EARACHE

DEFINITION

An earache is discomfort or pain caused by an infection of the ear. The medical term for an ear infection is otitis (pronounced oh-TI-tuss).

DESCRIPTION

The ear consists of three parts: the external, middle, and interior ear. The external ear also consists of three parts—the auricle, the auditory canal, and the tympanic membrane. The auricle (pronounced OR-uh-kull) is the outermost part of the ear; the part you can see attached to the sides of your head. The auricle is connected to the interior parts of the ear by means of a narrow opening called the auditory canal. At the end of the auditory canal is the tympanic membrane, or eardrum.

Just beyond the tympanic membrane is the middle ear. The middle ear contains three bones called ossicles (pronounced AH-sih-kulls). These three bones are connected to the inner ear.

The middle ear also contains the eustachian (pronounced you-STAY-shun or you-STAY-shee-un) tube, which connects the middle ear to the pharynx (pronounced FAHR-inks). The pharynx is a passageway behind the nose through which air passes into the lungs. The eustachian tube helps maintain an equal air pressure between the middle ear and the outside world.

Sound waves enter the ear through the auricle and auditory canal. They cause the tympanic membrane to vibrate. That vibration is passed on to the ossicles in the middle ear. Those bones, in turn, pass on the sound vibrations to the inner ear. Once they reach the inner ear, the sound vibrations are sent to the brain by way of the auditory nerve. The brain then translates these vibrations into sounds.

Microorganisms that cause disease can enter the ear in one of two ways. They can enter by way of the auricle and auditory canal, or they can come in through the eustachian tube. In either case, these microorganisms can cause an infection. Infections usually occur in the outer ear or the middle ear. An infection of the outer ear is called otitis externa, and an infection of the middle ear is called otitis media.

CAUSES

Bacteria, viruses, and fungi can all cause ear infections. The way otitis externa and otitis media develop is somewhat different.

Otitis Externa

Infections of the outer ear occur most commonly in summer. People often spend time in swimming pools and lakes. Their outer ears are more likely to be filled with water than they are during the winter. The presence of water in the ear has two effects. First, it tends to wash away cerumen (pronounced seh-ROO-men) in the ear. Cerumen is ear wax. It coats the ear and protects it from microorganisms.

Second, water carries bacteria, viruses, and fungi into the external ear. The external ear is an ideal place for the growth of these microorganisms. It is warm, moist, and dark. In the absence of cerumen, these microorganisms grow rapidly and can cause an infection of the outer ear.

Otitis Media

Most cases of otitis media occur during the winter. They develop as a side effect of an upper respiratory infection (URI), such as a cold (see common cold entry) or the flu (see influenza entry). Bacteria or viruses that cause URIs travel down the Eustachian tube into the middle ear. There they grow and cause an infection of the middle ear.

Earache: Words to Know

Adenoid:

A mass of lymph tissue located near the pharynx.

Antibiotic:

A substance derived from fungi or bacteria that suppresses the growth of other microrganisms. Antibiotics are used to treat infections.

Auricle:

The external structure of the ear.

Cephalosporins:

A specific type of antibiotic used to treat many types of infections.

Cerumen:

Earwax.

Eustachian tube:

A small tube that connects the middle ear to the pharynx.

Ossicles:

Tiny bones located within the middle ear responsible for transmitting sound vibrations from the outer ear to the inner ear.

Penicillin:

A specific types of antibiotic used to treat many types of infections.

Pharynx:

The part of the airway that connects the nose and mouth with the upper part of the digestive system.

Otitis media is most common among young children between the ages of three months and three years. During this period, the eustachian tube is still quite short. Bacteria and viruses can travel down the tube to the middle ear quite easily.

SYMPTOMS

Symptoms vary depending on the type of ear infection.

Otitis Externa

The first symptom of otitis externa is usually itching in the outer ear. As the infection develops, the ear becomes very painful. Just touching the ear can often cause severe pain.

The auditory canal may also become swollen. When this happens, it becomes narrower, making it more difficult for sounds to pass to the middle ear. The patient may find it more difficult to hear.

In severe cases of otitis externa, the outer ear may become red and swollen. A fever often develops. The lymph nodes around the ear may also become swollen and painful.

Otitis Media

Otitis media is characterized by fever, pain, and problems with hearing. Fluid may develop in the middle ear. This fluid may press on nerves, causing severe pain. Babies may have difficulty feeding because of the pressure in the middle ear.

The lymph nodes around the eustachian tubes may also become inflamed and painful. These lymph nodes are called the adenoids. Infections of the adenoids often occur along with URIs and infections of the middle ear.

DIAGNOSIS

Diagnosis of an ear infection is usually quite simple. A patient's complaint about pain in the ear is a strong hint of the problem. A simple physical examination usually confirms the diagnosis. The doctor can look into the ear with the unaided eye or with an instrument that shines light into the ear. The ear usually looks red and swollen if an infection is present.

An infection of the middle ear can usually be diagnosed by examining the tympanic membrane. The membrane itself will appear red and swollen. The pattern produced by the ossicles on the membrane may also be characteristic of an infection. Under normal circumstances, this pattern has a distinctive shape called a "landmark." When the middle ear becomes infected, the landmark may no longer be visible.

The microorganism responsible for the infection can be determined by taking a culture. A clean cotton swab is wiped on the inner surface of the ear, and a small sample of tissue is removed. In the case of otitis media, fluid leaking from the middle ear can also be taken. These samples can then be incubated (kept in a warm, moist place) to encourage the growth of bacteria and viruses. After twenty-four to forty-eight hours, the samples can be studied under a microscope to determine which microorganisms are present.

TREATMENT

Most infections of the ear are treated successfully with antibiotics. The antibiotics kill any bacteria responsible for the infection. If the infection is caused by a virus, the antibiotics are of no value.

The antibiotics can be applied directly to the outer ear in cases of otitis externa. They are often combined with steroids to help reduce inflammation and swelling.

Otitis media is usually treated with oral (taken by mouth) antibiotics. The most popular medications are penicillins and cephalosporins (pronounced seffa-lo-SPORE-inz). They are usually given over a seven to ten day period.

Pain from an ear infection can be relieved by holding a warm compress or a water bottle filled with warm water and wrapped in a towel against the infected ear. Over-the-counter pain relievers, such as aspirin, ibuprofen, and acetaminophen, may also offer some relief from the pain. Children under the age of twelve should not take aspirin as it can cause Reye's syndrome (see Reye's syndrome entry).

Alternative Treatment

Some practitioners believe that food allergies (see allergies entry) increase the risk of ear infections, since allergic reactions can cause the tissues in the middle ear to swell, making it a better environment for bacteria and viruses to thrive. They recommend eliminating foods from the diet that might cause allergic reactions, such as wheat, dairy products, corn, peanuts, citrus fruits, and eggs.

Ear drops that contain herbal products are also recommended for the treatment of earache. Some herbs that have been suggested include goldenseal, mullein, St. John's wort, and echinacea (pronounced ekk-ih-NAY-shuh). Massage therapy of the skull may also be useful in relieving pressure on the ears and improving the functioning of the eustachian tube.

PROGNOSIS

With proper treatment, the prognosis for ear infections is very good. If left untreated, however, infections of the middle ear can lead to complications that may cause hearing and speech problems.

A VACCINE FOR EAR INFECTIONS

Help for ear infections may be on the way. California scientists announced in 1999 that a new vaccine for certain ear infections had been developed. The vaccine does not work on all bacteria that cause ear problems. In fact, it affects only about 7 percent of all ear problems. That may not seem like a big number, but scientists are excited about the news for two reasons.

First, eliminating even 7 percent of all ear infections could save up to $500 million a year in doctor bills. Up to two million trips to the doctor for ear problems could be eliminated.

Second, the vaccine may lead to similar treatments for other ear disorders. Other vaccines might also be developed that could totally eliminate the $5 billion a year that Americans spend on ear infections.

PREVENTION

Infections of the outer ear can be prevented by keeping the ear clean and dry. Adding a few drops of a mixture of alcohol and acetic acid after swimming can insure that the ear dries properly.

There seems to be little chance of preventing infections of the middle ear in young children. The problem appears to be a normal part of growing up. One step that parents can take is to reduce as much as possible the young child's chance of catching a cold, the flu, or some other infection of the upper respiratory tract. In addition, the patient should receive medical attention as soon as an infection appears. Children who have had otitis media should have follow-up visits to the doctor after the infection has disappeared.

FOR MORE INFORMATION

Books

Greene, Alan R. The Parent's Complete Guide to Ear Infections. Allentown, PA: Peoples Medical Society, 1997.

Schmidt, Michael A., and Doris Rapp. Healing Childhood Ear Infections: Prevention, Home Care, and Alternative Treatment, 2nd edition. Berkeley, CA: North Atlantic Books, 1996.

Periodicals

"Keep Your Ears Dry." Consumer Reports on Health (July 1995): pp. 80+.

Organizations

American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314–3357. (703) 836–4444.

Web sites

"Ask NOAH About: Pain." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/pain/pain.html#E (accessed on October 25, 1999).

Earache

Definition

An earache is a commonly used term for ear pain or discomfort that is a symptom of disease or injury.

Description

An earache itself is not a disease, but it is a symptom of disease or injury in the external or middle ear. It may also be a symptom of problems in the mouth, nose, or throat. Infants or very young children may be unable to say that they are in pain. Increased irritability or pulling at the ears is often a sign of ear pain in infants.

Causes & symptoms

The most common cause of an earache is a buildup of pressure in the eustachian tube. Among other functions, the eustachian tube drains fluids out of the middle ear via the back of the throat. A cold, allergy, or sore throat can cause the eustachian tube to swell shut. Infants and young children are especially susceptible to earaches caused by problems with the eustachian tube, since the structure is still underdeveloped in that age group. When the normal drainage of fluid is prevented, it can accumulate in the middle ear, causing pressure, pain, stagnation, and possibly infection.

An earache may be due to a perforated, or broken, eardrum. The eardrum can be broken as a result of a blow to the head, infection in the inner ear, suction applied to the ear, or the insertion of a foreign object into the ear. Infections of the middle and outer ears are often associated with earaches. Other causes of an earache may be the obstruction of the ear canal with a foreign object or excessive ear wax, boils in the ear canal, a herpes zoster infection of the ear, keratosis of the ear, tumors, an infection of the mastoid process, "swimmer's ear," and the aftermath of surgical procedures. Ear pain can also be caused by a rapid descent from high altitudes, during air travel or travel in the mountains. A sinus infection , arthritis of the jaw, sore throat, tonsillitis , and dysfunction of the temporomandibular joint (TMJ) may be the source of referred pain to the ears.

Diagnosis

A history of the illness should be obtained, including information about the symptoms accompanying the earache. A physical exam should be performed, which may include an examination of the ears, the nasal passages and sinuses, and the throat. An otoscope may be used to see more deeply into the ears, nose, and throat. In addition, the teeth, tongue, tonsils, salivary glands, and TMJ should be examined for problems that might be causing referred pain to the ears. A culture and sensitivity test should be done if there is any discharge from the ears. X rays or a computed tomography (CT) scan may be required to diagnose the problem. Hearing and balancing tests are important to the diagnosis of an earache.

Treatment

Three to five drops of the warmed oil extract of mullein flowers (Verbascum thapsus ), garlic (Allium sativa ), or St. John's wort (Hypericum perforatum ), or a combination of any of the three should be placed into the affected ear. The oil of Calendula officinalis may be used in the same manner. If there is a persistent ear infection, goldenseal (Hydrastis canadensis ) salve or tincture can be placed directly onto the outer ear or into the ear canal three to four times per day. Glycerin can be introduced into the ear if it is suspected that excessive earwax or water in the ear is causing the problem.

Food and environmental allergies should be considered as contributors to the development of ear pain and infections, especially if the earache is chronic or recurrent. Allergy testing should be done, and then the allergens should be avoided. Alcohol, dairy products, smoking, caffeine , sugary foods, and processed foods should also be avoided to keep from stressing the immune system. One or two cloves of raw garlic daily may help end chronic episodes of earache, since garlic can kill many of the pathogens that cause earaches. If there is trouble tolerating raw garlic, a daily garlic supplement can be taken instead. Daily supplementation of vitamin C, bioflavonoids, zinc , and beta carotene is recommended to treat some of the underlying conditions causing ear pain and bolster general immune function.

Several homeopathic remedies may also be helpful in treating earaches. Depending upon the symptoms, a 6C or 12C dose of Pulsatilla , Mercurius, or Hepar sulphuris , or a 30C dose of Belladonna can be taken for up to four doses. If there is no symptom relief, a homeopath or other healthcare practitioner should be consulted.

Hydrotherapy treatment for earaches includes the use of hot compresses. To make a compress, a large cloth soaked in hot water should be placed over both ears and the throat for about five minutes. A hot water bottle or smaller compress can also be used. A new hot compress can be used every three to five minutes until the earache is relieved for a maximum of 30 minutes. This treatment is best when the feet are in a hot footbath while the compresses are being applied. Hot water can be added as needed to keep the water comfortably hot. The soak can be repeated two or three times a day as needed.

Massage such as tui na or reflexology can be helpful in clearing up ear pain, congestion, and TMJ dysfunction. A knowledgeable practitioner should be consulted.

Allopathic treatment

If an earache is accompanied by any of the following symptoms, a healthcare provider should be consulted as soon as possible:

• severe pain
• discharge from the ear
• a fever of 102°F (38.8°C) or higher
• a sudden change in hearing
• a sudden onset of dizziness
• an inability to concentrate
• facial muscle weakness
• earache lasts for more than a few days
• earache is worse during chewing
• sudden or severe ear pain without any other accompanying symptoms
• does not respond to home treatment
• appears to be getting worse
• pain, tenderness, or redness of the over the area of the mastoid process, which often indicates a serious infection

Antibiotics, decongestants, and antihistamines are often prescribed to halt the infection and inflammation that may be the cause of ear pain. The insertion of ear tubes may be recommended for children who have persistent ear infections to reestablish proper functioning of the middle ear. However, the effectiveness of this treatment is still widely debated. Repeated swallowing or gum-chewing can relieve ear pain caused by changes in pressure secondary to changes in altitude. Allowing infants and young children to suck on a bottle during descent can help relieve popping and ear pain. TMJ dys-function should be evaluated by a dentist. Anti-inflammatory medication, tranquilizers, or muscle relaxants may be prescribed for temporary relief. Other treatments for TMJ problems include braces to correct the bite or a bite plate to wear when sleeping.

Expected results

Earaches can generally be relieved by attending to the underlying problem. Untreated problems may lead to serious ear damage and possible hearing loss . Most children with chronic earaches due to infections tend to out-grow the condition.

Prevention

A hair dryer or other method should be used after swimming if there is a tendency for the ears to retain water. Earplugs should be worn while swimming and cotton or wool should be loosely inserted into the outer ear canal during showers or when the hair is being washed. Objects such as cotton swabs should not be inserted into the ear canal. A healthy immune system should be maintained to reduce the opportunity for infections.

Resources

OTHER

Merck & Co., Inc. The Merck Manual of Diagnosis and Therapy. (http://www.merck.com/pubs/mmanual/section7/chapter82/82a.htm.

WebMD, Inc. Earache. (http://webmd.lycos.com/content/article/3172.10330.

Patience Paradox

ear·ache / ˈi(ə)rˌāk/ • n. pain inside the ear.

earache (eer-ayk) n. see otitis, otalgia.