History of earache

•    Adults can describe earache, but small children cannot. Children may indicate they have earache by head-shaking, losing balance, crying, irritability, refusing feeds (infants), clutching at the ear, sleep disturbance or other unusual behaviour.

•    Older children and adults may describe the type of pain, for example (aching or sharp pain), when it started, previous history of earache, what makes it worse and other associated symptoms. These may include nausea, fever, abnormal noises, vertigo, hearing loss, fluid discharge from the ear or pain elsewhere.

•    Pulling the ear slightly upwards will cause pain in nearly all cases of otitis externa. Examining the ear canal may reveal the cause, for example a foreign body, impacted wax or infection.

•    Inspecting the ear canal and drum with an instrument called an otoscope may show drum abnormalities, middle ear infection or fluid discharge.

•    Tympanometry and audiology can measure the flexibility of the eardrum and assess hearing loss.

General examination may find signs of associated disorders causing referred pain such as jaw problems, tooth infection or oral cancers. These conditions will need to be investigated on their own merits, for example using X-rays or scans, or being referred to another specialist.

Reviewed by Dr Gary Kroukamp MBCHB, FCORL (SA). Ear Nose and Throat Specialist in private practice, Cape Town. February 2015.