From the Guidelines
For an earache, the next step is to take over-the-counter pain relievers like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours to reduce pain and inflammation, as recommended by the clinical practice guideline for acute otitis externa 1.
Key Considerations
- Apply a warm compress to the affected ear for 15-20 minutes several times daily to help alleviate discomfort.
- If the pain is due to water in the ear, tilt your head to drain it or use over-the-counter ear drops designed to dry excess moisture.
- However, if symptoms persist beyond 2-3 days, worsen, are accompanied by fever above 101°F, hearing loss, discharge from the ear, or severe pain, seek medical attention promptly.
Importance of Medical Evaluation
A healthcare provider can determine if you have an ear infection requiring antibiotics or if there's another underlying cause.
- Avoid inserting objects into the ear canal as this can cause injury or push wax deeper, potentially worsening the condition.
- Earaches often result from fluid buildup, pressure changes, or infections affecting the middle or outer ear, and proper treatment depends on identifying the specific cause, as outlined in the clinical practice guideline for acute otitis externa 1.
Additional Guidance
- The clinical practice guideline emphasizes the importance of acute pain assessment and management in patients with AOE, and recommends the use of analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs to manage pain 1.
- Topical anesthetic drops should not be used if a tympanostomy tube is present or there is uncertainty regarding the integrity of the tympanic membrane, as they are not approved for use in the middle ear 1.
From the FDA Drug Label
INDICATIONS AND USAGE Acute Otitis media of various etiologies -prompt relief of pain and reduction of inflammation in the congestive and serous stages. DOSAGE AND ADMINISTRATION Acute otitis media: Instill Antipyrine and Benzocaine Otic Solution, permitting the solution to run along the wall of the ear canal until it is filled.
The next step for an ear ache is to instill benzocaine (OTIC) solution into the ear canal, allowing it to fill the canal, and then insert a moistened cotton pledget into the meatus. This can be repeated every one to two hours until pain and congestion are relieved 2 2.
- Key points:
- Use benzocaine (OTIC) solution for acute otitis media
- Instill solution into the ear canal
- Insert a moistened cotton pledget into the meatus
- Repeat every one to two hours as needed
From the Research
Ear Ache Next Steps
The next steps for ear ache depend on the underlying cause, which can be primary otalgia (pain originating from the ear) or secondary otalgia (pain originating outside the ear) 3.
- Primary Otalgia: The most common causes are otitis media and otitis externa 3, 4.
- Otitis media is often treated with antibiotics, such as ampicillin or amoxicillin, although the first line of treatment may vary depending on the causative agent and patient factors 5.
- Otitis externa is typically treated with ototopical broad-spectrum antibiotics and thorough cleaning of the canal 4.
- Secondary Otalgia: The most common causes include temporomandibular joint syndrome and dental infections 3.
- Treatment for secondary otalgia depends on the underlying cause and may involve consultation with a specialist, such as a dentist or an ear, nose, and throat (ENT) specialist.
Pain Relief
For pain relief in acute otitis media, paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used 6, 7.
- Paracetamol vs. Placebo: Paracetamol may be more effective than placebo in relieving pain at 48 hours 6, 7.
- NSAIDs vs. Placebo: NSAIDs, such as ibuprofen, may also be more effective than placebo in relieving pain at 48 hours 6, 7.
- NSAIDs vs. Paracetamol: The evidence is very uncertain about the effect of ibuprofen versus paracetamol in relieving ear pain in children with acute otitis media 6, 7.
Further Evaluation
If the diagnosis is not immediately clear, a trial of symptomatic treatment, imaging studies, and consultation with a specialist may be reasonable options 3. It is essential to consider risk factors for malignancy, such as smoking, alcohol use, diabetes mellitus, and age 50 years or older, and to perform computed tomography, magnetic resonance imaging, or otolaryngology consultation if necessary 3.