Ear Pain Causes: What It Could Be

Most ear pain is an ear infection — either otitis media, behind the eardrum, or otitis externa, in the ear canal. But the ear is also where pain from the jaw joint and the throat is felt, and where earwax, trapped water and cabin pressure make trouble without any infection at all. Which one it is changes the treatment completely.

Main causes of ear pain

• Outer ear infection (otitis externa): inflammation of the ear canal, with itching, a plugged feeling and pain that flares when the outer ear is tugged. StatPearls puts the lifetime incidence at about 10% of people and reports that swimming raises the risk about fivefold.
• Middle ear infection (otitis media): infection behind the eardrum, most common in small children and usually arriving on the back of a cold.
• Eustachian tube dysfunction: a cold, allergy or upper respiratory infection blocks the tube, negative pressure builds behind the eardrum, and mucus collects there.
• Earwax impaction: StatPearls reports it in up to 6% of the general population, 10% of children and more than 30% of older adults, causing fullness, hearing loss, itching and pain.
• Referred pain from the temporomandibular joint, from a throat infection, or — rarely, and the reason a one-sided persistent earache with a normal ear exam gets investigated — from throat cancer.
• Pressure changes while flying or diving, which stretch the eardrum when the tube cannot equalize.
• Cotton swab use, which MedlinePlus lists as a cause of earache in its own right.

Children, and the eustachian tube that will not drain

The NIDCD gives three reasons, and none of them is bad luck. A child’s eustachian tubes are smaller and more level than an adult’s, which makes it hard for fluid to drain out of the middle ear. The immune system is still developing, so infections take hold more easily. And the adenoids — pads of immune tissue near the eustachian tube openings — can trap bacteria that then travel to the middle ear.

The scale of it is worth knowing: roughly five out of every six children have at least one ear infection before their third birthday, which makes it the most common reason parents bring a child to the doctor. Secondhand smoke, bottle feeding at bedtime, day care attendance and contact with sick playmates all push the odds up. More on that in ear pain in children causes.

Outer ear infection versus middle ear infection

	Otitis externa	Otitis media
Where it sits	Ear canal	Behind the eardrum
What makes the pain worse	Tugging the tragus or the outer ear	Nothing you can do from outside
Typical extras	Intense itching, plugged feeling, drainage	Fever, irritability, muffled hearing
Usual trigger	Water in the canal	A preceding cold
First-line treatment	Topical eardrops	Oral antibiotics, when indicated

Uncomplicated swimmer’s ear is a topical problem with a topical answer: StatPearls describes cleaning the canal plus topical eardrops, with oral antibiotics reserved for infection spreading beyond the canal. StatPearls reports 65% to 90% of cases clearing within 7 to 10 days.

When ear pain is not an infection

Earwax builds up until it blocks the canal and causes fullness, tinnitus and a dull ache — the picture is in clogged ear causes. Ringing that comes with ear discomfort has its own list of causes, in tinnitus causes. And the jaw joint deserves special mention: StatPearls notes that the auriculotemporal branch of the trigeminal nerve supplies the temporomandibular joint, which is why TMJ dysfunction is one of the commonest sources of referred ear pain — a problem that has nothing to do with the ear, felt squarely inside it. Women aged 20 to 40 are the group most likely to have it; over 65, cervical spine disease becomes the likelier source. The bruxism side of it is in bruxism headache.

What to do about ear pain

1. Keep everything out of the ear canal — swabs, hairpins, home-chosen drops. Nothing smaller than an elbow.
2. Do not put liquid in the ear before knowing whether the eardrum is intact; with a perforation or a tube, drops and water can start an infection.
3. Use an oral analgesic for the pain itself while you arrange to be seen.
4. Keep the ear dry while it hurts, especially if water started it.
5. Get the eardrum looked at, because the treatments for the two infections do not overlap.

Warning signs that call for medical care

• High fever with the pain
• Pus-like or bloody drainage from the ear
• Swelling or redness behind the ear — see swelling near ear causes
• Severe pain of sudden onset, or severe pain that suddenly stops
• Rapid hearing loss, dizziness, stiff neck, severe headache, or twitching of the face muscles
• In babies: inconsolable crying, fussiness, and any fever under 6 months of age

This content is informational and does not replace a medical consultation, diagnosis, or treatment. See also ear infection symptoms and ear pain in children causes.