An earache is pain in the outer, middle or inner ear, usually caused by an infection or build-up of pressure behind the eardrum. Earache is most common in children.
Guidelines
- If trained and it is safe to do so, first aid providers may give the person paracetamol for pain relief. *
Good practice points
- A source of heat can be held against the affected area and may reduce pain.
- Advise the person not to pick their ear.
- Medical advice should be sought when there is fever, fluid draining from the ear, vertigo, loss of or decreased hearing associated with ear pain.
- The person should seek medical advice if the symptoms don’t get better (or get worse) within 48 hours.
Chain of survival behaviours
Prevent and prepare
- Teach children to avoid putting objects in their ears, such as cotton swabs or buds, or pencils.
- People using noisy equipment should use ear defenders to reduce noise below 85 decibels.
- Be alert to earache in people who use a hearing aid or who listen to music through headphones.
- Be alert to earache in people who spend a lot of time in the water, have an abscess or infection in their gums or have had a cold or flu.
- Keep ears warm and dry where possible.
Early recognition
- The person may complain of pain, hearing changes or sensation of fullness in their ear.
- The ear may be hot or sensitive to touch.
First aid steps
- 1. Help the person to take the recommended dose of an over-the-counter painkiller (e.g., paracetamol) to reduce pain.
2. Give them a warm compress such as a hot water bottle wrapped in a towel to hold against their ear to reduce pain.
Access help
- Seek medical advice if there is discharge coming from the ear, hearing loss, vertigo or fever. Seek medical advice if the earache does not improve within 48 hours.
Education considerations
Learner considerations
- Individuals who look after children or spend time in water contexts (e.g., public swimming pool) could benefit from learning about earaches.
Scientific foundation
Systematic reviews
As a scientific foundation for this topic, three evidence summaries from the Centre for Evidence-Based Practice (CEBaP) and an additional systematic review were used.
An evidence summary about using paracetamol in case of earache resulted in the identification of a Cochrane systematic review, which included one randomised control trial. It was shown that paracetamol resulted in a statistically significant decrease in pain in the ear compared to no paracetamol. Evidence is of low certainty and results cannot be precise due to limited sample size.
An evidence summary about heat or cold application in case of earache, as well as an evidence summary about posture in case of earache, could not identify any studies.
Additional information
Earache is an infection of the middle ear that causes inflammation and a build-up of fluid behind the eardrum. An earache can develop from inflammation of the outer, middle or inner ear and is often caused by an infection in case of a cold or flu (Pukander, 1983). An ear can become painful if an object is stuck in the ear canal. Pain from a tooth, such as an abscess can also cause an earache. An earache can cause temporary hearing loss and infection can cause pus to gather in the middle of the ear, causing the eardrum to rupture.
Acute earache predominantly occurs in children. Canadian research shows that babies between six and 15 months old are most commonly affected (Casselbrant and Mandel, 2003). It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old. Medical care should be sought when there is fever, ear drainage, vertigo, loss of hearing or decreased hearing associated with ear pain (Worrall, 2011).
An outer ear infection is one of the more common diseases and is also frequently encountered in primary and paediatric care. More than 90% of the cases are due to bacteria (Wiegand et al., 2019). An outer ear infection is thought to affect 10% of people at some stage and can present in acute, chronic, or necrotising forms. The inflammation may be associated with eczema of the ear canal, and is more common in humid environments, in people with narrow ear canals, who swim regularly or use a hearing aid, and after mechanical trauma, such as from ear cleaning or earphones that go into the canal.
Outer ear infection ranges in severity from a mild infection of the external auditory canal to a life-threatening infection. Pain relief is an essential part of the treatment of outer ear infection (Wiegand et al., 2019) The treatment should be done by a general practitioner. Individuals should not clean their ears with cotton swabs, because they may damage them and encourage bacterial invasion.
It has been estimated that in around 80% to 85% of children with an earache, the fever and pain resolve within two to three days. After seven days, the absence of all symptoms and signs (except for middle ear effusion) can be expected. The use of nasal drops or spray containing xylometazoline has no effect on earache and is not recommended (Coleman et al., 2008).
References
Systematic reviews
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Earache – Paracetamol. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Earache – Heat or cold application. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Earache – Posture. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Non-systematic reviews
Casselbrant, M.L. & Mandel, E.M. (2003). Epidemiology. In R.M. Rosenfeld & C.D. Bluestone (Eds.), Evidence based otitis media, 2nd edition (147-162). BC Decker.
Coleman, C., & Moore, M. (2008). Decongestants and antihistamines for acute otitis media in children. Cochrane Database Systematic Reviews. DOI https://doi.org/10.1002/14651858.CD001727.pub4
Pukander, J. (1983). Clinical features of acute otitis media among children. Acta Otolaryngol, 95, 117–122. DOI 10.3109/00016488309130924
Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa—investigation and evidence-based treatment. Deutsches Ärzteblatt International, 116, 224–234. DOI 10.3238/arztebl.2019.0224
Worrall. G. (2011). Acute earache. Canadian Family Physician, 57(9), 1019–e322.
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