Ear pain

Overview of ear pain

The ear is the most important sense organ that plays a direct role in “sound perception” and an indirect role in maintaining body balance. During his entire lifetime and individual might experience abnormalities in normal ear functions due to environmental factors or some structural defect present at birth. The World Health Organization has estimated that almost 360 million people in the world are suffering from hearing impairments due to acute ear infections. These infections mostly give rise to ear pain of persistent nature. This has alarmed doctors and global health organizations who are establishing health units in different countries and regions to educate parents about maintaining a healthy and infection-free ear from childhood.

What is ear pain?

Ear pain or otalgia is a mild to moderate pain and discomfort in the ear. It usually occurs in one ear, but in a few rare cases, both the ears may be involved. Ear pain mostly arises from infections in the ear. But in some cases, infections in the adjoining areas such as the tonsils or sinuses may also give rise to secondary ear pain. Therefore ear disease is the cause of ear pain, but the reverse is not true.

What are the possible causes of ear pain?

Ear pain is primarily caused by infections in the ear. But a number of other factors may also precipitate ear pain. The general causes are given below-

• Bacterial infections caused by Streptococcus, Haemophilus or Moraxella species.
• Viral infections caused by Cytomegalovirus, Respiratory Syncytial virus or Influenza virus
• Existing diseases of the Central Nervous System such as Encephalitis or Meningitis
• Presence of foreign body within the ear canal
• Perforations present anywhere in the ear canal (ear drum) due to mechanical piercing (by earbuds) or due to structural defects
• Accumulation of excess cerumen (ear-wax)
• Accumulation of excess fluid in the middle ear
• Degradation of ear parts due to aging
• Seasonal or climatic changes (cold weather)
• Inflammation of adenoid glands present near tonsils (adenoiditis)
• Accumulation of excess mucus in the nasopharyngeal tract
• Infection of the sinus
• Drainage of excess fluid from the middle ear
• Allergy triggered by irritants such as pollen grains or animal danders
• Excessive smoking (active or passive)
• Overuse of dummies in infants
• Harsh blowing of the nose which can directly affect the Eustachian tube
• Exposure to environmental pollutants such as lead
• Blocking of the Eustachian canal during feeding a new-born (when they are lying down)
• A family history of ear diseases

What are the possible symptoms of ear pain?

Ear pain when associated with ear infections typically exhibit the following symptoms-

• Persistent ear pain
• Discharge of sticky fluid from the ear
• Constant itching, redness, and irritation of the ear
• Impaired hearing and delayed response to any sound
• A headache and pain in the pharyngeal glands
• Swelling and reddening of adenoid glands
• Occasional fever and dizziness
• Twisting and pulling of the ear (infants)
• Irritability and frequent mood swings (infants)
• Disturbed sleep
• A feeling of increased pressure and obstruction of the ear canal
• Nausea and vomiting
• Loss of appetite (children)
• Discharge of blood (in critical cases)
• Buzzing or ringing sound in the ear (Tinnitus)

What are the different types of ear pain?

Ear pain is broadly classified into two categories- primary ear pain and referred ear pain. These will be discussed in separate sections.

Primary ear pain

This type of pain originates in the ear itself. It is caused by diseases or infections of the ear. This may be felt in the external, middle or inner ear. These are described below-

• External ear pain: It may be caused by infections in the external ear known as External Otitis. The skin in this region is easily affected (due to inflammation and corrosion) by environmental conditions such as heat or moisture. It also occurs due to the rise in temperature of the exterior ear canal due to overuse of ear muffs. Blockage of the external canal also occurs due to accumulation and hardening of excess ear wax. At times cyst-like outgrowths (exostosis) are formed on the ear wall which blocks the ear passage partially. Perforations of the tympanic membrane are observed in few cases. External ear pain is of two types-
• Mechanical: Trauma induced by earbuds, hairs or insects.
• Infective: Caused by viral or bacterial pathogens.
• Middle ear pain: Middle ear pain usually occurs due to the accumulation of excess fluid. It is of two types-
• Mechanical: It is caused by barotrauma (damage to tissues caused by the difference in pressure), Eustachian tube obstruction (leads to acute otitis media).
• Inflammatory: Acute otitis media and mastoiditis are observed in this case.
• Inner ear pain: It is accompanied by immunological diseases or bacterial infections like Meningitis and causes a high degree of hearing loss. In this condition, buzzing or ringing sound is perceived inside the ear (Tinnitus) which causes irritation and hearing impairment.

Referred ear pain

Referred pain is the type of pain that is felt in the ear, but does not originate there. Pain occurring in the adjoining areas is radiated to the ear via the-

• Trigeminal nerve: Trigeminal neuralgia can cause earaches.
• Facial nerve: Pain can radiate from the temporomandibular joint, parotid gland or the teeth
• Glossopharyngeal nerve: Ear pain is caused by tonsillitis, pharyngeal ulceration or oropharyngeal carcinoma.
• Vagus nerve: Pain can radiate from the laryngopharynx or the esophagus.
• Second and third spinal segments (C2 and C3)

Diagnosis and treatment

A special instrument called otoscope is normally used by specialists to diagnose ear infections, primarily by observing the color of the eardrum (pinkish gray under healthy conditions and red and swollen under infected conditions). Ear pain can be lessened by analgesics or manual therapy.

Treatment of ear pain mainly focuses on alleviating the root cause of the pain. In case the pain is due to an infection, Non-Steroidal Anti-Inflammatory drugs (NSAIDs) and antibiotics can be given based on the advice of a registered medical practitioner. Depending on the site of infection, antibiotics can be given either orally or in the form of ear drops.

Prevention of ear infections and pain

• Washing hands frequently, coughing or sneezing in your arm crook, not sharing drinking and eating utensils etc. are some measures which can prevent the spread of infections. Keeping the child at home when the child is ill and limiting the time in child care settings can also prevent the spread of infection.
• Breastfeeding the baby can also impart immunity to the infant and thereby protect from ear infections and cold.
• Avoid exposure to irritants and second-hand smoke– irritants such as chemicals in perfumes, hair sprays etc. and smoke can cause irritation of the sinuses and cause earaches.
• Dry the ears gently after taking bath or swimming. Avoid swimming on days with high bacterial counts (watch for the signs alerting the swimmers).
• Use noise-canceling headphones or well-fitting earplugs to protect yourself from the noise of banging construction, drilling, loud music etc.
• Get regular flu shots and vaccinations (for mumps etc.) so as to prevent infections and resultant earache.
• Maintaining oral hygiene can prevent tooth decay and consequent ear pain.

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