Learn more about earache: introduction
Earache is a common problem, particularly in children. It can be worrying, but it's usually only caused by a minor infection and will often get better in a few days without treatment.
Earache can be a sharp, dull or burning pain in the ear that comes and goes or is constant. You may get pain in just one or both ears.
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When to get medical advice
It's not always necessary to see your GP if you or your child have earache. The pain will often improve in a few days and there are things you can do to help in the meantime (see below).
- you or your child also has other symptoms, such as a high temperature (fever), vomiting, a severe sore throat, swelling around the ear, or discharge from the ear
- there's something stuck in your or your child's ear
- the earache doesn't improve within a few days
What you can do at home
Placing a warm flannel against the affected ear may also help relieve the pain.
Your pharmacist may be able to recommend over-the-counter eardrops for your earache. Tell them about your symptoms and ask for their advice first.
Eardrops or olive oil drops shouldn't be used if your eardrum has burst (a perforated eardrum), and in treating an ear infection.
It's important to avoid getting the affected ear wet if you have an ear infection.
Common causes of earache
If an ear infection is causing your earache, there may be a watery or pus-like fluid coming out of your ear.
Ear infections often clear up on their own without treatment after a few days or weeks, but in some cases your GP may prescribe eardrops or antibiotics.
Glue ear, also known as otitis media with effusion (OME), is a build-up of fluid deep inside the ear, which commonly causes some temporary hearing loss. The condition tends to be painless, but sometimes the pressure created by the fluid can cause earache.
Glue ear often clears up on its own, but it can take a few months. If the problem is particularly persistent, a minor procedure to place small tubes called grommets in the ear may be recommended to help drain the fluid.
Read more about treating glue ear.
Earache can sometimes be caused by an injury to the inside of the ear – for example, by scraping earwax from the ear canal using a cotton bud, or poking a cotton bud too far into your ear, which can puncture the eardrum.
The ear canal is very sensitive and can be easily damaged. The ear should heal on its own without treatment, but it can take up to two months for a perforated eardrum to heal.
If you have a perforated eardrum, you shouldn't use eardrops.
A build-up of earwax can sometimes cause earache.
If you have a build-up of earwax in your ear, your pharmacist will be able to recommend eardrops to soften it so it falls out naturally.
In some cases, your GP may need to remove the wax (once softened with eardrops) by flushing the ear with water. This is known as ear irrigation.
An object in the ear
If there's something in your or your child's ear that's causing pain, don't try to remove it yourself because you may push it further inside, which could damage the eardrum.
Contact your GP or local out-of-hours service. Your GP may need to refer you or your child to a specialist to have it removed.
If you find it painful to swallow and you have a sore throat, your earache could be a symptom of a throat infection, such as:
- tonsillitis – inflammation of the tonsils that's usually caused by a viral infection
- quinsy – an abscess on one side of the back of your throat, which can sometimes make it very difficult to swallow even fluids
Tonsillitis sometimes clears up after a few days without the need for antibiotics.
If you have quinsy, you'll need to see your GP as soon as possible for treatment. You may have quinsy if you have a sore throat that gets worse very quickly.
Earache can be caused by a problem with the joint of your jaw bone (where the jaw meets the skull).
Jaw pain can often be relieved with painkillers, warm or cold compresses, and trying not to clench your jaw and grind your teeth.
A dental abscess is a collection of pus that can form in your teeth or gums as a result of a bacterial infection. The main symptom is pain in the affected tooth, which can be intense and throbbing. Sometimes, the pain can spread to your ear.
Make a dental appointment as soon as possible if you think you have a dental abscess. Your dentist will need to remove the source of the infection and drain the pus from the abscess.
Read more about treating dental abscesses.
Learn more about earache: outer ear infection
Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.
Otitis externa is often referred to as "swimmer's ear" because repeated exposure to water can make the ear canal more vulnerable to inflammation.
Symptoms of otitis externa include:
- ear pain, which can be severe
- itchiness in the ear canal
- a discharge of liquid or pus from the ear
- some degree of temporary hearing loss
Usually only one ear is affected.
With treatment, these symptoms should clear up within a few days. However, some cases can persist for several months or longer.
Read more about the symptoms of otitis externa.
When to see your GP
You should see your GP if you may have otitis externa.
Your GP will ask about your symptoms and whether you regularly use any items that are inserted into your ears, such as hearing aids or ear plugs. They may also examine inside your ear using an instrument called an otoscope.
If you have recurring episodes of otitis externa that haven't responded to treatment, your GP may take a swab of the inside of your ear. This will be tested to help determine what type of infection you have, if any, so appropriate medication can be prescribed.
What causes otitis externa?
Most cases of otitis externa are caused by a bacterial infection, although the condition can also be caused by:
- fungal infections
There are a number of things that can make you more likely to develop otitis externa, including:
- damaging the skin inside your ear
- regularly getting water in your ear
Getting water in your ear is particularly significant, because this can cause you to scratch inside your ear, and the moisture also provides an ideal environment for bacteria to grow.
Read more about the causes of otitis externa.
Who is affected?
Otitis externa is relatively common. It's estimated that around 1 in 10 people will be affected by it at some point in their lives.
The condition is slightly more common in women than men and is most often diagnosed in adults aged 45 to 75.
People with certain long-term (chronic) conditions are at greater risk of developing the condition. These include:
How otitis externa is treated
Otitis externa sometimes gets better without treatment, but it can take several weeks. Your GP can prescribe ear drop medication that usually improves the symptoms within a few days.
There are a number of different types of ear drops that may be used to treat otitis externa, but they all tend to be used several times a day for about a week.
Your GP may refer you to a specialist for further treatment and advice if symptoms are severe or they fail to respond to treatment.
Read more about treating otitis externa.
Preventing otitis externa
To help reduce your chances of developing otitis externa, you should avoid inserting cotton wool buds and other things into your ears (including your fingers), as this can damage the sensitive skin in your ear canal.
If you're a regular swimmer, consider using ear plugs when swimming or wearing a swimming cap to cover your ears and protect them from water.
You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath.
Read more about preventing otitis externa.
Complications of otitis externa are uncommon, but some can be very serious.
One rare complication of otitis externa is malignant otitis externa, which is where an infection spreads from the ear canal into the surrounding bone.
This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated.
Read more about the complications of otitis externa.
Learn more about earache: earwax
Earwax is produced inside your ears to keep them clean and free of germs. It usually passes out of the ears harmlessly, but sometimes too much can build up and block the ears.
A build-up of earwax is a common problem that can often be treated using eardrops bought from a pharmacy.
If pharmacy treatment doesn't work, contact your GP surgery. They may suggest having your ears washed out.
If these treatments don't help, your GP may refer you to an ear, nose and throat (ENT) department for specialised treatment.
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What can cause an earwax build-up?
Some people regularly get blocked ears because they naturally produce a lot of earwax.
Other factors that can increase the risk of too much earwax include:
- producing naturally hard or dry earwax
- having narrow or hairy ear canals (the tube between the opening of the ear and the eardrum)
- being elderly, as earwax becomes drier with age
- bony growths in the outer part of the ear canal
Earwax can also block your ear if you frequently insert objects into your ear canal, such as cotton buds, ear plugs or hearing aids.
Symptoms of an earwax build-up
A build-up of earwax in your ear can cause:
- hearing loss
- tinnitus (hearing sounds from inside your body)
- itchiness in or around the ear
- vertigo (a spinning sensation)
- ear infections
These problems will usually improve once the excess earwax has been removed.
What to do if you think your ear is blocked
Don't try to remove a build-up of earwax yourself with your fingers, a cotton bud or any other object. This can damage your ear and push the wax further down.
If the earwax is only causing minor problems, you can try buying some eardrops from a pharmacy. These can help soften the earwax so that it falls out naturally.
There are several different types of eardrops you can use, including drops containing sodium bicarbonate, olive oil or almond oil.
However, eardrops aren't suitable for everyone and some can irritate the skin. For example, eardrops shouldn't be used if you have a perforated eardrum (a hole or tear in your eardrum).
Speak to your pharmacist about the most suitable product for you and make sure you read the leaflet that comes with it.
When to see your GP
Contact your GP surgery if you have particularly troublesome symptoms or eardrops haven't helped after three to five days.
Your GP or practice nurse will look inside your ears to check if they're blocked and might carry out some simple hearing tests.
They may suggest using eardrops for a bit longer, or they may carry out a minor procedure called ear irrigation to clean out your ear canal.
If these treatments aren't suitable or don't help, your GP may refer you to the ENT department of your nearest hospital for more specialised treatments such as microsuction or an aural toilet.
Treatments to remove earwax
There are several different earwax removal treatments available.
The main treatments are:
- eardrops – drops used several times a day for a few days to soften the earwax so that it falls out by itself
- ear irrigation – a quick and painless procedure where an electric pump is used to push water into your ear and wash the earwax out
- microsuction – a quick and painless procedure where a small device is used to suck the earwax out of your ear
- aural toilet – where a thin instrument with a small hoop at one end is used to clean your ear and scrape out the earwax
Not all these treatments are suitable for everyone. Your pharmacist or doctor can let you know what treatments may work for you and they can tell you about any associated risks or side effects.
Preventing an earwax build-up
Some people are naturally prone to earwax building up in their ears and may need frequent treatment to remove it when it becomes a problem.
It's not clear if there's anything you can do to stop earwax blocking your ears, although some doctors recommend using eardrops regularly to keep your earwax soft.
Don't try to scrape out the earwax with your finger or an object inserted into your ear, as this this can make the problem worse.
Speak to your doctor for advice if earwax builds up in your ears regularly.
Learn more about earache: treatment
The aim of taking medication is to improve your quality of life. All painkillers have potential side effects, so you need to weigh up the advantages of taking them against the disadvantages.
This page covers:
Paracetamol is used to treat headaches and most non-nerve pains.
Two 500mg tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are not common and this dose can be taken regularly for long periods.
Overdosing on paracetamol can cause serious side effects, however, so don't be tempted to increase the dose if your pain is severe.
If the pain lasts for more than three days, see your GP.
More on paracetamol.
So-called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, seem to work better when there is clear evidence of an inflammatory cause, such as arthritis or an injury.
They should not be used for long periods unless you have discussed it with your doctor.
If you take them for long periods, there's an increased risk of stomach upset, including bleeding, and kidney and heart problems.
Don't take more than the recommended dose, as this will increase the risk of serious side effects.
More on ibuprofen.
Aspirin is another type of NSAID.
It produces the same kind of side effects as other NSAIDs, but is not as effective as a painkiller, which means it's not usually prescribed for pain.
It is dangerous for children under 16.
Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill.
You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher-dose codeine has to be prescribed.
Codeine and other medium-strength prescribed painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period.
If you need more and more of these drugs, contact your GP or other healthcare professional for advice.
Effervescent painkillers are high in salt, containing up to 1g per tablet.
Too much salt can raise your blood pressure, which puts you at increased risk of health problems such as heart disease and stroke.
You may want to consider switching to a non-effervescent painkiller, especially if you've been advised to watch or reduce your salt intake.
Amitriptyline and gabapentin
Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy.
Each of these medicines can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica.
You don’t have to have depression or epilepsy for these tablets to help your nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP.
Side effects include drowsiness and dizziness.
Morphine and morphine-like drugs (such as oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are.
Some come as a patch, but they all work in similar ways and should only be used for severe pain.
They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.
Read about the NHS help on offer if you have persistent pain.
Further advice on painkillers
Talk to your pharmacist or GP, or call NHS 111 if you need more advice on painkillers.