Earache is uncommon, but when it occurs it is a very distressing condition. In some cases it is the most excruciating pain known. Usually it is caused by either an infection in the outer ear (the ear canal) or the middle ear (behind the ear drum). Outer ear infection (called otitis externa) usually follows swimming in dirty pools, or introducing sharp instruments in the ear canal in an effort to remove wax! These infections are more likely to occur if there is an underlying skin condition like eczema. However, there is no significant hearing loss with otitis externa but, characteristically, touching any part of the outer ear increases the pain significantly. The bacteria concerned are usually not the sort easily dealt with by using antibiotics taken by mouth and so antibiotic drops are the treatment of choice. Often the ear canal is so swollen that drops cannot be adequately introduced; in such cases careful suction of debris has to be undertaken and the possible use of a wick in order to get the antibiotics to the affected area.

Middle ear infections frequently start with earache, usually after a cough or cold. In these cases the pain may increase to a crescendo resolving only when the drum perforates and pus comes out of the ear. Hearing is inevitably affected in the short term. As the bacteria are those found in throat and chest infections antibiotics by mouth can be used. Chronic ear infections that can be difficult to manage and dangerous in some cases are usually associated with no pain at all.

An important variant of earache is pain in the ear but coming from a problem elsewhere. Examples would be an infection in the tonsils or, perhaps, a tumour right at the back of the tongue, so when the ear appears normal and the patient complains of earache the doctor has to search for the underlying complaint.

How we balance is a most complex system that works without thought, but when there is a system breakdown we are in real trouble. Our balance system tells us at any one time where we are in space; the monitors are:-

1. our eyes
2. the balance organs in our inner ears, and
3. the position sensors in our joints and tendons of our muscles.

The monitors lead to that part of the brain called the cerebellum that integrates the information. The information from the balance organs are themselves perfectly balanced, so an increased input from the right organ is associated with a decreased input from the left. If one of the balance organs is affected by infection, usually viral, the input is reduced and the “balance” between the sides is lost. This results in loss of integration in the cerebellum, causing abnormal information to be sent to the eye muscles which allows the eyes to move spontaneously. This movement (called nystagmus) is a flickering of the eyeball from side to side which makes us think we are, or anything around us is, rotating; this sensation is called vertigo. As the hearing organ (the inner ear) and the balance organ are joined together hearing loss and tinnitus (buzzing, hissing or ringing noises in the ear) often go together with vertigo. There are, of course, lots of different causes for vertigo and the specialised investigation is needed, usually by an ENT surgeon specialising in ear disease (an otologist). Wooziness, light-headedness are not conditions associated with the balance mechanism and may suggest abnormalities in blood flow or blood pressure.