Ear pain is caused by a build-up of fluid and pressure in the portion of the ear behind the eardrum (called the middle ear).

The middle ear is drained by a short narrow tube (the Eustachian tube) into the nasal passages. A cold or allergy can cause the Eustachian tube to become swollen shut, especially in small children where the tube is smaller. When the Eustachian tube closes, the normal flow of fluid from the middle ear is prevented. The fluid begins to accumulate, which can cause stuffiness, pain, and hearing loss.

Increased irritability or pulling at the ears is often a sign of ear pain in infants. Ear pain in a child or infant is not always from infection. Other causes include water from bathing, soap or shampoo retention, or ear canal irritation from cotton-tipped swabs.

Ear infection symptoms may include fever, ear pain, fussiness, increased crying, irritability, or pulling at the ears. They are very common in infancy and childhood and are often associated with colds.

Most children will have temporary and minor hearing loss during and right after an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has.

• obstruction of the outer ear (due to a foreign object or ear wax)
• infection of the outer or inner ear
  • otitis externa (Swimmer's ear)
  • acute otitis media
  • otitis externa; chronic
  • otitis externa; malignant
  • otitis media; chronic
• high altitudes (and other causes of acutebarotrauma)
• ruptured or perforated eardrum
• tooth infection
• sinus infection
• arthritis of the jaw
• sore throat (pharyngitis, tonsillitis, and so forth) with referred pain to the ears

A vaporizer can help by adding moisture and humidity to keep the mucous thin.

Over-the-counter analgesics such as acetaminophen or ibuprofen can provide partial pain relief for adults with an earache.

A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.

Opening the Eustachian tube can help. Antihistamines, decongestants, or nose drops decrease the amount of nasal secretion and shrink the mucous membranes. Use these products for only a few days; if symptoms last longer than this you should consult your health care provider.

Severe pain may require analgesic eardrops, which can be prescribed by your health care provider. If these cannot be obtained, 2 or 3 drops of olive oil or another plain cooking oil may be used as long as there is NO ear discharge, NO ear tubes or other hole in the eardrum.

Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help.

Pediatric home care:

• Give the child pain-relieving tablet or liquid (acetaminophen or ibuprofen). Follow the dosage recommended on the package label.
• Avoid cigarette smoke near the child (possible increased risk of infection).
• Your child's doctor can prescribe analgesic eardrops for pain. If these cannot be obtained, 2 or 3 drops of warm (not hot) olive oil or another plain cooking oil may be used as long as there is NO ear discharge, NO ear tubes or other hole in the eardrum. Do not use oil more than two nights.
  
• Apply a cold pack or cold wet wash cloth to the outer ear for 20 minutes to reduce discomfort.
• If the child is uncomfortable lying down, resting in an upright position may help reduce pressure in the middle ear.
• Avoid the use of aspirin in teenagers or children who might have the flu or chicken pox because of the risk of Reye's syndrome, which is a serious problem of the brain and liver.

• a child has an earache and discomfort is severe or lasts for longer than 2 days. All ear infections, even mild ones, require treatment.

• time pattern
  • When did it begin?
  • Is it getting better, worse, or staying the same?
  • Is the pain constant?
• other
  • What other symptoms are also present?
  • Is there ear pressure?
  • Is there drainage from the ear?
  • Are there unusual ear noises?
  • Is there a fever?
  • Is there pain in the bone behind the ear?