What is Earache?
Key Symptoms
What Causes Earache?
Conventional Treatments
Medications
Tests and Procedures
Treatment and Prevention
How Supplements Can Help
Self-Care Remedies
Alternative Therapies
When to Call a Doctor
Evidence Based Rating Scale
References

What is Earache?

An earache is usually the result of an inflammation or infection that occurs somewhere inside the ear. Otitis media is an infection of the middle ear (the area between the eardrum and inner ear) that frequently afflicts children. Middle-ear infections occur when the Eustachian tube -- the part of the anatomy that helps drain fluid from the middle ear -- gets swollen and blocked. Depending on the severity, this can result in a mild but constant ache or in relentless, throbbing pain.

Otitis externa -- also often called swimmer's ear although there can be other causes -- is an inflammation or infection of the outer ear, including the visible, fleshy part as well as the portion of the ear canal that leads to the eardrum. Both causes of ear pain are not serious when properly managed. In some cases, earaches simply go away without treatment. But persistent earaches that are ignored can lead to serious problems, including permanent hearing loss.

Key Symptoms

What Causes Earache?

Earaches are usually caused by an infection that is bacterial, viral, or fungal in nature. Middle-ear infections may develop from an upper respiratory infection, such as a cold. In some cases, bacteria travel up from the back of the throat through the Eustachian tube and settle into the middle ear. This occurs "behind" the eardrum. When examined by a health care practitioner with an otoscope, the normally shiny gray eardrum may be bulging and appears inflamed and reddened.

Swimmer's ear is more like an extension of a skin infection, in that it's limited to the external ear and the inch-long canal that ends at the eardrum. This can be the result of an infection by fungi or bacteria, which thrive in the moist environment of the ear canal and are aggravated by a moisture source, such as swimming. Other causes of middle and external ear infections include:

 Nasal allergies. Excessive mucus production from allergies can block the Eustachian tube and promote infection in the middle ear.

 Inherited disorders. Because of an abnormality in the structure of their Eustachian drainage system, children with Down's syndrome and cleft palates are more susceptible to middle-ear infections.

 Second-hand smoke. Children who live in smoking households are more likely to suffer from middle ear infections than children who live in smoke-free environments.

 Skin problems. Inflammation caused by seborrheic dermatitis and eczema can spread into the ear canal and produce an external ear infection.

 Earwax. An overproduction of earwax can trap moisture and trigger an inflammation in the canal.

 Foreign matter. Inserting objects (such as cotton swabs) into the ear, as well as exposure to abrasive chemicals (such as those used in hair dyes) can scratch or irritate the sensitive lining of the ear canal, making it susceptible to infection.

Conventional Treatments

Conventional treatment for earache involves alleviating symptoms as well as diagnosing and determining the best treatment for any underlying illnesses or infections. Often a period of watchful waiting is indicated to allow for spontaneous resolution. Further treatment is warranted in patients who do not show improvement in pain or if symptoms worsen during an observation period of 48 to 72 hours. Most often, treatment involves analgesics to ease pain and antibiotics to clear up bacterial infection. Surgery may be required in patients with chronic or recurrent middle ear infections. 

Medications

For anyone who is especially prone to developing an earache in association with a head cold, including a decongestant in the treatment plan may be beneficial. For those who prefer to avoid using oral decongestants because of side effects (nervousness, rapid heart rate, poor sleep), other options include a nasal decongestant spray or steam inhalation with eucalyptus oil.

In the past, pediatricians have routinely prescribed antibiotics for virtually all ear infections; however there is increasing evidence that antibiotics are being overused. In fact, the necessity of having an antibiotic for recurrent bacterial ear infections is now being seriously questioned. Such factors as diet (reducing sugar, eliminating dairy or other food allergies,), avoiding second-hand smoke, keeping the room well humidified, and checking for hidden allergies may turn out to be the better approach for many of these infections.

For adults, if an earache is caused by a bacterial infection, a course of antibiotics is probably needed to clear it up. In cases where fluid has accumulated, a doctor may use a small suction device to remove it.

Over-the-counter and prescription eardrop analgesics can help ease ear pain. And some supplements may bring added relief and help facilitate the healing process. However, these should be avoided if drainage from the ear suggests the possibility of a perforation of the ear drum or if "tubes" have been surgically placed in the ears. For those in severe pain, it may be best to check first with a physician.

Tests and Procedures

Children who suffer from chronic or recurrent middle-ear infections may be encouraged to undergo surgery to have tubes placed in the ear drums, especially if tests indicate that hearing may be compromised or there is delay in language development. The tubes, which stay in place for about 6 to 12 months, allow fluid to drain from the ears decreasing the pressure in the middle ear and allowing the tympanic membrane (ear drum) to vibrate more freely. Like the overuse of antibiotics, some doctors are beginning to question the long-term benefit of this procedure as well, as it does not address the source of the problem.

Treatment and Prevention

Some earaches can be prevented. Do not insert cotton swabs or any other object into the ear canal. Despite their apparent softness, swabs can be abrasive to the tender ear canal: use them only on the external portions of the ear.

In the event an earache occurs, there are a variety of ways to ease the pain and speed healing.

Just a reminder: For those with a serious medical condition, it's always a good idea to check with a doctor before starting a supplement regimen.

How Supplements Can Help 

Eucalyptus oil, when added to the water of a steam bath and inhaled several times a day, may ease pressure in the Eustachian tube and encourage drainage of any fluid that has collected in the middle ear. (1-3) Studies have shown that eucalyptol, the key medicinal ingredient in eucalyptus oil, works as an expectorant, loosening sticky Mucus and making it easier to cough up and out of the chest. (4) In addition, astringent substances in the oil, called tannins, tighten and, thus, soothe mucous membrane Inflammation in the mouth, nose and throat. (5, 6) The oil's germ-fighting actions may reduce the risk of a secondary respiratory infection, thus preventing probable ear infection. A 2006 laboratory study of 200 samples collected from patients with respiratory tract disorders indicated potential antibacterial affects of Eucalyptus globules leaf extract. (7) When creating a eucalyptus steam inhalation, place a few drops of the oil in a pan of water (which is heated to boiling) or in the bathtub. Eucalyptus oil should never be taken internally and should be avoided (or used only with extreme caution) around children, who are especially susceptible to the fumes.

Garlic oil and mullein oil can be used separately or together as ear drops. Laboratory studies have shown the anti-fungal and astringent properties of garlic oil may help to treat both fungal and bacterial ear infections. (8, 9) The astringent (constricting) and soothing compounds in mullein oil helps to fight infection and may lessen discomfort. (10) In a 2001 study of 103 children ages 6 to 18 with acute otitis media, a naturopathic ear drop formula containing garlic and mullein oil, as well as calendula and St. John's wort, was found to be as effective as a conventional anesthetic ear drop in reducing earache. (11) In a  double-blind  trial in 2003, 171 children ages 5 to 18 were randomly assigned to receive treatment with a similar naturopathic herbal extract ear drop (NHED) or with anesthetic ear drops, with or without amoxicillin. The NHED, which was dosed at five drops, three times a day, contained 30% St. John's wort, 28% Calendula, 25% mullein in olive oil, and the essential oils of lavender (5%) and vitamin E (2%). After three days, all groups showed a statistically significant improvement in ear pain, with a 95% reduction in pain in the NHED-alone group and a 90.9% reduction in the group given NHED plus antibiotics. The anesthetic alone group showed a reduction in pain of 84%, while the anesthetic with antibiotics showed a 77.8% reduction. (12) More research is needed.

Temporarily using higher than normal daily amounts of vitamins A and C can enhance the immune system. Vitamin A has also shown efficacy in reducing inflammation in the respiratory tract. (13, 14) Taking vitamin C at the first sign of a cold or the flu, for instance, may keep the illness from fully developing, and may shorten the duration of illness. This may prevent the onset of fluid build-up in the ear. (15) In a 1995 review of studies investigating the effect of vitamin C on colds, researchers concluded that doses of 1,000 to 6,000 mg a day of vitamin C at the onset of symptoms reduced a cold's duration by 21%, and shortened its duration by one day on average. Taking vitamin C doesn't prevent colds, however. (16)

Echinacea is another immune system booster. Especially when used early in an infection, this herb has been shown to help ward off colds, which can lead to ear infections. A natural antibiotic, Echinacea also can help fight chronic upper respiratory infections in adults and children and fight ear infections that are viral or bacterial in origin. In a study of 524 children between the ages of 2 and 11 conducted during the winter months of 2000 - 2002, researchers found that the children who took Echinacea after the occurrence of the first upper respiratory tract infection experienced 28% fewer recurrent infections. For best results, take Echinacea at the first sign of illness. (17)

Zinc gluconate lozenges have both antiviral and immune-stimulating effects. Studies have shown that using zinc lozenges that provide 9 to 24 mg of elemental zinc every two hours within 48 hours of the onset of cold symptoms may help to decrease the duration of a cold. (18-20)

Flavonoids are naturally occurring plant pigments that have anti-inflammatory, antihistamine, and antiviral properties. They may enhance the effect of vitamin C when dealing with infections and be especially helpful when an infection has been triggered by allergies such as hay fever.

Self-Care Remedies

Apply heat. Warming the ear with a heating pad or warm compress can relieve pain and promote healing. For an earache that occurs during air travel, relief can often be obtained by placing a styrofoam cup with a heated wet paper towel in the bottom over the ear: it provides heat as well as increasing the atmospheric pressure over the ear drum.

Elevate the head while sleeping. Keeping the head raised can help fluids drain from the ear. If there is external drainage, be sure to wash pillowcases -- as well as heating pads and washcloths -- to prevent re-infection.

Use a nasal spray or steam inhalation to reduce nasal and Eustachian tube congestion.

Rinse and dry the ears thoroughly after swimming with fresh water and a towel.

Chewing gum or ingesting syrup that contains the artificial sweetener xylitol during a respiratory infection may help prevent recurrence of acute otitis media and, hence, the need for antibiotics. It seems to kill Pneumococcus, one of the kinds of bacteria responsible for middle ear infections. Recommended dosages of xylitol range from 8.4 to 10 grams daily. (21, 22)

Alternative Therapies

Although few studies have examined the effectiveness of homeopathic treatment, practitioners choose individualized homeopathic remedies for earache based on general constitution and personal attributes. Homeopathic medicines are classically prescribed on an individual basis, depending on the specific symptoms in each case. Ideally, the homeopathic medicine chosen matches the patient's mental and emotional state as well as the specific symptoms associated with the condition. This highly personalized approach makes a controlled study difficult. However, pilot studies in children have evaluated the use of individually chosen homeopathic medicines to treat earache. In a 2001 randomized, double-blind, placebo-controlled study, 75 children ages 18 months to six years with middle ear effusion and ear pain and/or fever for more than 36 hours received individualized homeopathic medicine or placebo by mouth three times a day for five days or until symptoms subsided. The homeopathic treatment group showed statistically significant improvement in the reduction of symptoms compared to the placebo group. (23) Another study in 2001 found that taking a homeopathic medicine offers pain relief two and a half times faster than placebo in pediatric patients. In the study, pain control was reached in 39% of patients after six hours, and in another 33% after 12 hours. (24) A 2007 multi-centre cohort study of data from 1,577 patients with acute respiratory and ear complaints found that the onset of improvement in symptoms and pain was faster within the first seven days in a group treated with homeopathic medicine than in a group treated with conventional medicine. However, response rates after 7 and 28 days showed no significant difference between the groups. (25) More research is needed, but many self-help books are available to help choose the appropriate homeopathic medicine for specific symptoms.

Some evidence indicates that Osteopathic Manipulative Treatment (OMT) may be effective in treating ear infection. Osteopathy, a holistic approach to the practice of medicine, includes an emphasis on the relationship between organ function and imbalances or asymmetry in physical structure. A 2006 pilot cohort study evaluated the use of OMT in eight patients, ages 7 months to 35 months, with recurrent, acute otitis media. Three weeks of treatment with osteopathic structural examinations and manipulative treatment were added to usual treatment with conventional medication. During one year of follow-up, five of the eight treated subjects had no further recurrence of symptoms. However, of the three remaining patients, one had a bulging tympanic membrane, one had four episodes of otitis media, and the last subject underwent surgery for recurrence at six weeks after treatment. (26) More, large trials are needed. 

When to Call a Doctor

• If earache or hearing loss lasts longer than three or four days despite treatment, or if symptoms worsen.
  
  
• If ear pain is accompanied by a fever, sore throat, or severe headache.
  
  
• If ear is red and swollen or produces discharge.
  
  
• If severe ear pain that stops suddenly is followed by hearing loss. This may mean that the eardrum has burst.

Supplement/ Therapy	Rating	Explanation
Echinacea		May help to prevent and shorten duration of colds and flu, possibly preventing fluid build-up in the ear. (17)
Eucalyptus		Long history of use and preliminary evidence indicates efficacy as expectorant to relieve congestion that causes earache. (1-7)
Garlic		Several studies indicate antibacterial and antifungal properties. Some evidence indicates efficacy when combined with mullein, Calendula, and St. John's wort in naturopathic herbal eardrops. (8-12)
Homeopathy		Preliminary evidence indicates efficacy of individualized remedies to relieve pain and shorten duration of symptoms. (23-25)
Osteopathy		Preliminary evidence indicates fewer recurrences of acute otitis media when Osteopathic Manipulative Therapy is combined with conventional medication. (26)