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August 2026I don’t really keep statistics about what the office phone calls are for, but certainly one of the more common complaints that I deal with has to be ear pain. Often when the call comes in, the request is for an antibiotic rather than an office visit. I am sure that over the years, physicians have likely prescribed antibiotics countless thousands of times for someone with an ear infection, so it would seem perfectly sensible to skip the visit and go straight to the solution, a prescription.
For all of my career, I have been trying to minimize the use of antibiotics. Some days I am better at that than others. Antibiotics have their place, but they don’t solve every case of ear pain. Even though ear pain is often from an infection, it still deserves a visit to make sure that the right medicine is being applied to the right problem.
There are many causes of ear pain besides a bacterial infection. One of the non bacterial causes of ear pain is a viral infection of the ear. Antibiotics are not needed for a viral infection. With better culture techniques than at the beginning of the antibiotic era, it is estimated that up to 70% of ear infections are viral. These kinds of infections will resolve without any medication needed.
It is not always easy to tell the difference between viral and bacterial infection. I have this conversation with patients and offer them a choice about treatment. The number of parents electing to monitor for another day or two is encouraging as many now understand the consequences of unnecessary antibiotics. For many years, there were pain medication ear drops. These have been removed from the pharmacy so it is difficult to find a good way to make someone comfortable waiting for the infection to get better, but antibiotics are not pain medicine and should only be used when needed.
Another viral infection of the ear is from the chicken pox virus. This is called Ramsay-Hunt Syndrome. Generally seen in adults, it requires a different medication to try to bring this under control.
I have seen plenty of trauma to the ear over the years. It seems that people of all ages know that they shouldn’t be doing certain things, but they do, and then when something goes wrong, it is hard to admit. Seen that, dealt with it. Little to surprise me with. My advice is to never stick anything smaller than your elbow in your ear and you will be fine.
Otitis externa, commonly called Swimmer’s Ear, is also pretty common. This happens when a fungal infection occurs of the ear canal skin. The skin lining the ear canal is pretty thin and essentially attached to the bone. There is not a lot of play here, so when the swelling starts from the infection, the pain can be intense. Often, water seems to be blamed, and it probably has something to do with it, but I have had many people without water exposure develop this. Using cotton swabs is not always the answer to prevention. See trauma above. There are over-the-counter alcohol based solutions that seem to help and are likely more safe to use than a cotton swab.
One diagnosis that I seem to have made quite often this year is Eustachian tube dysfunction. This tube runs from the middle ear space to the back of the nose. It opens and closes when we use our mouths. This allows the air pressure on both sides of the ear drum to be equal giving the ear drum the maximum range of movement to improve our hearing. When the tube stops working, the body first absorbs the air in the middle ear space creating a vacuum. This is painful when the ear drum is stretched tight. It is probably a bit more common during allergy season, but I write this from Wisconsin and just when isn’t it allergy season? The goal of treatment is to decongest the tube so that it opens and closes naturally again. Topical decongestant nose sprays work well, paired with trying to “pop” your ears. Pill decongestants just make the mucous sticky and glue the tube shut.
The last cause of ear pain that I want to cover always gets a “eew, GROSS!” Ear wax. While it may not seem like it should be painful, it can be. Cotton swabs, when used to clean too deeply in the ear, act like the ram rod of a muzzle loader and pack that cerumen (ear wax) down into the ear canal pretty tight. This compacted cerumen is then pressing on the ear drum and can become painful. The complaint most often is hearing loss, but I have cleared an ear canal more than once and the pain has resolved. For those that seem especially prone to cerumen, my prevention advise is to use a drop or two of oil in the ear canal. Mineral oil is inexpensive and a bottle of this will likely last a lifetime or two. Sweet oil is another choice.
This is just a low grade olive oil that is not fit for cooking and sold at 100 times the price. But, it comes with a handy dandy dropper.
The biggest mistake I see here is the use of hydrogen peroxide. It is not harmful, it is just not useful. I am not really sure how this one got started other than the bubbles always make it seem like something is happening. Short version though, is that oil and water don’t mix, so don’t expect much for results. Another possible explanation for the use of hydrogen peroxide is related to similar sounding chemicals. There are wax removal kits that contain a liquid called “carbamide peroxide.” These kits are more expensive than the hydrogen peroxide that most people have in the bathroom. They both contain the word “peroxide,” so they are the same, right? Not even close. I have not seen a lot of success with carbamide peroxide, nor with hydrogen peroxide.
The best solution is to flush the ear out. “Eew, gross!” And nearly always followed by, “let me see!” Happy to oblige.
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