A deep, nagging kind of pain

Earache has a way of taking over. It may be a dull, full ache that muffles sound, a sharp stab when you swallow, or a throbbing pain that seems worse when you lie down at night. In young children, it might show up as tugging at the ear, crying more than usual and refusing to settle. Because the ear sits close to the throat, jaw, teeth and sinuses, ear pain doesn't always start in the ear itself.

Many earaches settle within a few days with simple comfort care. Some need a doctor, and a few need urgent attention. Here is how to tell the difference.

Common causes

• Middle ear infection (otitis media): very common in young children, often after a cold. It causes pain, fullness, muffled hearing and sometimes fever. Occasionally the eardrum bursts, which may release fluid and often eases the pressure.
• Outer ear infection (otitis externa, or "swimmer's ear"): an infection of the ear canal, often after swimming or using cotton swabs. The ear is painful to touch or when the outer ear is gently pulled, and may itch or discharge.
• Blocked Eustachian tube: the small tube linking the middle ear to the back of the nose can block during colds, allergies or flying, causing pressure, popping and muffled hearing.
• Pressure changes: flying or diving can cause ear pain when pressure isn't equalized.
• Earwax buildup: usually causes blockage and muffled hearing rather than strong pain, but can be uncomfortable.
• Pain referred from elsewhere: a sore throat, tonsillitis, tooth problems or jaw joint (TMJ) problems, including clenching or grinding, can all cause pain felt in the ear. This is common in adults.
• Something in the ear, especially in young children.

Comfort at home

• Warmth or cold. A warm or cool cloth held against the outer ear soothes many people. Make sure it isn't too hot.
• Rest upright. Sleeping with the head slightly raised may ease pressure for some.
• Chew or swallow to help pop the ears when pressure is the problem, such as during flights. Yawning helps too. Babies can feed during takeoff and landing.
• Keep the ear dry if you suspect swimmer's ear, and avoid swimming until it settles.
• Pain relief. A pharmacist can advise on suitable over-the-counter pain relief for adults and children, including the right product and dose for a child's age and weight. Don't give aspirin to children or teenagers.

What to avoid

• Cotton swabs and other objects in the ear. They can push wax deeper, scratch the canal or damage the eardrum.
• Ear candling. It is not recommended and can cause burns and blockages.
• Putting drops or oils in the ear if there is discharge, or if the eardrum might be perforated, unless a clinician has advised it.
• Waiting it out with a young baby. Infants with ear pain and fever need assessment.

Spotting ear pain in little ones

Babies and toddlers can't tell you their ear hurts, so parents often have to read the clues. Signs can include pulling or rubbing at an ear, crying more than usual, especially when lying down, trouble sleeping, being off their feeds or food, fever, fluid from the ear, or not responding to quiet sounds. Ear infections often follow a cold. Trust your instincts: if your child seems very unwell, is unusually sleepy or floppy, has a stiff neck or a rash that doesn't fade when pressed, seek urgent care straight away.

What the doctor may do

A doctor will usually look into the ear with a small light to check the ear canal and eardrum, and may examine your throat, jaw and neck. Many middle ear infections clear up on their own, so a doctor may suggest pain relief and a short wait before deciding on antibiotics, depending on age and symptoms. Swimmer's ear is often managed with prescribed ear drops. If wax is the problem, they may suggest softening drops or removal by a trained professional. For recurring problems, a referral to an ear, nose and throat specialist may be offered.

Lowering the chances of another one

• Dry your ears gently after swimming or showering by tilting your head; a towel on the outer ear is enough
• Consider earplugs for frequent swimmers who keep getting swimmer's ear
• Avoid cleaning inside the ear canal; ears usually clean themselves
• Keep children away from cigarette smoke, which is linked to more ear infections
• Keep up with recommended vaccinations
• Treat jaw clenching or grinding with your dentist's help if referred pain is the issue

The bottom line

Earache is often caused by middle or outer ear infections, pressure problems, or pain spreading from the throat, teeth or jaw. Warmth, rest, safe pain relief and keeping objects out of the ear help many people. Get urgent help for swelling behind the ear, a stiff neck or severe headache, facial weakness, or sudden hearing loss, and see a doctor if pain lasts more than a few days or there is discharge.