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Otalgia
Common in children and usually self-limiting — pain relief matters more than immediate antibiotics.
Also known as: ear pain · otalgia · otitis · middle-ear infection
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Earache is unpleasant, but usually treatable and rarely dangerous. Common causes are a middle-ear infection (often after a cold, especially in children), inflammation of the outer ear canal (e.g. after swimming — “swimmer’s ear”) or simply hardened earwax. Sometimes the pain doesn’t come from the ear itself but radiates from the teeth, the jaw joint or the throat. Many middle-ear infections are viral and improve on their own; often the first aim is to ease the pain. A few warning signs matter — above all a painful redness/swelling behind the ear, high fever or sudden hearing loss — which call for prompt medical assessment.
Proven pain relievers and warmth (e.g. a warm cloth) often help well over the first days.
With canal irritation avoid water, insert nothing; hardened wax is best gently removed by a doctor.
With severe/persistent pain, fever, discharge, hearing loss — and rather sooner in small children.
Swelling/redness behind the ear, high fever, sudden hearing loss → don’t wait, get checked quickly.
Place a cherry stone cushion or a warm compress at hand warmth for 15 to 20 minutes, with the head raised when lying down.
In children, about eighty out of a hundred middle ear infections settle within two to three days without an antibiotic — which is why over the age of two, without a severe general state, two days of waiting are common. Under two and with both ears affected, treatment is given more readily. Fluid behind the eardrum after the infection takes up to three months before hearing is normal again; that is not a relapse.
Decongestant nose drops open the nose, not the eustachian tube — their benefit for the middle ear could not be shown in studies. What works is a painkiller, given early and at a sufficient dose. An antibiotic shortens the pain by about a day and is often not the first step in children over two without a severe general state. Ear drops do not reach the middle ear as long as the eardrum is closed.
Swallow, yawn, chew; if needed pinch the nose and blow very gently against it. Pressing hard can damage the eardrum.
Often after a cold, especially in children — frequently viral and self-healing, pain relief comes first.
Outer-ear-canal inflammation (“swimmer’s ear”) or hardened wax can press and hurt — don’t dig with cotton buds.
Sometimes pain radiates from teeth, jaw joint or throat into the ear, though the ear itself is healthy.
A tender, reddened bone behind the ear with fever can be serious → get checked quickly.
Sudden hearing loss, pus/bloody discharge with fever, or severe pain in infants → see a doctor promptly.
The ear is mostly examined directly; with a stronger infection CRP can help with classification.
Fever, sweating and faster breathing clearly raise the need. Drinking enough keeps the mucus thin and the circulation steady — in children and older people it is the most important point of all.
With low levels airway infections occur somewhat more often; correcting a deficiency makes sense, a high single dose during the infection does not act on it.
Needed by the defence cells. For lozenges at the start of a cold there are hints of a slightly shortened duration; at a high dose over months zinc lowers copper.
Antibodies and defence cells are protein. After several days with little appetite it is worth at least keeping the protein up — soup with egg, quark, yoghurt, lentils.
In children with recurrent middle ear infections a small study at 25 µg (1000 IU) a day over 4 months showed fewer relapses. It does not act on the acute pain.
Particular strains have been studied for prevention in children; the difference is small. Oil or drops into the ear are not part of this as long as it is unclear whether the eardrum is intact.
In children with recurrent middle ear infections a small study with vitamin D over four months showed fewer relapses. It does not act on the acute pain — there painkillers and time count.
Ear pain with nothing to find at the ear often comes from elsewhere — jaw joint, teeth, neck, tonsils. The nerve that supplies the ear also supplies those areas; which is why the pain is reported there.
If the ear hurts while chewing it often comes from the jaw joint and not from the ear. Soft food for a few days tells the two apart faster than any examination.
A warm compress eases it. Onion poultices are the classic home remedy; controlled studies are lacking, the risk is low. With discharge from the ear nothing warm and nothing liquid belongs inside.