Earaches originate from a number of different causes. Although potentially painful and frustrating, most are not dangerous. As with most symptoms you experience, it is an indication of something wrong. It's important to also pinpoint the origin of the pain and not just treat the symptom.
More children than adults suffer from earaches. Your child's pediatrician may offer antibiotics or pain medication for an earache; however, research demonstrates that most middle ear infections, while uncomfortable, may resolve spontaneously within a week.1
Neither the Centers for Disease Control and Prevention (CDC)2 nor the American Academy of Pediatrics (AAP)3 recommend using antibiotics immediately to treat ear infections. But, ear infections are not the only reason you or your child may experience an earache.
Before delving into the reasons for earaches and some of the more effective ways to treat them at home, it's helpful to have an overview of how the ear is structured and where pain may be coming from.
Inside Your Ear
Your ear is a complex structure designed to gather sound waves from your environment, funnel them through delicate boney structures and send signals to your brain that you interpret as sound and language.
Each part of your ear has a specific function. This short video examines the outer ear structure, essential to the initial stage of hearing.
The way your ear is structured on the side of your head helps to funnel sound waves through the canal. The outer ear ends once sound travels through the ear canal and hits the tympanic membrane, also called the ear drum. When sound hits this membrane, it starts to vibrate.4
The vibrations next enter the middle ear, consisting of three small bones and the entrance to the Eustachian tube. This tube travels between the middle ear and your nasopharynx, at the back of your nose and mouth, to maintain pressure in your ear.
From there, sound enters the inner ear and the fluid-filled cochlea. Tiny hairs in the cochlea pick up the sound waves and transmit the information to your auditory nerve, which communicates this data to your brain. The process from sound generation to your brain interpretation happens in milliseconds.
Keep the Wax, Leave the Q-Tip
You may be swabbing your outer ear after a shower as part of your daily hygiene, but you'll want to reconsider removing earwax as it provides protection, lubrication and has some antibacterial properties to protect the outer ear.
The American Hearing Research Foundation explains there are at least 10 antimicrobial peptides in earwax to prevent bacteria and fungi from growing.5
Normally, earwax is formed in the outer third of the outer canal and naturally migrates outward carrying dirt and debris with it. Consistently wearing ear plugs, head phones or hearing aids can slow or stop the process.
If you have earwax against your eardrum, it's likely you've been too vigorous with a Q-tip, rolled napkin or other object in your outer ear canal. It's best to leave earwax alone unless you have symptoms of buildup or blockage in your canal. Those symptoms may include:
Itching, odor or discharge from your ear
Partial or progressive hearing loss
Tinnitus, ringing or noises in your ear
Feeling of fullness in the ear canal
Dr. Peter Svider, otolaryngology resident at Wayne State University, Michigan, talked about using cotton swabs in the ear in Time Magazine. He shared they are the major cause of ear-related ER visits for U.S. adults, adding that:6
"Swab incidents are really a common clinical thing we see. The way the cotton swab is designed — it's really not a good tool for removing wax. You tend to push more in than you pull out."
What's Causing Your Ear to Hurt?
Compare the difference between the first video demonstrating a healthy ear drum, and this examination, above, showing scar tissue, fluid effusion and infection. There are several reasons you may experience an earache, including earwax buildup against the eardrum, as discussed above. Other causes for ear pain include:7
Middle ear infection
Outer ear infection (also known as swimmers ear)
Injury to the ear canal after inserting something
Pimple, infected hair follicle or boil
Throat infection or cold
Temporomandibular joint pain (TMJ)
Bruxism or teeth grinding
Trigeminal neuralgia or fascial nerve problem
Barotrauma after pressure or altitude changes; also called airplane ear
Dental abscess, tooth pain or wisdom teeth problem
Foreign body stuck in the ear canal; more frequently in children
Although there are several remedies you may use or start at home to ease the discomfort of an earache, it's important to understand why your ear hurts so you may seek medical attention for the underlying cause if necessary.
You may start by evaluating your own symptoms and history of ear discomfort. If you can't find a reasonable cause or the problem persists, it is time to see a doctor.
Evaluate Your Symptoms
While many middle ear infections will clear without antibiotics, you or your child may have one that requires medical attention. Other known causes of an earache may clear at home or require the attention of an orthodontist, dentist or your primary care physician. Start by asking yourself some of the following questions about your symptoms to help assess whether medical attention is necessary.
Is the pain associated with a cold or the flu?
This pain is more likely to come on slowly as congestion with a cold builds. It usually goes away as the cold resolves.
Is there pus around the outside of the ear?
May be the result of an eardrum rupture from fluid build-up in the middle ear. When the eardrum ruptures the pain almost disappears.
Have you been flying in an airplane or scuba diving?
You may be suffering from barotrauma from altitude change. If you have other body symptoms after scuba diving seek medical care immediately.
When localized to the ear, most cases resolve with chewing gum, sucking on hard candy or yawning frequently to equalize pressure.8
Do you grind your teeth at night?
This increases muscle tension at the jaw and may be interpreted as an earache. Seek attention from your dentist or orthodontist for a night brace to stop the grinding and prevent permanent damage to your teeth.
Is the earache associated with tooth pain or discomfort near the back of your mouth?
This may be the result of impacted wisdom teeth or a cavity. Your pain will not resolve without attention to your cavity or wisdom teeth by a dentist.
Does the pain in the ear get worse when you tug on the outer ear?
This may indicate swimmer's ear. You may also experience fever, drainage and pain that spreads to your face and neck.9
If you don't experience quick relief with an at home treatment seek medical care to reduce the potential for hearing loss or cartilage damage.
Delay Antibiotics and Pain Medication Until They Are Necessary
Here, a massage technique is demonstrated to help the Eustachian tubes drain and reduce pressure on the middle ear from fluid build-up. Although infections may occur in any of the three parts of your ear, an infection in the inner is the most dangerous to your hearing. Common middle ear infections rarely require medication except when they are severe in young infants.10
When possible avoid using antibiotics or pain medication. Antibiotics can wreak havoc on your intestinal system, destroying your microbiome and increasing your risk of developing other health challenges. For more information about how antibiotics may affect your gut, see my previous article titled, "Many Prescribed Antibiotics Are Unnecessary and Cause Damage." While necessary in some instances, most of the time you may be able to get by using natural antibacterials.
The American Academy of Pediatrics recommends cautiously administering antibiotics for ear infections as they don't always completely kill the bacteria present, making the bacteria left behind more resilient to the antibiotics and more likely to cause chronic ear infections.11
Pain medications create another list of problems for you and your children. While seemingly innocuous and sold frequently over the counter, even taking just a little too much acetaminophen may have severe, even deadly, results. Several of the options available at home listed below may help to reduce your pain and discomfort without the added risk of pain medications.
Reduce Earwax Buildup and Pressure in Your Middle Ear
As you consider these options for treatment at home, remember to never put anything into the ear canal if you think the eardrum may be ruptured or if you know there is a small hole in your eardrum. Fluid or oils will drain through the hole and potentially damage the delicate bones behind the eardrum, leaving you with permanent hearing loss.
If you experience a buildup of wax near your eardrum, it can cause pain and a feeling of fullness in the ear. You may easily remedy the situation at home by using a liquid to soften the wax so it can migrate out, or use an ear irrigation tool to flush out the wax.
Acceptable fluids are saline solution, coconut oil, hydrogen peroxide, carbamide peroxide or olive oil. It may require irrigation of the ear canal with a syringe to remove. However, if done improperly it can damage your eardrum. You should not irrigate your ears if you have diabetes, a tube in the eardrum, if your eardrum is perforated or your immune system is weakened. Removal in these circumstances require the care of an Ear, Nose and Throat doctor.
When ear pain is associated with a middle ear infection, there may be an increase in fluid behind the eardrum that triggers the pain. There are several ways to reduce the pressure and thus reduce the pain. Massage techniques can help open the Eustachian tubes and increase the flow of fluid out of the middle ear.
In the same manner, yawning or sucking on hard candy encourages thick fluid to flow down the Eustachian tubes. Sleeping sitting up will also help reduce the pressure on the eardrum, the cause of the pain for an increase in fluid.
Gargling with salt water may help to loosen thick fluid in the Eustachian tube and may help to kill viruses in the back of your throat, reducing the length of a viral infection.12 Gargling with apple cider vinegar will also help if you have an infection from a fungus.13 If you are bottle feeding your baby, it is important they eat in a more upright position to reduce the amount of formula that enters the Eustachian tube.
Reducing Ear Pain and Infection at Home
Hot and cold packs can be used to help reduce pain.14 A cold, damp washcloth held on the area for 20 minutes may help to numb it and reduce the pain, while a warm, wet cloth for 20 minutes may help relax the muscle tension around the ear and improve blood flow. You can also make a hot pack with a cup of salt or rice, warmed in the microwave or stove and placed in a sock. When bearable on the skin, place it over the ear for five to 10 minutes.15
Garlic has natural antimicrobial and pain relieving properties.16 You can eat two to three raw cloves of garlic daily, and make ear drops by cooking two cloves in 2 tablespoons of sesame or mustard oil until it darkens, then strain. When the oil has cooled to the point it isn't too hot on the inside of your wrist, apply one to two drops in the affected ear.
The same can be done with onion juice. Chop a small onion and heat it in the microwave for one to two minutes. Once it has cooled, strain the liquid off and place several drops in one ear. Leave it in for approximately 10 minutes and then turn your head to drain it out. Repeat with the other ear.
Breast milk has natural antibodies that speed healing and reduce swelling, working in both adults and children. Use two to three drops in the affected ear every three to four hours as needed. A few drops of 3 percent hydrogen peroxide into each ear at the start of symptoms of a cold or an earache may also improve symptoms within 24 hours. You can read more about the benefits and why it works in my previous article titled, "Hydrogen Peroxide for Colds and Flu."
Chiropractic adjustments are effective when your ear pain originates from neck and shoulder muscle tension or if you have middle ear fluid. In the first case, a chiropractor may evaluate your posture and give you exercises to reduce a potential problem with imbalanced muscle development in your shoulders and back that trigger the tension. An adjustment may also help open your Eustachian tube so fluid flows more freely out of the middle ear and reduces your pain.