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Ear Ache


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Ear, nose and throat
Pain in the ears is particularly uncomfortable and is usually an indication that the space behind the ear drum has become infected. Ear infections leading to ear ache are particularly common in children, but may occur in anyone at any age. Although ear infections can be extremely painful they are rarely serious and do not tend to cause any permanent damage or permanent loss of hearing.
The ear is divided into three parts - the outer ear, the middle ear and the inner ear. The outer ear comprises the pinna (the part of the ear visible at the side of the head) and the ear canal leading up to the ear drum. The middle ear is an air filled cavity separated from the external ear by the ear drum. The middle ear connects to the throat via a tube called the eustachian tube. The eustachian tube helps to equalise the air pressure on either side of the ear drum. Also located within the middle ear are small bones called ossicles that are responsible for converting sound waves into vibrations. The inner ear comprises a maze of fluid-filled tubes called the cochlear, semi-circular canals and vestibule that are responsible for hearing a balance.

The most common cause of ear ache is a middle ear infection, also called otitis media. This infection often starts with a cold but there can be other causes. Children are more likely than adults to get middle ear infections. This is because the eustachian tube linking the throat and the ear is much shorter in children than adults and so allows infections to pass more easily from the throat to the middle ear. The eustachian tube can also become blocked with mucus which then becomes infected by bacteria or viruses.

An infection in the outer ear is called otitis externa, it may itch but is not as painful as otitis media. It can be caused by putting items in the ear to remove ear wax, or can occur as a result of swimming in infected water. Surfers are particularly prone to ear infections if surfing in areas where sewage has been discharged into the sea.

Other causes of ear ache include a build-up of wax in the ear and sometimes tooth ache, where the pain from the aching tooth is also felt in the ear.
Symptoms of a middle ear infection, otitis media, include a high temperature as well as ear ache. There may also be a temporary loss of hearing, dizziness and balance may be affected. Children are often sick and can feel quite unwell. Persistent crying in babies can be a sign of an ear infection. With severe infections, the build-up of fluid in the ear may put so much pressure on the ear drum that it causes it to burst, releasing the infected fluid out of the ear - this can sometimes relieve the pain. The burst ear drum, known as a perforated ear drum, normally heals once the infection has passed.

Symptoms of an outer ear infection, otitis externa, include swelling, itching and, sometimes, the appearance of pus in the ear. Hearing is not usually affected.
Mild ear ache generally gets better by itself in 2 or 3 days and treatment may not be necessary. Over the counter painkillers can be used to ease the pain during the healing process. If ear ache does not get better after two days in an adult or one day in a child, see your doctor who will examine the ears to see if antibiotics are needed. If you think your ear may be blocked with wax, you can try and soften the wax with over the counter ear drops.
When to see your pharmacist
Ask your pharmacist for advice if you or your child has ear ache. It is important that you describe your symptoms clearly and tell the pharmacist how long the symptoms have been present. If your pharmacist decides that you have a mild infection of the outer ear he or she may recommend ear drops containing acetic acid which acts as an antibacterial agent. There are no ear drops available over the counter to treat otitis media, but ear drops containing choline salicylate may be recommended to ease the pain. If the pain is severe, your pharmacist may also suggest the use of analgesics such as ibuprofen or paracetamol. Decongestant nasal drops will clear mucus from the nose and may help unblock the eustachian tube to ease the pressure in the middle ear. If these remedies do not work in one or two days and your ear ache continues you will be advised to visit your doctor. If your child is suffering from ear ache, it is important that you tell the pharmacist the age of your child. Decongestants, such as pseudoephedrine, phenylephrine, oxymetazoline and xylometazoline, should not be used in babies and infants. If your baby has a blocked nose, your pharmacist will be able to provide nose drops containing saline that will help. Vapour rubs or inhalations containing menthol and essential oils may also be applied to a baby's or infant's clothing to help ease nasal congestion.
When to see your doctor
If painkillers do not ease your ear ache or if it lasts for more than two days (one day in a child) you should see your doctor. If fluid is coming out of the ear or you are worried about your hearing seek medical advice. Always check with the doctor if you feel dizzy, drowsy or have a sudden loss of hearing.

Your doctor will examine your ear with an instrument called an otoscope to help decide whether you have otitis externa or otitis media. Antibiotics in the form of ear drops to be placed in the ear, or in the form of tablets and liquids to be taken by mouth, may be prescribed if your doctor thinks that you have a particularly painful bacterial infection. If there is inflammation in the ear canal as a result of otitis externa, ear drops containing a corticosteroid may be prescribed. If you have repeated attacks of ear ache your doctor may refer you to an ENT (ear, nose and throat) specialist in a hospital.
Living with ear ache
There is no need for anyone to go through prolonged pain with ear ache. Treatments available on prescription will quickly clear the problem. If the ear ache is accompanied by dizziness or loss of balance, be careful in whatever you are doing, and do not drive or operate machinery until the dizziness has gone and your balance is restored.

Some people, particularly young children, are prone to getting repeat bouts of ear infections that cause ear ache. In such circumstances, some simple life style changes will reduce the chances of ear infections.

To avoid otitis externa, do not put objects such as cotton buds or paper clips in the ear canal in an attempt to remove ear wax. There is a risk that the ear canal will be scratched, allowing bacteria or fungi to infect the canal to set up a painful inflammation. There is also a risk that poking around in the ear will just compact the wax within the canal, preventing it from being dislodged naturally. Another wise precaution is to wear ear plugs when swimming or surfing, especially if there are any doubts about the cleanliness of the water. If water does get in the ears, tilt the head to one side to let the water drip out, then dry the ears gently.

Otitis media is more difficult to prevent, but if it is a frequent occurrence in babies or children then early treatment of any throat or chest infections will help. Also, never smoke in the presence of babies and children because, apart from all of the other risks to the child's health, passive smoking appears to increase the risk of ear infections in children.
Advice for carers
If you care for someone with ear problems who needs help putting drops in the ear, learn to apply the preparations properly. Your pharmacist is always available to provide help if you need it.When putting drops in someone else's ear, it is easier if the person lies on one side with the affected ear uppermost. With one hand, gently move the ear so that you can see into the ear canal more easily. With the other hand, bring the ear dropper close to the ear, resting the hand on the side of the face for balance and to avoid touching the ear with the dropper. Squeeze the ear dropper gently, allowing a drop to fall one at a time into the ear. Count out the required number of drops. Release the ear and ask the person to remain on their side for a few moments. If necessary, a small plug of cotton wool placed in the ear will help to keep the drops in the ear canal. If necessary, repeat the procedure for the other ear, if both ears are affected.
Useful Tips
  • Raising your pillow a little can help fluid drain from the ear
  • Avoid getting the ears wet, if possible
  • Use ear plugs when swimming
  • Check out the quality of the water if bathing or surfing in the sea
  • Do not smoke near babies or children