Causes of ear pain

The most common cause of ear pain is acute otitis media (viral or bacterial); somewhat less common are otitis externa and chronic otitis media.

Among all ear diseases, otitis media accounts for about half, and in children their number approaches 70%.

Mechanisms of development of otitis media. The key role in the development of acute otitis media is played by the transition of the inflammatory process from the nasopharynx to the pharyngeal opening of the auditory tube. As a result of obstruction of the auditory tube, negative pressure develops in the tympanic cavity. This leads to the formation of effusion in the tympanic cavity and the entry of mucus and bacteria from the nasopharynx into the middle ear. Thus, the main mechanism of infection penetration into the middle ear cavity is tubogenic, i.e. through the auditory tube.

There are other ways of infection penetration into the tympanic cavity: traumatic, meningogenic, and finally, comparatively rarely, hematogenous; it is possible with such diseases as sepsis, scarlet fever, measles, tuberculosis, typhus. Other etiologic factors include immunoglobulin deficiency, HIV infection, and possibly genetic predisposition.

Pathogens of otitis media. The main pathogens of acute otitis media are: S. pneumoniae and non-typable strains of H. influenzae, less often - M. catarrhalis. Much less often the disease is caused by S. pyogenes, S. aureus or associations of microorganisms, as well as viruses.

Acute otitis media is a disease with a fairly clearly expressed staged course. Catarrhal, purulent and reparative (restorative) phases are distinguished.

In adults and children, the following are typical: malaise, weakness, fever, a feeling of congestion and pain in the ear, and hearing loss. The discharge of pus indicates a perforation of the eardrum. After perforation, the pain in the ear significantly weakens, the temperature decreases. In infants, the diagnosis is made based on indirect signs: loss of appetite, screaming when sucking, crying when pressing on the tragus.

Non-ear diseases that can cause ear pain: dental diseases, osteoarthritis of the cervical spine, damage to the temporomandibular joint, epidemic parotitis ("mumps"), inflammation of the cervical lymph nodes, pharyngitis and tonsillitis. The cause of ear pain, especially in the elderly, can be a herpes virus infection (shingles), its rash is often localized in the external auditory canal.

There are also a number of other conditions that can cause ear pain.

Earwax impaction, barotrauma, foreign bodies and ear pain

Earwax. Excessive accumulation of earwax may cause earwax to form. If the ear canal is completely blocked, there is a feeling of congestion in the ear and decreased hearing, including the resonance of one's own voice in the blocked ear. These disorders develop suddenly, most often when water gets into the external auditory canal while swimming or washing your hair. You should not try to remove the earwax yourself, as this can damage the eardrum and the walls of the ear canal. You should consult an otolaryngologist.

Foreign bodies. Quite often (especially in children) foreign bodies get into the ear. Children, playing with various small objects (pebbles, cherry pits, beads, buttons, sunflower seeds, peas, paper balls, etc.), put them in their ears. In adults, foreign bodies can be parts of a match, pieces of cotton wool. It is dangerous to remove them yourself, since if you try to remove a foreign body unskillfully, you can push it deeper and damage the eardrum. Live foreign bodies - insects - can get into the external auditory canal, which cause very unpleasant sensations and pain. First aid for insects getting into the ear consists of pouring a few drops of liquid oil (vegetable, petroleum jelly) or an alcohol solution of boric acid into the ear canal. In this case, the insect dies and the unpleasant sensations stop immediately. After this, the patient must be placed in such a way as to ensure drainage from the ear to the "sick" side. Often, the foreign body is removed from the ear along with the fluid. If the foreign body remains in the ear, the patient should consult an otolaryngologist.

Barotrauma. Occurs when there is a sharp change in pressure in the external auditory canal with a closed auditory tube. Barotrauma is common among scuba divers, and it also occurs after air travel. Barotrauma manifests itself as periodic or constant pain and noise in the ears, dizziness, hearing loss, and, less commonly, discharge from the ear. Menthol inhalations and analgesics are used for treatment. If the symptoms do not disappear after a few days, the patient is referred to an otolaryngologist, who performs ear inflation.

People suffering from nasal diseases or otitis media are not recommended to dive.

Mastoiditis. In the pre-antibiotic era, it occurred in 1-5% of cases as a complication of otitis media. With otitis media, drainage from the middle ear cavity is disrupted, pressure in it increases, and the thin bone partitions between the air cells of the mastoid process are destroyed. This process can continue for 2-3 weeks. Patients complain of pain, a slight increase in body temperature, general weakness, and hearing loss.

Ear discharge usually has an unpleasant odor. The disease should be suspected in people complaining of ear discharge lasting more than 10 days. When a subperiosteal abscess forms, a classic swelling appears behind the ear with a downward displacement of the auricle - this is the most characteristic feature of mastoiditis. The diagnosis can be excluded radiographically, when the image shows normal air cavities in the mastoid process, whereas in mastoiditis or external otitis, these cavities are not clearly visible.

Treatment begins with intravenous antibiotics (eg, ampicillin 500 mg every 6 hours), myringotomy (cutting the eardrum), and appropriate cultures should be made to select adequate antibiotics. If there is no improvement, then mastoidectomy is necessary.

Bullous myringitis (inflammation of the eardrum).

Viral infection (flu), Haemophilus influenzae and Mycoplasma infection can be accompanied by the formation of painful hemorrhagic blisters on the eardrum and in the external auditory canal. Hemorrhagic fluid is also found in the middle ear cavity.

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