Children are particularly prone
Parents will be all too familiar with the scenario: their child is whingeing, constantly tugging at their ear and refuses to sleep. Earache is particularly common in young children. The reason lies in their anatomy.
The Eustachian tube - a narrow passage between the throat and the middle ear - is significantly shorter in children than in adults. This makes it easier for pathogens from the nose and throat to reach the middle ear.
If a cold sets in, this canal swells up quickly. Ventilation of the middle ear is disrupted, and pressure equalisation no longer works properly.
This in itself can cause pain and often leads to a middle ear infection, medically known as otitis media. It is one of the most common reasons why children are taken to the doctor’s surgery with earache.
Adults are not spared either
Although middle ear infections can also occur in teenagers and adults, another condition, inflammation of the ear canal, is more commonly involved in these cases.
The ear canal is the narrow passage between the outer ear and the eardrum. If bacteria, viruses or fungi enter, the sensitive skin there can become inflamed.
Typical symptoms include severe itching, pain when the ear is touched and, sometimes, discharge from the ear canal. If the tissue swells significantly, hearing may even be affected.
Statistically speaking, one in ten people will develop an ear canal infection at least once in their lifetime. Certain groups are particularly at risk, in particular those who swim or dive regularly, frequently wear earplugs or hearing aids, or suffer from skin conditions such as atopic dermatitis.
Poorly controlled diabetes also increases the risk of infection, as the immune system then functions less effectively.
Furthermore, if the diabetes has already damaged fine nerve endings, those affected sometimes do not even notice the pain. The infection then goes unnoticed and, in the worst-case scenario, can spread to the bone.
Stay away from cotton buds
One of the most common causes of ear canal infections is well-intentioned but incorrect ear care. Poking around in the ear canal with cotton buds is only likely to push the earwax deeper in, irritate the sensitive skin and can even risk injuring the eardrum. Experts therefore strongly advise against this action.
A healthy ear will clean itself. Anyone prone to recurrent infections should gently dab moisture from the outer ear with a tissue after a bath or shower and have the ear canal cleaned regularly by a doctor.
When the pain comes from elsewhere
The cause of earache is not always actually in the ear. Dental problems, tension in the temporomandibular joint, night-time teeth grinding or problems with the cervical spine can trigger pain that radiates into the ear. Tonsillitis is also frequently accompanied by earache.
Even rapid changes in pressure, such as when flying or diving, can cause what is known as barotrauma, which is associated with severe pain, hearing loss and dizziness. In rare cases, the symptoms may be caused by shingles affecting the ear area, an infected piercing or even a tumour.
What really helps
Anyone suffering from earache should consult a doctor to determine the cause. This is because treatment depends entirely on the underlying cause. In the case of an ear canal infection, antiseptic or antibiotic ear drops are usually prescribed.
Where there is severe swelling, cortisone-based drops may also be prescribed to reduce the swelling of the mucous membrane and restore hearing. If the treatment is not effective, a swab test can identify the exact pathogen.
Decongestant nasal drops may be useful in the short term for colds accompanied by earache to improve ventilation of the middle ear. It is important though that these remedies should not be used for longer than a week, as there is a risk of developing a tolerance.
Painkillers such as ibuprofen or paracetamol relieve the symptoms. However, an important restriction applies for children under the age of twelve. Acetylsalicylic acid, better known as ASA or aspirin, must not be given for viral infections. This active ingredient increases the risk of Reye’s syndrome in children, a rare but serious condition that can damage the brain and liver.
Although the home remedy of onion pouches is popular, its effectiveness has not been scientifically proven. Anyone wishing to try it should consult their doctor first.
Chronic and persistent
If the ear canal becomes inflamed at least four times a year, or if the inflammation persists for longer than three months, doctors refer to this as a chronic condition. Whilst it is not life-threatening, it is extremely unpleasant and often difficult to manage.
Typical symptoms include persistent itching and hearing loss; pain is less common. In the long term, the underlying condition must be treated, whether it is poorly controlled diabetes or a skin condition. The ear canal should be kept consistently dry and free from any irritants such as shampoos.