Ear Ache vs. Ear Infection: What's the Difference?

December 15, 2020

Ear pain can range from a minor nuisance to a major source of agony. Ear pain is a common problem, especially in children, and can have a number of causes – some of which have nothing to do with the ear.

But how to know whether it’s an ear ache or an ear infection? And when is it serious enough to seek medical help? We talked with UH family medicine physician Meredith Hale, DO, to find out.

Ear Infections

Ear infections are the most common cause of ear pain. It’s especially common in children and is the most common reason parents bring their child to a doctor. In fact, five out of six children will have at least one ear infection by their third birthday.

An ear infection happens when fluid in the interior space behind the eardrum becomes infected, usually with bacteria. The tube leading into the body becomes blocked, and fluid builds up behind the eardrum. The increased pressure pushes the eardrum outward, causing pain and fever.

An ear infection often occurs after a sore throat, cold or other upper respiratory infection, Dr. Hale says. Symptoms include hearing loss, fever and feeling unwell.

Most ear infections happen to children before they’ve learned how to talk. Here are a few things parents should look for if they suspect their young child has an ear infection:

Tugging or pulling at the ear
Fussiness and crying
Trouble sleeping
Fluid draining from the ear
Clumsiness or balance problems

Ear Ache

Ear aches are not always caused by an ear infection. Other conditions also can cause ear ache or ear pain, especially in adults.

Ear ache is often described as a feeling of pressure in the ear.

“It can begin suddenly or gradually, and it can be quite severe,” Dr. Hale says.

Aside from infection of the inner ear, other causes of ear pain include:

Injury
Swimmer’s ear – inflammation and infection in the channel that leads from the eardrum to the outside.
Cellulitis -- infection of the external ear and ear lobe
Pain caused by irritation of the nerves in the ear
Pain from a sore throat or a problem with the jaw joints
Referred pain from infections or inflammation elsewhere in the body such as a toothache
Allergic reactions from soap, shampoo, earrings or other allergens
Water trapped in the ear
Changes in altitude

Many people wonder if ear wax buildup causes ear pain. Normally, your ear canal does not need to be cleaned. But sometimes ear wax does build up, become impacted and cause symptoms, usually a sensation of fullness or muffled sound as if you are wearing ear plugs.

“When too much wax blocks the ear, you may feel pressure, but this usually doesn’t cause pain,” Dr. Hale says.

When To See a Doctor

Ear infections don’t always need to be treated with antibiotics. “Sometimes, we observe and initiate antibiotic therapy if signs and symptoms worsen or fail to improve after 48 to 72 hours,” Dr. Hale says.

If your child has repeated ear infections or trouble hearing, your doctor may suggest meeting with an ear, nose and throat specialist to discuss placing small tubes in your child’s ear to help maintain a healthy environment.

If you experience intense pain, a high fever or a hearing loss, it’s important to seek medical attention immediately, Dr. Hale says.