The pain nobody should have to hear

Causes: What can trigger ear pain?

Ears are very sensitive because they contain countless nerve endings that react to even the smallest stimuli. Even minor issues such as a cerumen (earwax) plug or an inflammation can therefore cause uncomfortable pain. Symptoms can arise in the outer, middle or inner ear and be perceived very differently: sharp, dull, throbbing or pounding. Often additional symptoms such as dizziness, hearing problems or a feeling of pressure accompany the pain.

Infections and inflammations are particularly common triggers. An acute middle ear infection, which occurs especially in children after a respiratory infection, can cause severe, sudden pain. It is often accompanied by fever and reduced hearing. An inflammation of the outer ear canal, sometimes triggered by dirty water, viruses or allergies, presents with severe pain, swelling and a feeling of pressure. Even a harmless tonsillitis or sinus infection can radiate pain into the ear via nerve pathways.

But infections are not the only cause; mechanical factors also play a role. A blocked ear canal, for example from earwax or a small foreign body like a marble in children, can cause pressing or dull pain. Injuries such as a tear in the eardrum, caused by sharp objects, overly vigorous cleaning with cotton swabs or strong pressure changes during diving or flying, are considered eardrum injuries and often lead to sharp pain and dizziness. Loud explosions or bangs can also damage the delicate tissue.

In addition, "indirect" causes should not be underestimated. Jaw joint problems, teeth grinding, wisdom tooth infections or tension in the cervical spine can cause ear pain. In older people a so‑called ear herpes (shingles) can sometimes occur, associated with blisters, severe burning and intense pain.

Less common but serious are tumours in the area of the ear, throat or larynx. These can also cause symptoms.

Symptoms: How do ear pains present?

Ear pain can present in different ways. It may occur suddenly and intensely or creep in slowly and almost unnoticed. Affected people often first feel an unpleasant feeling of pressure in the ear before the actual pain sets in. This pain can be dull, sharp, throbbing or pulling and sometimes even radiate into the jaw or head.

Depending on the cause, other symptoms may occur. Hearing difficulties are common, as well as annoying ringing or buzzing in the ear. Discharge from the ear or an unpleasant itch in the ear canal are also possible. Some people also report dizziness, fever, headaches or a general feeling of illness, especially when an infection is the cause.

Ear pain often occurs together with typical cold symptoms such as cough, sore throat or nasal congestion. While symptoms resolve on their own in most people after a few days, they can sometimes persist and indicate a chronic condition.

What symptoms can water in the ear trigger?

This can happen after swimming, showering or diving. Suddenly the ear feels muffled, as if you were still underwater. Often water becomes «stuck» in the ear canal and already after a few hours causes unpleasant symptoms.

At first you notice a dull feeling of pressure in the ear. Hearing seems muffled and sometimes you can even hear a slight crackling or rustling, as if water were moving inside. The ear canal often itches and even a slight tug on the earlobe or pressure on the small cartilage in front of the ear canal (tragus) is painful.

If water remains in the ear for longer and bacteria spread, a so‑called swimmer's ear may develop, a painful inflammation of the ear canal. Typical signs are redness, swelling and warmth of the skin around the ear. Often a yellowish fluid also runs out of the ear, which dries in the canal and leaves crusts or flaky skin.

How can ear pain be avoided during flights?

Many people know it: when the plane takes off or lands the ear suddenly feels «blocked». An unpleasant pressure spreads, it pops, sometimes it whistles or hums, and in the worst case a sharp pain occurs. The cause is the sudden air pressure difference between the cabin and the middle ear, which stresses the eardrum. In medicine this phenomenon is called barotrauma.

To allow pressure equalisation, the Eustachian tube normally ensures that air flows from the throat into the middle ear. This natural ventilation keeps the pressure on both sides of the eardrum balanced. If it is blocked by a cold, swelling or a too rapid pressure change, it can become very unpleasant. Fortunately there are some simple tricks to prevent or quickly relieve ear pain when flying.

The best known method is to stimulate the Eustachian tube by chewing or swallowing to equalise the pressure. For babies, breastfeeding or drinking from a bottle works on the same principle. If these measures are not sufficient, the so‑called Valsalva manoeuvre often helps. Pinch your nose, close your mouth and gently try to exhale through the nose. There should be a quiet «pop» in the ear.

If your nose is blocked, it is worth using a decongestant nasal spray or drops before take‑off and landing. This opens the Eustachian tube and allows pressure equalisation even if the airways are congested. There are also special airplane earplugs that slow down the pressure increase and protect the eardrum. They are especially suitable for people with sensitive ears.

If the pain does not disappear after landing despite all measures, it is better to see a doctor — especially if fever, severe dizziness or persistent hearing loss occur. In rare cases untreated barotrauma can injure or even rupture the eardrum.

Can stress cause ear pain?

Stress affects more than nerves; it can also have concrete effects on our ears. Under stress the muscles in the neck and jaw often tense up. These tensions can press on the sensitive nerves around the ear and thus cause pain or a feeling of pressure. Tension headaches or migraine, which can also be stress‑related, are often accompanied by ear pain.

With prolonged stress the immune system also becomes imbalanced, increasing the risk of inflammations in the ear area. In some cases stress may even favour sudden hearing loss or tinnitus. Typical signs are a sudden loss of hearing in one ear, accompanied by ringing, buzzing and a dull feeling of pressure.

Poor hearing due to stress‑related hearing problems also costs a lot of energy and concentration. The constant effort to perceive sounds and follow conversations can lead to additional fatigue and even more stress — a vicious circle.

With relaxation, targeted stress management strategies and, if necessary, medical support, these complaints can be brought under control. Anyone experiencing persistent ear pain or hearing problems should have this checked by a doctor — not only to rule out serious causes, but also to act in time.

When should a doctor be consulted for ear pain?

Ear pain is not only unpleasant but can also indicate serious illness. For this reason it should be examined by a doctor at any age — especially if it occurs suddenly and severely, lasts a long time or is accompanied by unusual symptoms.

You should be particularly attentive if fluid or pus drains from the ear, the ear or the area behind it swells and reddens markedly, or the pain occurs together with a cold, hoarseness or difficulty swallowing. People with a weakened immune system or diabetes are also advised to see a doctor promptly.

It is also important to avoid trying to treat the ear yourself with cotton swabs or other implements, as this can worsen the situation or cause injuries.

The general practitioner or paediatrician is the first point of contact. If necessary they will refer to an ENT specialist who is experienced in these complaints. In some cases dentists, neurologists or orthopaedic specialists can also help if the cause lies in the teeth, jaw or nerves.

What examinations do doctors perform for ear pain?

For ear pain the doctor investigates the causes step by step. The starting point is a conversation in which the doctor asks about the type, duration and intensity of the pain as well as possible accompanying symptoms and past illnesses. This already allows a first suspicion to be formed.

This is followed by the physical examination to arrive at as precise a diagnosis as possible. With a small specialised instrument the doctor takes a close look into the outer and inner ear. Usually the nose, throat and sometimes the larynx are also examined to detect possible sources of inflammation.

Depending on findings, a hearing test can be useful to determine the extent of any hearing loss. If discharge comes from the ear, it is sometimes analysed in the laboratory. A blood test can also provide clues to an infection.

In certain cases, for example with unclear or severe complaints, doctors also use imaging techniques such as ultrasound, MRI or CT. This allows them to assess the structures in the ear and head area more precisely. They can thus determine the cause of the pain accurately and initiate the appropriate treatment.

Ear pain: how to relieve and prevent complaints properly

• Take ear pain seriously, even if it initially seems harmless. If left untreated it can lead to serious complications such as hearing loss or infections. See a doctor for severe, long‑lasting or recurring pain.
• Do not use cotton swabs or other objects to "clean" the ear. This can injure the eardrum or pack earwax so tightly that it forms a painful plug. Instead, clean only the outer ear carefully with a damp cloth.
• If you have a cold, pressure equalisation during flying or diving may be difficult. In that case use a decongestant nasal spray to relieve the Eustachian tube and help prevent pain. With a severe cold, avoid flying or diving.
• Protect your ears from wind and cold with a hat or headband. Even a cool draft after bathing or sweating can cause pain in sensitive ears. In winter ears are particularly prone to inflammation.
• After swimming, let the water drain from the ear by tilting your head to the side. Then pat the ear dry with a soft towel. This prevents bacteria from causing inflammation in the moist environment.
• When diving, make sure to perform regular pressure‑equalising manoeuvres. Move your jaw forwards and backwards or pinch your nose and gently blow to protect your ears. This prevents painful barotrauma.
• Warm compresses such as a cherry‑stone pillow or an infrared lamp can be soothing for mild ear pain. Heat promotes blood flow and relieves pain. However, be careful not to apply heat that is too hot to avoid burns.
• Home remedies like an onion poultice can have a calming effect for mild complaints. The onion's essential oils have anti‑inflammatory and disinfectant properties. Place chopped onion in a cloth and put it on the affected ear for about 30 minutes.
• If you frequently get ear pain after swimming, you can buy special ear drops at the pharmacy. These strengthen the natural protective film of the ear canal and help prevent inflammation. Alternatively, earplugs also protect against water entering the ear while bathing.
• When using ear drops it is important to lie still and gently pull the ear slightly backwards. This helps the medicine reach the painful area. Remain in this position for at least five minutes so the drops can work optimally.
• In children ear pain is particularly common and should always be examined by a doctor. Often a middle ear infection is the cause and requires medication. Watch for signs in babies and toddlers such as frequent touching of the ear, crying or fever.
• Strengthen your immune system to prevent infections that can cause ear pain. A balanced diet, sufficient sleep and low stress are helpful. Regular physical activity also boosts the immune defences.

Ear pain is a common but often underestimated symptom that can have many causes — from harmless irritations to serious diseases. With the right prevention, attention and, if necessary, medical treatment, complaints can usually be relieved quickly and complications avoided. Pay attention to your body's signals and act early to keep your ears healthy.