Earaches are among the top reasons for doctor’s office visits. If you or one of your loved ones are suffering from an earache, seeing a doctor is the best thing to do. Earaches are typically related to viral or bacterial infections in the middle ear or the outer ear. An infection of the outer ear is typically what we refer to as “swimmers ear” whereas an infection of the middle ear is what we classical think of as an “ear infection” and is often associated with symptoms of an upper respiratory tract infection like fevers, nasal congestion, sinus pain, or a sore throat.
It is easy for anyone to distinguish between the two in the vast majority of cases. If you pull on your ear or stick your finger in your ear and you feel a lot of pain then you likely have swimmer’s ear. If you have a fever and other upper respiratory tract symptoms then you likely have a middle ear infection. Occasionally these clear distinguishing features can be blurred. This occurs when one infection spreads to the tympanic membrane (otherwise referred to as the eardrum which separates the “outer” ear from the “middle” ear. An infection of the tympanic membrane can lead to a rupture of the membrane cause the infection to spread across this boundary causing symptoms of both swimmer’s ear and middle ear infection.
It’s important to distinguish between the two infections because while both require antibiotics, swimmer’s ear’s antibiotics are administered via ear drops whereas the middle ear infection’s antibiotics are administered through an oral tablet.
What Are the Types of Earaches and Their Symptoms?
The majority of patients who come to the doctor for an earache usually have one of three common conditions:
- Acute otitis media (middle ear infection)
- Otitis externa (swimmer’s ear)
- Displaced pain from a throat or sinus infection
These common earaches tend to be associated with the following symptoms:
- Ear fullness: The sensation of clogged ears causes the urge to yawn or swallow repeatedly, which provides little to no relief. Your hearing is often slightly diminished or muffled.
- Earache: This is what most people are used to feeling when they develop ear infections. Whatever provokes the pain is often what doctors use to distinguish between the three most common causes of earaches. See the diagnosis section below.
- Ear tenderness: Tenderness refers to external ear pain caused by a specific action, such as pulling a shirt over the head.
If you are experiencing ear tenderness without fevers (as described above), you more than likely have swimmer’s ear. However, if the ear tenderness coincides with fevers or ear drainage, then the infection has likely spread from the external ear canal into the middle ear canal or vice versa. Nasal congestion and fevers commonly co-occur with middle ear infections but almost never with swimmer’s ear. If you have these symptoms with your earache, you likely have a middle ear infection.
It can be difficult to distinguish between a middle ear infection and displaced pain from a throat or sinus infection. Adults and older adolescents whose throat or sinus symptoms have been the main symptom for more than 10 days are likely experiencing referred pain in the ears from strep throat or a sinus infection. Otherwise, the patient likely has a middle ear infection.
What Causes Earaches and When Are They Serious?
Most of the serious or life-threatening illnesses that cause earaches or ear tenderness are a direct result of untreated middle ear infections or otitis externa infections (swimmer’s ear infections). Because the middle ear is so close to critical neurologic and vascular systems, it is always important to treat ear infections with antibiotics.
Some of the more serious conditions associated with earaches are:
- Rupture of the tympanic membrane
- Inner ear infection
- Malignant otitis externa
- Venous sinus thrombosis
Your doctor will ask you questions to screen you for any of these more serious conditions. Some of them may include:
- Have you had any ear drainage from your ear?
- Have you had a significant loss in your hearing?
- Has there been any trauma to your ear or ear canal?
- For infants and small children, has a small, ear canal-sized toy gone missing?
How Are Earaches Treated?
All of these conditions are easily treatable, but they typically require a course of antibiotics. The antibiotics are administered in a way that’s best suited to the type of ear infection. For example, a middle ear infection can be treated with oral antibiotics. For swimmer’s ear, on the other hand, the patient will receive antibiotic ear drops. Work with your doctor to determine which antibiotic treatment is best for you and your condition.
When Is It Time To See A Doctor for My Earache?
All earaches should be evaluated by your doctor in order for you to receive timely antibiotics. The majority of cases of ear aches results in antibiotics being prescribed. The delay of antibiotics increases the risk of the infection spreading and rupturing the tympanic membrane. Additionally, for those with suppressed immune systems, especially diabetics, infections can spread into nearby bone and result in a truly devastating infection.