Courtesy of THIS Quarterly magazine  

NAN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE. THIS IS because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Earache on plane flights usually occurs just before landing, especially on a fast descent (more common on shorter flights) or when a patient has a cold or flu which causes a blockage of the Eustachian tube and prevents it from doing its job properly.


The pain is caused by the change in pressure and the ears’ inability to equalize that pressure. Negative pressure may cause the ear drum to be “sucked in” and in severe cases, ruptured. The pain can be relieved by opening the mouth wide, swallowing hard or by performing the “valsalva manoeuvre”. This manoeuvre reguires the patient to pinch his nose firmly, close his mouth tightly and then blow as if he is blowing out hard. This should cause the eardrums to “pop” and relieve the pressure.

If the earache is accompanied by a crackling or fluttering noise, this may indicate that “an insect has landed.” I have seen adult cockroaches, beetles, biting ants, fleas, bees and many other insects happily burrowing and squirming away inside patients’ ears. Or even worse, dead and decaying insects. If you suspect that an insect has invaded the privacy of your ear, you should pour some olive oil into the affected ear to immobilize (and eventually kill) the insect before immediately heading to see a doctor. Make sure you do not put anything into the ear other than olive oil. Substances like alcohol or insecticide will make the insect struggle, causing even more damage (especially to the ear drum).

I mentioned earlier that the ear shares its nerve supply with the surrounding structures of the head. If there is a disease of or problem with these surrounding structures, they may pass the pain sensation along the nerve supply to the ear. This type of pain is called “referred pain”. The ear may be perfectly normal, but it may still feel pain. The most common cause of referred pain to the ear is temporomandibular joint (TMJ) dysfunction. This is an inflammation of the jaw joint, which occurs more often in people with dental problems (which cause a strain on the jaw joints) or who grind their teeth during sleep. Other causes of referred earache include ulcers and infections of the tonsils and throat and cancers of the throat, parotid glands and skull base.

If an earache fails to resolve or if it becomes progressively worse, the patient should seek medical attention, as it could indicate a more serious underlying condition.

Dr Lau Chee Chong
Senior Consultant, Ear Nose Throat, Head & Neck Surgery

Ear Nose & Throat Centre CC Lau
3 Mount Elizabeth
#14-11 Mount Elizabeth Medical Centre
Singapore 228510
Tel : (65) 6235 9535
Fax : (65) 6738 4377
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