How Do You Know if Ear Pain Is Serious?

Children and adults can have ear pain resulting from minor issues or major problems. Experiencing extreme pain, high fever, sore throat, rash, or last several days could signify a serious condition and visit to see a doctor.

The causes of ear pain range from minor issues to serious problems. Children often experience frequent earaches, but adults can have them, too.

Common symptoms that may accompany ear pain or earaches include:

• Feeling pressure in the ear
• Hearing loss
• Fever
• Feeling ill
• Fluid draining from the ear
• In children: irritability or pulling at the ear.
• Sore throat

Middle ear infection

A middle ear infection, usually just called an ear infection, is a common cause of ear pain. It occurs when fluid gets trapped in the middle ear. Normally, the Eustachian tube allows this fluid to drain, but sometimes that tube gets blocked. If the fluid is trapped in the ear for too long, it can get infected with bacteria. 

Symptoms of an ear infection include ear pain and fever. It may also include fluid draining from the ear. Another name for a middle ear infection is otitis media. 

Blockage of the Eustachian tube

Congestion from allergies, colds, and sinus infections can block your Eustachian tubes, preventing fluid from draining from the middle ear. Sometimes this can cause ear pain even with no infection present. 

Outer ear infection (swimmer's ear)

Swimmer's ear is an infection that occurs when water doesn't fully drain from the canal that runs between your outer ear and your eardrum. This often occurs if water gets stuck in your ear after swimming, hence the name.

You can also get it from irritation of the skin in this part of the ear. That may occur from putting things in your ear, like a finger or a cotton swab.

Another name for swimmer's ear is an outer ear infection or otitis externa. 

Air Pressure Changes (ear barotrauma)

Ear barotrauma happens when the air pressure changes rapidly. Many people experience this during and after flying in an airplane. 

Normally, the air pressure remains the same inside and outside the ear. When you swallow and yawn, your ear "pops," equalizing the pressure between the inner and outer ear. This is one of the functions of the Eustachian tube.

However, when the air pressure changes rapidly, the Eustachian tube may not be able to keep up, leading to discomfort. Additionally, if your Eustachian tube is blocked due to congestion, you may experience barotrauma without any pressure changes. If that is the case, you are also more likely to experience barotrauma in situations with air pressure changes like flying or scuba diving.

Earwax buildup

Earwax, also called cerumen, is an important substance for ear health. It moisturizes our ears, preventing them from getting itchy. It also helps to keep infections at bay. But sometimes, too much earwax can cause a blockage leading to ear pain. 

Other Infections

When ear pain also comes with a sore throat, you may have tonsillitis — an infection of the tonsils. It could also be pharyngitis, the medical term for a sore throat that can be a sign of another infection like strep throat.

Other Serious Health Issues

In rare cases, ear pain may be a sign of a more serious health problem like a tumor or cellulitis.

You should see a doctor if:

• Your ear pain is very bad
• You have a high fever
• You have a sore throat
• You also have a rash
• Ear pain doesn't go away after a few days of home treatment

In general, doctors will first look in your ears, nose, and throat with an otoscope, a lighted magnification device. They may also test your hearing by rubbing their fingers together next to your ear. If further tests are needed, they may do any of the following:

• Use a pneumatic otoscope to send a puff of air into the eardrum. If the eardrum has no movement, that means there is fluid behind it and you likely have an ear infection.
• Use a tympanometry machine, to measure just how much your eardrum can move.
• Perform acoustic reflectometry to find out how much sound your eardrum absorbs and reflects.
• Take a sample of the fluid from your eardrum to test it for microorganisms that may cause infections. This procedure is called tympanocentesis.

The treatment for ear pain depends on the cause. 

Earwax blockage

You can treat a minor earwax blockage at home with an over-the-counter kit. Your doctor may prescribe medication if you have chronic earwax buildup or blockages.

Air pressure changes

While flying: 

• Take a decongestant before flying if you have nasal congestion
• Chew gum
• Swallow frequently
• Try to make your ears pop
• Use special ear plugs that help to slow down the pressure changes, reducing the symptoms of barotrauma 

While scuba diving:

• Make your ears pop before and during your descent
• Descend feet first
• Slowly ascend if you have ear pain to prevent ear injuries

Swimmer's ear

Doctors usually prescribe antibiotics. They may be ear drops or an oral medication. In some cases, they may prescribe antifungal medicines or steroids if needed. 

Middle ear infection

The treatment for this is also usually antibiotics. However, doctors may wait for two to three days before prescribing them to see if the body's immune system will fight the infection on its own.

Doctors may place an artificial tube in the ear to help it drain in people with chronic ear infections.

Home treatment

Before you see a doctor, you can try treating your ear pain at home. If these methods don't work after two to three days, seek medical attention.

• Use over-the-counter pain medications like acetaminophen
• Use a hot or cold compress over the ear
• Sleep with your head elevated and on the opposite side to relieve the pressure