Earache: causes, warning signs and care

Earache may start inside the ear or be referred from the throat, teeth or sinuses, so assessment focuses on the pattern.

Pain may be sharp, dull, throbbing, burning or a pressure sensation. It can be constant or more noticeable when chewing, swallowing, lying down or touching the outer ear. Blocked hearing, discharge, itching, fever, sore throat, a runny nose or facial pressure can give useful clues. In children, pulling at an ear, irritability, poor feeding or disturbed sleep may be the first signs.

Get urgent medical help for severe pain with swelling or redness behind the ear, a stiff neck, confusion, new facial weakness, severe headache, or a person who is very unwell. Seek prompt assessment for bloody discharge after an injury, sudden marked hearing loss, persistent vomiting, or pain in someone with a weakened immune system. Keep water and objects out of a painful ear until it has been examined.

These causes are listed alphabetically, not as a ranking. A cold or sinusitis can block the tube that helps equalise pressure in the middle ear. Earwax can press against the ear canal or eardrum. Middle-ear infection may follow an upper-respiratory illness, while swimmer's ear affects the outer canal and can hurt when the outer ear is moved. Tonsillitis and dental problems can also send pain toward the ear.

A clinician will ask when the pain began, whether it followed water exposure or a cold, and whether hearing has changed. They examine the outer ear and canal with an otoscope, look at the eardrum, and may examine the nose, throat, jaw and nearby lymph nodes. Hearing testing, a swab of persistent discharge or further assessment may be arranged when the examination suggests a more complex problem.

Simple pain relief may help while the cause is being clarified, provided it is safe for you to take. A clinician may recommend ear drops for an outer-ear condition, treatment for nasal or throat inflammation, or removal of troublesome wax. Antibiotics are used when a clinician identifies a bacterial infection or another reason they are appropriate; they do not treat every earache. Do not put cotton buds, oils or unprescribed drops into the ear, particularly if there is discharge.

Keep ears dry after swimming by gently drying the outer ear with a towel. Avoid inserting cotton buds, hairpins or other objects, which can push wax deeper and injure the canal. Follow pool hygiene advice, address allergies or nasal symptoms with a clinician when they are recurrent, and avoid smoking exposure around children. If swimming repeatedly causes outer-ear symptoms, ask about preventive measures tailored to your ears.

Track which ear hurts, whether pain spreads to the jaw or throat, and whether hearing, balance or sleep is affected. Note fever, discharge, itch, fullness, nasal congestion, tooth pain and recent swimming. For a child, record changes in feeding, crying, sleep and response to sound. These details help separate ear-canal, middle-ear and referred pain.

Many earaches improve when the underlying irritation or infection settles. Arrange review if pain continues, returns, hearing remains reduced or discharge develops. Follow-up can include wax care, a hearing check, treatment adjustment or referral to an ear, nose and throat specialist when symptoms do not follow the expected course.