mixing a spicy salt in a deciliter of water. The water does not need to be boiled, but it can feel better if the solution is lukewarm when using it. To get the saline solution into your nose you can use a special nasal rinse or a small plastic syringe. Both are available at pharmacies.

Painkillers for adults

There are several different prescription drugs. Examples are drugs containing paracetamol and drugs belonging to the NSAID group, or cox inhibitors.

Here you can read about which prescription drugs are available and which may be suitable for you. 

Medicines that relieve ear pain in children

  • You can give medicines containing paracetamol to children from three months of age. 
  • You can give medicines containing ibuprofen from the age of six months. 

The drugs are available in several different forms that are suitable for children, for example tablets that melt in the mouth and in liquid form. Ask a pharmacy what is right for your child.

Follow the instructions on the package carefully and do not combine different medicines. Here you can read about combining paracetamol and ibuprofen. 

You can read more about a medicine in the package leaflet that comes with the package. You can also lookup the drug at fass.se and read the package leaflet there.

Tips on how to relieve ear canal eczema

Hearing eczema often goes away by itself in children and adults, but it can itch a lot. To relieve the hassle, it may be good to keep your ear dry by using grease, earplugs or bathing cap when bathing or showering. It can make the trouble go over. It is also good not to scratch the ear as it can aggravate the trouble. You as an adult can also try ear spray for ear canal eczema that is available at pharmacies. The sprayer can also be used by children older than five years.

Pressure equalization can help with ear problems

The hearing can become worse temporarily after an ear infection if the pressure in the middle ear has changed. Then it can help to equalize pressure. You do this by holding your nose and at the same time trying to blow air through your nose. The air is then pressed up through the ear trumpet instead. It is a little easier to even out the pressure if you use nasal drops or nasal spray which reduces the swelling of the mucous membranes. To help young children to equalize pressure, you can let them suck on something, such as a pacifier or drink from a pacifier bottle. There are also aids to buy at the pharmacy.

It can also be good to equalize pressure during air travel if you have ear problems.

Ear trouble and bathing

You should not bathe in the event of ongoing ear problems with pain and fluid from the ears. If you have had ear inflammation where there is a hole in the eardrum, you should avoid getting water in your ears for a week after it has stopped draining from the ear. You can use grease wax or earplugs in the shower or bath.

Avoid getting water in the ear right after an operation where you or your child has received a tube in the ear. After a few weeks you can swim freely as long as you do not dip your head more than a meter under the water. 

When should I seek care?

Ear pain often goes by itself and most people do not need to seek care for their troubles.

Seek care at a health center or emergency room if you as an adult or your child

  • have pain in the ear and the pain has not diminished in a day
  • has fluid that runs out of the ear
  • have irritation or swelling in the ear canal for more than two days.

Seek care directly at an emergency room if you as an adult or your child

  • have pain in the ear and at the same time is stiff in the neck and feels very tired and weak
  • have ear pain, have a high fever and feel seriously ill
  • is red and swollen behind the ear or if the ear has started to stand out.

Contact a health care center again if the inconvenience of ear pain or running fluid in the ear is left two to three days after a doctor has assessed the inconvenience.

Contact a health care center if, as an adult or your child after an ear infection, you have a feeling of ear lid, impaired hearing, ringing or beeps in the ears that have not gone over after three months. Seek medical care earlier if the problems are very large.

Treatment of pain in the ear

Ear pain often goes away by itself. Ear pain in colds and ear catheters are not treated with antibiotics.

Some ear infections are treated with antibiotics

All adults and some children need treatment of pain in the ear with antibiotics for ear infections caused by bacteria. The treatment of ear inflammation looks different at different ages as the risk of complications varies with age. 

Those who should always be treated with antibiotics are:

  • Children under one year.
  • Children under two years who have ear inflammation in both ears.
  • Children over the age of twelve and adults.
  • All children and adults who have cracked eardrum.

In children between one and twelve years, ear inflammation usually heals without antibiotics. But also ear infections in children should be treated if:

  • The child has a high fever.
  • The child has a lot of pain in the ear, despite treatment of pain in the ear with non-prescription painkillers.
  • There is some evidence that the infection may spread or if the child has some other serious illness.

Hearing eczema is treated with ear drops

The most important thing in treating ear canal eczema is that the ear canal is cleansed. Sometimes cleaning is enough as a treatment. In some cases, you may receive ear drops by prescription . They often contain a combination of antibiotics, cortisone and antifungal agents. Antibiotics help if you have a bacterial infection and cortisone helps with the inflammation, which causes itching, and the swelling.

If the ear canal is very swollen you can get a small compress that is soaked in decongestants in the ear canal. It’s called a tamponade. Once the swelling has settled, you can start treatment of pain in the ear with the ear drops.

In some cases, the inflammation can spread to the outer ear. Then antibiotics may be needed in the form of tablets.

Stir in the ear

Children and adults who have a lot of fluid in the ear or recurring ear infections may have tubes implanted in the ear. In adults, the operation can be done with local anesthesia, but children are usually anesthetized. Children can sometimes get an enlarged gland behind the nose removed at the same time. This is done if the gland causes the ear trumpet to become too narrow or causes the child to snore.

During the operation, a small plastic tube is inserted through the eardrum so that air can enter the middle ear. This means that the eardrum can move more easily and that less fluid is collected behind the eardrum. It improves hearing and can also reduce the risk of new ear infections.

It is important that you understand the information

In order for you to be active in your care and to make decisions, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. You can also ask to have the information printed so that you can read it peacefully.

You may also have the right to  get help from an interpreter if you have a hearing loss.

Investigation

The doctor uses an otoscope to examine the ear. It looks like a handle with a small funnel and lamp at the top. Sometimes the doctor uses an ear microscope that is like a pair of binoculars.

The doctor examines what the eardrum looks like, if there is any fluid behind the eardrum, what the fluid looks like and how the eardrum moves. Using a balloon, they can blow air to the eardrum to see if it is moving. Sometimes, the doctor uses a so-called tympanometer to examine the movement of the eardrum and the pressure in the middle ear. The doctor then places a small soft plug in the opening of the ear canal and connects an apparatus to the plug. The device emits a hissing sound. The survey does not hurt.

Hearing eczema can make it difficult to see the eardrum. It can make it difficult for the doctor to see if you have any other ear problems besides the eczema. Then both children and adults usually get treatment for eczema first. Then you can come back for a visit a few days later for another examination.

Does the ear hurt?

Ear infections such as ear inflammation and ear catheter do not infect. However, they often come in conjunction with a cold. Cold viruses spread very easily. The infection can be passed on by handshake and another direct contact. You can try to avoid infecting others by coughing or sneezing in the elbow and trying to wash your hands frequently. 

Auditory eczema does not infect but in the grainy mass that can form inside the ear there may be bacteria that infect.

How can I prevent ear pain?

It is difficult to avoid infecting children and adults with a cold virus, which is often the cause of ear pain.

Difficult to avoid ear infections

As an adult, the risk of ear infections is quite small. It can be difficult to completely avoid ear infections in children. These things can help:

  • Keep breastfeeding your baby if you already do. Breastfeeding has a protective effect during the child’s first year.
  • Avoid smoky places as it will make your child’s mucous membranes more susceptible to infections.

Children and adults who get many ear infections may have a small tube implanted in the ear. It can reduce the risk of getting more ear infections.

How to avoid ear canal eczema

Don’t poke your ear. It interferes with the natural cleaning of the ear canal and increases the risk of bacteria entering the ear. You can also get ear canal eczema by bathing or cleaning your ear frequently.

It is good to use ear protectors and headphones that sit outside the ear instead of those that sit inside the ear canal.

You who use earrings can try to use those that are tested and recommended for allergies. Allergies and eczema that sit on the outer part of the ear can spread to the ear canal. It is also good to use allergy tested shampoos and soaps.

It is important to air the ear canal if you have a hearing aid

You who use hearing aids may think that it is good to air the ear canal by removing the device when you are not using it. It is also important to clean the insert so that no bacteria are introduced into the ear canal. 

If you often get problems with ear canal eczema, it may be better to use one that is behind the ear instead of a device that is inserted into the ear. 

Complications and sequelae

Ear pain usually heals on its own in a few days. Occasionally, fluid may remain behind the eardrum for some time after ear inflammation has healed. It can make your hearing worse temporarily. It is good to contact a doctor if the symptoms of pain in the ear remain several weeks or get worse. Children younger than four years who have had inflammation in both ears should always go back after three months. The check is done by a doctor at a health center. If the doctor discovers that the hearing is not fully restored or if the eardrum does not look healthy, a referral is written to an ear-nose-throat surgery.

Mastoiditis and other complications

In a few cases of ear inflammation, the infection spreads and causes a complication. Mastoiditis means that the ear inflammation has spread to the skull bone behind the ear. The symptoms of pain in the ear are severe pain in and behind the ear, fever and protruding ear. In young children, the complication can come so quickly that you have not noticed the ear inflammation. The disease is serious. Seek medical care directly at an emergency room if you think you as an adult or your child have mastoid. People with mastoiditis may stay in the hospital and receive antibiotics directly into the bloodstream. Most become healthy after treatment, but sometimes surgery is required.

Ear inflammation can also cause, for example, facial paralysis and meningitis if it spreads. Then you, as an adult or your child, need urgent care.

Hearing eczema coming back

It is common to have relapses of ear canal eczema. Keep your ear dry and use allergy-tested shampoo and soap, as ear canal eczema is sometimes due to allergy. It can reduce the risk of getting into trouble. Avoid poking in the ear. It is also better to use earplugs than earplugs when listening to music or protecting yourself from noise.

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