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Ear Problems and Injuries, Age 12 and Older
Ear problems may be caused by many different health problems. In children, ear pain is more likely to be a symptom of an inflammation, infection, or fluid buildup in the external or middle ear. But ear pain at any age may be a symptom of:
- Infection of the middle ear (acute otitis media).
- Inflammation or infection of the ear canal (otitis externa).
- Buildup of fluid behind the eardrum (otitis media with effusion), without infection.
Ear problems caused by an injury to the ear can occur at any age. Common injuries include the following:
- A fall or a forceful, direct blow to the side of the head can burst the eardrum or damage the tiny bones in the inner ear that send sound to the brain.
- An injury during contact sports can cause an injury, such as "cauliflower" ear from wrestling.
- Loud noises or explosions can damage the eardrum (acoustic trauma).
- Atmospheric pressure changes (barotrauma) can cause problems with the eustachian tube and trap air in or keep air out of the middle ear. Middle ear problems can be severe (for example, the eardrum can burst or the middle ear can fill with blood or pus) or mild and only be felt as changes in pressure.
- Cuts or scrapes may injure the outside of the ear or ear canal. For more information, see the topic Ear Canal Problems (Swimmer's Ear).
- Cleaning the ear canal too often, too forcefully, or with a cotton swab, bobby pin, or sharp fingernail can cause irritation or injury.
- Burns or frostbite can cause ear injuries (thermal injuries).
- Objects placed in the ear can cause injury to the ear canal or the eardrum (tympanic membrane).
Hearing loss often comes with age. As people get older, ear problems are more likely to be related to:
- Heredity. The age of onset and how quickly the hearing loss progresses can often be determined by studying family members with hearing loss.
- The buildup of earwax. For more information, see the topic Earwax.
- Exposure to loud noises, such as setting off an air bag during a car crash, machines at work, power tools, gunshots, or loud music.
- Other serious medical problems, such as Ménière's disease or an acoustic neuroma.
- Skin reaction (dermatitis) on the outside of the ear or in the ear canal from perfume, hair dye, or wearing hearing aids.
The ear shares nerves with other parts of the face, eyes, jaw, teeth, and upper neck. Pain that feels as if it is in the ear may be coming from another part of the head or neck. This is called referred ear pain and is more common in older adults. Causes of referred ear pain can include dental problems, jaw pain (temporomandibular disorder), salivary gland infection, or a sinus infection.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.
Oral (by mouth) temperature
- High: 104°F (40°C) and higher
- Moderate: 100.4°F (38°C) to 103.9°F (39.9°C)
- Mild: 100.3°F (37.9°C) and lower
A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.
- High: 105°F (40.6°C) and higher
- Moderate: 101.4°F (38.6°C) to 104.9°F (40.5°C)
- Mild: 101.3°F (38.5°C) and lower
Armpit (axillary) temperature
- High: 103°F (39.5°C) and higher
- Moderate: 99.4°F (37.4°C) to 102.9°F (39.4°C)
- Mild: 99.3°F (37.3°C) and lower
Symptoms of an external ear infection may include:
- Moderate to severe pain in the outer ear.
- Pain with chewing.
- Redness and swelling of the ear, ear canal, or the skin around or behind the ear.
Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
If you're not sure if a fever is high, moderate, or mild, think about these issues:
With a high fever:
- You feel very hot.
- It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.
With a moderate fever:
- You feel warm or hot.
- You know you have a fever.
With a mild fever:
- You may feel a little warm.
- You think you might have a fever, but you're not sure.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Symptoms of a stroke may include:
- Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Home treatment may be all that is needed to relieve minor or intermittent ear discomfort.
- To ease ear pain, apply a warm washcloth. There may be some drainage from the ear when the heat melts earwax.
- Do not use a heating pad when you are in bed. You may fall asleep and burn yourself.
- Do not use a heating pad on a child.
- Try an ice or cold pack to reduce swelling from a minor injury or sunburn. Apply for 15 minutes 3 or 4 times a day during the first 48 hours after the injury. The sooner you apply a cold pack, the less swelling you are likely to have. Place a cloth between the ice and your skin.
- Oral or nasal decongestants may relieve ear pain, especially if the pain is related to fluid behind the eardrum (otitis media with effusion). Avoid products that contain antihistamines, which tend to cause more blockage, unless allergies seem to be the problem.
- Chewing gum may help relieve pressure changes in the ear, such as when flying in an airplane.
- Try a nonprescription earwax remover if your ear feels plugged but you do not have obvious signs of infection. Be sure to follow the label directions carefully.
- Do not use ear candles. They have no proven benefit in the removal of earwax or the treatment of other ear problems, and they can cause serious injury.
Try a nonprescription medicine to help treat your fever or pain:
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Pain develops or increases.
- Fever or other signs of ear infection develop.
- New or different drainage from the ear develops.
- Other symptoms develop, such as hearing loss or vertigo.
- Your symptoms become more severe or frequent.
You may be able to prevent ear problems.
- Teach your children to blow their noses gently. Remember to do this yourself also.
- Keep soap and shampoo out of the ear canal. These products can cause itching, which can be mistaken for an ear infection because of the need to scratch or pull at the ears.
- Do not put cotton swabs, bobby pins, or other objects (especially if they are sharp) in the ear canal.
- Limit your contact with others who have colds, when possible.
- Protect your ears from sunburn and frostbite.
- Apply sunscreen to your ears and wear a hat that shades the ears in the summer.
- Wear a hat that covers the ears in the winter.
- Limit or avoid exposure to loud noises such as music, power tools, gunshots, and industrial machinery.
- Wear protective earplugs or earmuffs if you can't avoid loud noises.
- Avoid the prolonged use of earplugs. They can cause irritation, itching, and can plug the ear with wax.
- Do not use wadded-up tissue or cotton balls. These do not protect adequately against loud noises (especially the more dangerous high frequencies) and they may become lodged in the ear canal.
- Avoid exposing children to cigarette smoke, which is linked with more frequent ear infections. If you smoke and are unable to stop, smoke outside, away from children.
- Stop smoking. Smoking irritates the mucous membranes that line the nose, sinuses, and lungs, and it may contribute to inflammation or infection of the ear. See the topic Quitting Smoking.
- If ear pain appears to be related to a problem with your jaw, see the topic Temporomandibular (TM) Disorders for tips on relaxing the muscles in this area.
- Take good care of your teeth. Daily brushing and flossing, along with regular dental checkups, helps prevent tooth decay, infections, and other dental problems that can lead to referred ear pain.
- If you wear hearing aids, be sure to follow the manufacturer's recommendations carefully for cleaning and storing them.
- For tips on how to prevent swimmer's ear, see the topic Ear Canal Problems (Swimmer's Ear).
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- Do you have ear pain?
- When did the pain start?
- What were you doing when the pain started?
- Does the pain come from the inside or the outside of your ear?
- Has the pain been constant, or does it come and go?
- Does anything make the pain better or worse?
- Have you ever had this type of ear problem before? If yes, what was the diagnosis and how was it treated?
- What other symptoms do you have? Do you have a fever, runny nose, cough, congestion, or jaw discomfort?
- Do you suspect a hearing problem? Be prepared to describe your symptoms.
- Do you have hearing loss or ringing in the ears (tinnitus)?
- Does your hearing problem affect just one ear or both ears?
- Do you use hearing aids?
- Have you had a recent injury to the ear?
- Do you have any other symptoms in your eye, teeth, jaw, facial muscles, or neck that might suggest referred pain?
- Do you have drainage from the ear? If yes, what does it look and smell like?
- Have you had problems with earaches or ear infections in the past?
- Have you been swimming or had other recent exposure to water, such as through surfing, kayaking, or scuba diving?
- Do you regularly use a hot tub or home spa?
- Have you recently traveled by plane?
- What home treatment measures have you used? Be sure to include nonprescription and prescription medicines you have tried.
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine