The earache or ear pain, is a common disease. Its causes can be varied, according to the symptoms that accompany it. If its origin is in the ear we speak of primary otalgia and if it comes from another place it is called secondary or referred otalgia .

  • Primary ear pain: it is the most frequent. It is mainly due to infectious pathology ( otitis ) of the middle and external ear.
  • Secondary ear pain: of extraotic origin. It is usually due to pathology in the temporomandibular (TMJ), dental, sinus, pharyngo-tonsil or laryngeal joint.

Types of otitis

The most common cause of primary earache is acute ear infection , but it can also be due to the causes mentioned above. The main conditions where an inflamed ear and an ear infection will normally be seen are:

  • Diffuse external otitis : infectious process of the skin of the external ear. Produced by the entry of contaminated water, manipulation of the ear with pads or the use of hearing aids that prevent the normal expulsion of earwax.
  • Necrotizing external otitis : severe ear infection that occurs in immunocompromised patients such as diabetics, HIV + and the elderly. It is a rapidly progressive condition that can lead to death.
  • Perichondritis / pinna cellulitis / otohematoma: Associated with stings or trauma.
  • Acute otitis media: acute ear infection with discharge and of short duration. The main cause of earache in children is characterized by intense pain, occupation of the middle ear by serous, mucous or purulent fluid and inflammatory signs.
  • Chronic otitis media: chronic inflammatory process of the mucoperiosteum with an insidious onset, a slow course and an evolution of more than 3 months, affecting the structures of the middle ear cavity, mastoid cells and the Eustachian tube.

Signs and symptoms

            The signs and symptoms with which we can recognize an otitis normally depend on the type of otitis, but generally they present with an inflamed ear and an ear infection, which could guide us to identify an otitis .

Diffuse otitis externa

  • The skin of the EAC is swollen, red, tender, and painful to the pull of the ear.
  • Obstruction of the duct by remnants of skin, earwax and / or purulent discharge.
  • Clogged ear sensation, hearing loss, itching and otorrhea.
  • Inflammation of the EAC makes it difficult to see its medial portion and the tympanic membrane.
  •  The infection can spread to the tissues of the pinna making mobilization very painful.

Otitis externa necrotizante

  • Progress to the bone.
  • Otalgia intensa.
  • Otorrhea with granulation tissue.
  • Poor response to usual treatment.


  • The ear looks red, thickened, painful, and hot to the touch.

Acute otitis media:

  • The eardrum is red and bulging, sometimes with hemorrhagic blisters. The tympanic membrane may appear protruding, opaque, or hyperemic.
  • Sudden presentation and short duration.
  • The CAE must not be affected.
  • Tympanic perforation and discharge of purulent material through the EAC, which produces a remission of pain.
  • It can present with fever, listlessness, irritability, anorexia, vomiting and other symptoms.

Chronic otitis media:

  • Conductive hearing loss) (the sound does not reach the ear clearly), caused by alterations in the transmission of sound to the inner ear
  •  Otorrea of ​​mucoid type, mucopurulent or purulent.
  • Symptoms such as acute vertigo, headache, earache, otorrhagia, facial paralysis, among others, indicate that you must act quickly as a complication could occur.


Treatments for ear infection depending on the type of otitis.

Diffuse otitis externa

The treatment consists of:

  • Cleaning of the external auditory canal, generally it is ?? very sensitive and tight, then you have to wait a day or two. If necessary this procedure must be repeated.
  • Ear drops or ear drops with antibiotics that achieve a high concentration in the affected tissues. If there is also an important inflammatory process, ear drops with corticosteroids can be indicated to reduce the inflammation of the ear. The duration of treatment should be at least 7 days.
  • Avoid getting water in the ears.
  • Oral anti-inflammatory pain relievers.
  • Local heat.

The drops must be placed correctly to be successful in treatment. The patient must lie on their side, they must be administered by another person to avoid excessive positioning and associated problems (fungus, skin maceration, among others). They must be warm (37 °) to avoid dizziness or vertigo and stay 5 minutes in that position.

Otitis externa necrotizante.

Its treatment should be with intravenous antibiotics and surgical debridement in the ward.


It must be treated with antibiotics. Sometimes it is necessary to perform a surgical cleaning or small drainage if a localized abscess has occurred.

Acute otitis media

The treatment of choice in an isolated condition and in a patient without previous antibiotic treatments is:

  • Amoxicillin at a dose of 90-100mg / kg per day divided into 2 doses for 7 to 10 days.
  • Anti-inflammatory or decongestant for a few days while the pain subsides, the local heat can help in the acute stages of pain.

Chronic otitis media

Treatment will depend on the clinical conditions at the time of the primary evaluation. The goal is to control the disease process and restore hearing function. But it is recommended:

  • Attention and care of upper respiratory infections. • Avoid putting any object into the ear.
  • Do not apply hydrogen peroxide, home remedies or non-prescription ear drops.
  • Avoid getting water into the ear.

It is very important that in the presence of any picture of earache, you go to a health professional, who makes a correct diagnosis and indicates a correct treatment, avoiding self-medication and possible complications.

Dr. Eric Jackson

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses. He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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