Medical Studies of ear aches and infections

http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm

Earache

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An earache can be a sharp, dull, or burning pain in one or both ears. The pain may be temporary or constant.

See also:

• Otitis media
• Swimmer's ear
• Malignant otitis externa

Considerations

The symptoms of an ear infection may include:

• Ear pain
• Fever
• Fussiness
• Increased crying
• Irritability

Many children will have temporary and minor hearing loss during, and right after, an ear infection. Permanent hearing loss is rare, but the risk increases with the number of infections.

Causes

The eustachian tube runs from the middle part of each ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. This may lead to pressure behind the eardrum or an ear infection.

Ear pain in adults is less likely to be from an ear infection. What you think is ear pain may actually be coming from another location, such as your temporomandibular joint, your teeth, throat, or other location. This is called "referred" pain.

Causes of ear pain may include:

• Arthritis of the jaw
• Acute ear infection
• Chronic ear infection
• Ear injury from pressure changes (from high altitudes and other causes)
• Object stuck in the ear or severely impacted ear wax
• Ruptured or perforated eardrum
• Sinus infection
• Sore throat with referred pain to the ears
• Temporomandibular joint syndrome (TMJ)
• Tooth infection

Ear pain in a child or infant may be due to infection, or the following causes:

• Ear canal irritation from cotton-tipped swabs
• Soap or shampoo staying in the ear

Home Care

The following steps may help an earache:

• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position can help reduce pressure in the middle ear.
• Over-the-counter ear drops are gentle and effective, as long as the eardrum has not ruptured.
• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give aspirin to children.)

You can relieve ear pain caused by rapidly descending from high altitudes by swallowing or chewing gum. Allowing infants to suck on a bottle or breastfeed while the plane is descending can help.

When to Contact a Medical Professional

Call your doctor if:

• Your child has a high fever or severe pain or seems sicker than is usual for an ear infection
• New symptoms appear, especially:
  • Dizziness
  • Severe headache
  • Swelling around the ear
  • Weakness of the face muscles
• Severe pain suddenly stops; this may be a sign of a ruptured eardrum
• Symptoms (pain, fever, or irritability) get worse or do not improve within 24 - 48 hours

What to Expect at Your Office Visit

The doctor will do a physical examination, and examine the ear, nose, and throat areas.

Pain, tenderness, or redness of the mastoid bone behind the ear on the skull is often a sign of a serious infection.

Prevention

The following steps can help prevent earaches:

• Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
• Prevent outer ear infections by not putting objects in the ear, and drying the ear after bathing or swimming.
• Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.

See: Traveling with children

Alternative Names

Otalgia; Pain - ear; Ear pain

References

Ely JW, Hansen MR, Clark EC. Diagnosis of ear pain. Am Fam Physician. 2008;77(5):621-628.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.

Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis mediain children: a systematic review. JAMA. 2010 Nov 17;304(19):2161-9.

Update Date: 1/26/2012

Updated by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine (5/1/2011).

J Manipulative Physiol Ther. 1996 Mar-Apr;19(3):169-77.

Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors.

Froehle RM.

Abstract

OBJECTIVE:

The aims of this study were to determine (a) if the patients improved while under chiropractic care; (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement.

DESIGN:

Cohort, nonrandomized retrospective study.

SETTING:

Private chiropractic practice in a Minneapolis suburb.

PARTICIPANTS:

Forty-six children aged 5 yr and under.

INTERVENTION:

All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.

OUTCOME MEASURE:

Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement.

RESULTS:

93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history on antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.

CONCLUSION:

Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

http://www.mayoclinic.com/health/ear-infection-treatment/MY00510

http://www.emedicinehealth.com/earache/article_em.htm