Earache, No Infection (Adult) 

Earaches can happen without an infection. They can occur when air and fluid build up behind the eardrum. They may cause a feeling of fullness and discomfort. They may also impair hearing. This is called otitis media with effusion (OME) or serous otitis media. It means there is fluid in the middle ear. It is not the same as acute otitis media, which is often from an infection.

OME can happen when you have a cold if congestion blocks the passage that drains the middle ear. This passage is called the eustachian tube. OME may also occur with nasal allergies or after a bacterial infection in the middle ear. Other causes are:

  • Trauma

  • Improper cleaning of wax from the ear

  • Bacterial infection of the mastoid bone (mastoiditis)

  • Tumor

  • Jaw pain

  • Changes in pressure, such as from flying or scuba diving

Image showing a cross-section of the external, middle, and inner ear, including the ear canal, eardrum, and eustachian tube.

The pain or discomfort may come and go. You may hear clicking or popping sounds when you chew or swallow. You may feel that your balance is off. Or you may hear ringing in the ear.

It often takes from several weeks up to 3 months for the fluid to clear on its own. Oral pain relievers and ear drops help if there is pain. Decongestants and antihistamines sometimes help. Antibiotics don't help since there is no infection. Your healthcare provider may give you a nasal spray to help reduce swelling in the nose and eustachian tube. This can allow the ear to drain.

If your OME doesn't get better after 3 months, surgery may be used to drain the fluid. A small tube may also be put in the eardrum to help with drainage.

Because the middle ear fluid can become infected, watch for signs of an infection. These may develop later. They may include increased ear pain, fever, or drainage from the ear.

Home care

These home-care tips will help you take care of yourself:

  • You may use over-the-counter medicine as directed by your healthcare provider to control pain, unless medicine was prescribed. If you have chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your healthcare provider before using any medicines.

  • Aspirin should never be used in anyone younger than age 18 who has a fever. It may cause severe liver damage.

  • Ask your healthcare provider if you may use over-the-counter decongestants such as phenylephrine or pseudoephedrine. Keep in mind they are not always helpful.

  • Talk with your healthcare provider about using nasal spray decongestants. Don't use them for more than 3 days, or as directed by your healthcare provider. Longer use can make congestion worse. Prescription nasal sprays from your healthcare provider don't often have such restrictions.

  • Antihistamines may help if you are also having allergy symptoms.

  • You may use medicines such as guaifenesin to thin mucus and help with drainage.

Follow-up care

Follow up with your healthcare provider or as advised if you are not feeling better after 3 days.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Ear pain that gets worse or that does not start to get better 

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Fluid or blood draining from the ear

  • Headache or sinus pain

  • Stiff neck

  • Unusual drowsiness or confusion

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