Introduction

Earache is mainly due to problems in either the outer ear (from the earlobe to the eardrum) or the middle ear (behind the eardrum).

In some cases, problems in the throat or the mouth, such as infection of the throat (tonsillitis, pharyngitis).

Tumour of the throat can also cause earache.

Causes

Listed below are some common reasons for earache.

1. Ear wax
   
   Ear wax can gather in the ear canal (auditory canal). Eventually it can form an ear plug, which impairs hearing and may cause pain.

1. Infection of ear canal
   
   Bacterial (furunculosis/boil) or fungal infection (otomycosis).

1. ‘Eczema’
   Eczema can occur in the auditory canal, causing dry, red, scaly and itchy skin. This can also become infected and painful.

   Inflammation of the middle ear

   • ‘Acute suppurative otitis media’
     
     Usually earache starts further inside the ear. Inflammation of the middle ear is the frequent cause and is often (although not always) due to an infection.

     Because of increased pressure in the middle ear, the eardrum is stretched and swollen. This impairs hearing and is painful.

     Common cold or flu is the commonest predisposing factor.

Signs & symptoms

Associated symptoms :

• Hearing loss
• Itchiness
• Ear discharge

Treatment

• An impacted wax can be softened with an olive / vegetable oil or sodium bicarbonate ear drops before removal by trained medical personal or ENT doctor.
• Ear drop can also be bought at the pharmacy that are designed for this purpose.
• Only trained Medical Personal are allowed to syringe the ears by flushing out the ear wax with warm water. This practice should not be performed on infected ear or perforated ear drum. This procedure if not performed properly can perforate the ear drum and cause giddiness, nausea and vomiting.
• Mild painkillers such as paracetamol can be used if the pain is severe.
• Ear canal infection should be treated by ENT Doctor. It may require proper cleansing, packing or even surgery.
• Ear drop containing corticosteroids may relieve and heal the irritated auditory canal. Topical Antibacterials or antifungals may be required if there is infection. Tablet or injection antibiotic may used for boil /furuncle in ear canal. Drainage of pus collection may be necessary.
• Acute earache with hearing loss and flu may indicate infection of the middle ear. This condition require early treatment with pain killer, antibiotic and decongestant. Otherwise, the eardrum would ruptured and discharging pus.

Prevention

• Earwax slowly migrates toward the opening of the ear canal and is sloughed off. Thus, regular cleansing is not necessary. However, washcloth can be used gently to wash the opening of your ear.
• Using a cotton bud doesn’t help because this usually only pushes the wax further inside the ear, doing more harm than good. Because the canal is at hourglass-shaped, earwax can create a plug that won’t come out on its own. It also carries the risk of perforating the eardrum and ear canal infection (otitis externa).
• Eczema sufferers should be careful about putting cotton buds into their ear because it usually only makes matters worse.
• Avoid blowing the nose forcefully or swimming/diving while having flu. These can predispose to acute middle ear infection (otitis media).