Earache (Ear Pain): Common Causes and When to See a Doctor

Introduction

An earache—also called ear pain or otalgia—is a common symptom that can affect people of all ages. The pain may feel dull, sharp, or burning and can come and go. In many cases, ear pain isn’t dangerous and improves with simple care. However, some patterns of symptoms signal the need for prompt medical evaluation. This article explains what an earache is, common verified causes, evidence-based self-care, and when to see a doctor, using only claims supported by high-quality medical sources.

   

 

Why Does My Earache?

The most common cause of ear pain is an ear infection which can occur in the inner, middle, or outer ear.

  

Inner Ear Infections (Otitis Interna): The inner ear is the deepest part of our ear. The inner ear plays a vital role in our sense of balance. Infections can occur here when a cold, flu, or middle ear infection spreads. Inner ear infections cause inflammation, leading to dizziness, a sensation of imbalance, nausea, and hearing impairments.

Middle Ear Infections (Otitis Media): The middle ear is the air-filled space behind the eardrum. An infection in this area is usually due to a malfunction of the Eustachian tube ( a thin tube that helps regulate the pressure between the outer and middle ear). When this tube becomes swollen or blocked, it prevents normal fluid drainage from the middle ear, opening the door to bacteria and viruses to grow and cause infection.

Anyone can get a middle ear infection. However, infants are most affected because their Eustachian tube is too small, making drainage more difficult.

Outer Ear Infections (Otitis Externa): This condition is also known as a swimmer’s ear. This is because swimmers often get this type of infection since repeated exposure to water can make the ear canal vulnerable to inflammation, trapping moisture that allows bacteria to grow.

Foreign Objects Stuck in the Ear: Children often stick objects in their ears. If this happens to your child, don’t try to remove the thing yourself, as you could push it further in or damage the ear canal or eardrum.

What Is an Earache?

Ear pain is a symptom, not a diagnosis. It can arise from conditions within the ear (primary ear pain) or be referred pain from nearby structures that share nerve pathways with the ear, such as the jaw, teeth, or throat.

 

 

When to Go to the ER

Most ear infections and earaches will pass on their own. However, there are certain times when medical attention is necessary to prevent long-term damage.

  

Rupture or Burst Eardrum

Eardrums are thin membranes located inside the ear that vibrate with sound. The membranes are very delicate and damage easily when hit by sudden loud noises, severe ear infections, or when objects are pushed inside the ear.

A burst eardrum is very painful, and you may have bloody discharge. If you think you may have a ruptured eardrum, place sterile cotton over the outside of the ear and rush to the nearest ER for help.

Severe Infection

Please come to the ER if you develop any of the following symptoms:

• Severe pain
• Symptoms that show no signs of improvement after 1-2 days
• Fluid or pus discharge from the ear
• Young children having trouble sleeping
• Children being unusually irritable, fuzzy, or moody
• Loss of hearing or difficulty hearing clearly
• High fever lasting more than one day
• Severe drowsiness
• Dizziness
• Stiff neck

Object Lodged in the Ear

If something gets stuck in your or your child’s ear, please seek a trained medical professional’s help to remove it.

When left untreated, ear infections can result in dangerous complications that compromise your hearing. If you have an ear infection or are unsure of the cause and severity of an earache, the best option is to visit the ER sooner rather than later.

At Post Oak ER, we are always open and have the most qualified medical staff to care for you and your family.

Primary vs. Referred Ear Pain

Primary (Ear-Origin) Pain

Primary ear pain starts in the ear itself. Verified causes include:

• Ear infections, especially middle ear infections.
• Pressure changes (for example, during air travel).
• Earwax buildup, which can be associated with ear pain.
• Eardrum injury, including perforation related to trauma.

Referred (Secondary) Pain

Referred ear pain originates outside the ear. Verified sources show this can occur because nearby areas share nerve pathways. Common referred sources include:

• Jaw (TMJ) disorders
• Teeth
• Throat
• Sinuses

Referred pain is commonly noted in adults.

Common Causes of Earaches

• Middle ear infection (otitis media): Often associated with fluid buildup behind the eardrum and may follow a respiratory infection.
• Outer ear infection (otitis externa): Inflammation or infection of the ear canal; moisture and irritation are common contributing factors.
• Pressure changes: Ear pain related to changes in altitude, such as flying.
• Earwax buildup: Can be associated with ear pain.
• Eardrum perforation: May occur with trauma.
• Referred pain: From the jaw (TMJ), teeth, throat, or sinuses.

Symptoms That Can Accompany Ear Pain

Symptoms vary by cause and age. Verified symptoms include:

• Adults: Ear pain, impaired hearing, and fluid drainage.
• Children: Ear pain, fever, irritability, difficulty sleeping, decreased appetite, and tugging or pulling at the ear.
• With infection: Fever and temporary hearing changes may occur.

What You Can Do at Home (When Symptoms Are Mild)

For mild ear pain without concerning features, the following approaches are supported by evidence:

• Cold or warm compresses applied to the outer ear.
• Rest and keeping the head elevated to help reduce pressure.
• Chewing or swallowing to help relieve pressure related to altitude changes.
• Over-the-counter pain relievers (such as acetaminophen or ibuprofen), used as directed and appropriate for age.

Avoid:

• Inserting cotton swabs, fingers, or other objects into the ear canal.
• Using ear drops if a ruptured eardrum is suspected.

When to See a Doctor

Schedule a Medical Visit

You should seek medical evaluation if any of the following verified situations apply:

• Ear pain lasts more than three days.
• Earaches are frequent or keep coming back.

Seek Prompt Medical Evaluation

You should seek medical evaluation if any of the following verified situations apply:

• High fever with ear pain, especially in infants or young children.
• Ear pain with dizziness, headache, swelling around the ear, or facial weakness.
• Blood or pus draining from the ear.
• Severe ear pain that suddenly stops, which may be a sign of eardrum perforation.
• Something is stuck in the ear, especially if removal attempts have failed.

Statements about specific emergency room thresholds (for example, exactly when ER care is required) are not fully supported by high-quality evidence and therefore are not asserted here.

Diagnosis and Treatment

• Evaluation typically includes a clinical assessment by a healthcare provider.
• Treatment depends on the cause:
  • Pain relief with appropriate medications.
  • Prescription medications may be used for certain infections.
  • Earwax may be managed with clinician-directed removal methods.
  • Foreign objects should be addressed by healthcare professionals.
  • Referred pain is treated by managing the underlying source (for example, jaw or sinus conditions).

Prevention

• Avoid inserting objects into the ear canal.
• Dry ears thoroughly after swimming or bathing.
• Avoid exposure to secondhand smoke, especially for children.
• Reduce exposure to allergy triggers when possible.

Evidence Limits & How to Use This Guide

Some common questions (such as exact emergency room thresholds or symptom timelines) do not have strong medical evidence. When evidence is limited, this article clearly states that limitation. Use this information to support—not replace—clinical judgment from a healthcare professional.

Frequently Asked Questions

APA Reference List

Cleveland Clinic. (2024, October 10). Ear pain (earache, otalgia): Causes & treatment. https://my.clevelandclinic.org/health/symptoms/earache-ear-pain

Cleveland Clinic. (2024, October 10). Eustachian tube dysfunction: Symptoms, causes & treatment. https://my.clevelandclinic.org/health/diseases/22527-eustachian-tube-dysfunction

Coulter, J., Hohman, M. H., & Kwon, E. (2024, February 29). Otalgia. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549830/

Mayo Clinic Staff. (n.d.). Ear infection (middle ear): Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616

Mayo Clinic Staff. (n.d.). Ruptured eardrum (perforated eardrum): Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ruptured-eardrum/symptoms-causes/syc-20351879

Merck & Co., Inc. (n.d.). Earache. MSD Manual Consumer Version. https://www.msdmanuals.com/home/ear-nose-and-throat-disorders/symptoms-of-ear-disorders/earache

National Health Service (NHS). (2023, April 19). Perforated eardrum. https://www.nhs.uk/conditions/perforated-eardrum/

National Health Service (NHS). (2025, January 16). Ear infections. https://www.nhs.uk/conditions/ear-infections/

National Health Service (NHS). (2025, October 27). Earache. https://www.nhs.uk/symptoms/earache/

U.S. National Library of Medicine. (2025, January 17). Earache. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/003046.htm