Ear Pain: Causes and Treatment Options

Ear pain (otalgia) can affect the outer ear or middle ear. Also known as an earache, otalgia can be caused by an infection, injury, or blockage in different parts of the ear (primary) or from a sinus, dental, or jaw issue (secondary).

For example, ear cartilage pain can be from an injury or infection of the outer ear. Ear canal pain is commonly due to swimmer's ear. Deeper ear pain can be related to an infection, a blockage, or a ruptured ear drum.

How ear pain feels (aching, sharp, dull, etc.), its intensity, location, and other symptoms (e.g., fever, dizziness) can help your healthcare provider diagnose your ear pain. Treatment may include ear drops, oral medications, and at-home treatments to ease the pain.

This article discusses ear pain. It explains the different causes of ear pain and how ear pain is treated.

Primary Causes of Ear Pain

Primary causes of ear pain originate within the middle ear or outer ear. The following conditions can cause primary ear pain.

Middle Ear Pain: Otitis Media

Otitis media describes a middle ear infection in which fluid and inflamed tissue build up in the middle ear space—the area between your eardrum (tympanic membrane) and the oval window of your inner ear.

Besides moderate to severe aching pain felt deep in the ear, you may experience several days of nasal congestion and/or a cough preceding the ear pain. Sometimes, a fever may occur.

If the eardrum ruptures as a result of the pressure buildup, purulent (containing pus) ear drainage may result.

Swimmer's Ear: External Otitis

External otitis—an infection of the ear canal—causes a feeling of ear fullness, itchiness, and significant ear pain when the earlobe is pulled. Yellowish or clear-colored ear discharge may also occur, along with decreased hearing and swelling of the ear canal.

The reason external otitis is commonly called "swimmer's ear" is that it often develops when water gets trapped in the ear canal.

Another common culprit behind external otitis involves the frequent use of cotton swabs. Inserting them into the ear can create small cuts in the ear canal that serve as a breeding ground for bacteria.

A severe complication of external otitis is necrotizing (malignant) external otitis, in which the ear canal infection spreads to the base of the skull. This condition is more common in older people with diabetes mellitus.

Ear Cartilage Pain: Perichondritis

Perichondritis arises from an infection of your ear cartilage, resulting in pain, swelling, and redness over the skin.

A bacterial infection, often caused by Pseudomonas aeruginosa, Staphylococcus aureus, or Streptococcus pyogenes, perichondritis can also cause a fever and an abscess (collection of pus) forms.

Without treatment, perichondritis can lead to ear deformity (called cauliflower ear) as the infection cuts off the blood supply to the cartilage, thereby destroying it. The infection can become quite severe and require hospitalization.

Perichondritis is most likely in people with certain autoimmune conditions, such as granulomatosis with polyangiitis. It can also be caused by trauma to the ear cartilage from an accident, burn, contact sport, or piercings.

Cartilage piercings carry an increased risk of perichondritis due to infection. While it can occur with piercings of the helix (the outer rim) or antihelix (inner ridge), post-piercing perichondritis commonly affects the scapha (flat surface between the helix and antihelix).

Otitis Media With Effusion

Otitis media with effusion (OME) describes the presence of middle ear fluid without signs of infection.

In other words, there is fluid buildup without tissue inflammation. Overall, the ear pain of OME is generally mild and associated with a feeling of ear fullness and/or decreased hearing.

Typically, OME follows acute otitis media, but it may also occur as a result of barotrauma (injury caused by air or water pressure) or allergy.

Rarely, OME occurs as a result of tumor blockage of the eustachian tube—a tunnel that connects the middle ear to the upper throat and back of the nose.

Perforated Eardrum

A perforated eardrum is a hole, or tear, in the eardrum.

The eardrum is a delicate structure within the ear and can be torn easily by an injury, a change in pressure, or explosively loud noise. It is also commonly associated with middle ear infections (otitis media).

Aside from sharp ear pain, people who have a perforated eardrum may experience sudden hearing loss, fluid leaking from the ear, or a ringing or buzzing sound in the ear.

Earwax Blockage

The purpose of earwax (cerumen) is to protect your ear canal from water, bacteria, and injury.

Sometimes though, too much earwax is produced or the wax gets pushed back too deep into the ear canal (which is why healthcare providers recommend not using cotton swabs to clean out your ears).

If an earwax blockage occurs, ear discomfort—often reported as a full or congested sensation—may occur. Problems hearing and ringing in the ear (tinnitus) may also result from earwax blockage.

Eustachian Tube Blockage

The eustachian tube is a narrow tunnel that connects your upper throat to your middle ear. It regulates the air pressure in and drains excess fluid from your middle ear.

If the eustachian tube becomes blocked, often as a result of allergy, infection, or a rapid altitude change, the following symptoms may occur:

• Ear pain
• Ringing or popping in the ears
• Hearing loss

Ear Skin Problems

Sometimes ear pain originates from the skin of the ear.

There are three related conditions:

• Dermatitis of the ear causes itching, flaking, and swelling of the skin of the ear canal. It may result from an allergic reaction (contact dermatitis) or as a result of an underlying skin problem (i.e., seborrheic dermatitis or psoriasis).
  
• Herpes zoster oticus ("shingles of the ear") causes severe ear pain along with a vesicular rash (tense, fluid-filled sacs). In rare instances, facial paralysis may occur along with the rash and ear pain in what's known as Ramsay Hunt syndrome.
• Periauricular cellulitis (infected skin on the ear) results in a red, hot, and extremely tender ear. A fever may also be present.

Meniere's Disease

Meniere's disease is caused by excess fluid buildup in the inner ear, although the precise reason behind this fluid retention is unknown.

In addition to the classic triad of symptoms—vertigo, ringing in the ears, and hearing loss—some people with Meniere's disease report ear pressure.

Tumor

Although not common, a cancerous or noncancerous tumor may be the source of a person's ear pain.

For example, nasopharyngeal cancer (a type of head and neck cancer) may cause ear fullness, along with hearing loss, ringing in the ears, and recurrent ear infections.

Two examples of noncancerous tumors or growths that may develop in the ear and cause pain include:

• Cholesteatoma: A benign skin growth that forms in the middle ear
• Acoustic neuroma: A benign inner ear tumor that develops on the vestibular nerve (eighth cranial nerve)

Secondary Causes of Ear Pain

These conditions may cause ear pain, though they originate outside of the ear.

Sinusitis

Sinusitis refers to infection or inflammation of the sinuses, which are hollow spaces located behind your nose, between your eyes, and within your cheekbones and lower forehead.

Sinusitis may cause a variety of symptoms, such as:

• Ear pressure, discomfort, or fullness
• Fever
• Nasal congestion and discharge
• Tooth pain
• Headache

Most cases of sinusitis are caused by a viral illness or allergy; only a small percentage of cases are due to a bacterial infection.

Dental Problems

Dental problems, such as a cracked tooth, decayed tooth, or tooth abscess, may refer pain to the ear. Usually, the pain is worsened by hot or cold stimuli or biting or eating.

TMJ Disorder

The temporomandibular joint (TMJ) connects your lower jaw to the temporal bone of your skull. Arthritis or erosion of the joint or stress/overuse of the surrounding muscles may cause TMJ disorder.

The pain of TMJ disorder is often described as a constant and dull jaw joint pain that worsens with opening or closing the mouth. Headaches and tenderness around the ear canal are also common.

Giant Cell Arteritis

Giant cell arteritis (GCA) refers to inflammation of the branches of the external carotid artery, a large artery located in your neck.

This inflammation may cause pain in the ear canal or outer ear, along with temple and/or forehead pain, fever, fatigue, and a loss of appetite. Vision changes and pain with chewing may also be present.

Mastoiditis

If a middle ear infection remains untreated, the infection may spread to the mastoid bone—a spongy, air-filled bone that is part of your skull.

A mastoid bone infection (mastoiditis) causes pain, redness, and swelling behind the ear.

If mastoiditis is not recognized and treated promptly, it can lead to complications like a brain or skull bone abscess, meningitis, facial nerve paralysis, or hearing loss.

When to See a Healthcare Provider

If you are experiencing ear pain that is worsening, severe, or persisting for two or more days, it's important to seek medical attention.

Other examples of situations that warrant a healthcare provider's attention include:

• Ear pain accompanied by a fever and/or a sore throat
• Pain when tugging on your earlobe
• Ear discharge
• Ringing in the ears, dizziness, or hearing loss
• Swelling or rash of the ear canal or earlobe

Diagnosing Ear Pain

Diagnosing ear pain often only requires a medical history and physical examination by a primary care provider or an ear, nose, and throat (ENT) specialist.

Imaging and blood tests are less commonly needed.

Medical History

When you see your healthcare provider for ear pain, expect them to ask several questions related to the details of your pain:

• What does the pain feel like?
• Does the pain come and go, or is it constant?
• Are there any associated symptoms present, such as fever, hearing loss, balance problems or dizziness, ear drainage, or tinnitus?
• Have you recently been ill or experienced any trauma to the face or ear?

Physical Examination

During your physical exam, your healthcare provider will inspect the outer ear, ear canal, and tympanic membrane (eardrum) with an otoscope.

They will also inspect your nose, mouth, and sinuses, press on your TMJ, look at your back molars to check for signs of grinding or frequent clenching of the teeth, and examine your neck to look for enlarged lymph nodes or other masses.

Specialized Tests

ENTs are able to examine your ear pain and its effects using specific in-office tests:

• Nasal endoscopy is a nonsurgical procedure that uses a thin tube with a camera and light (endoscope) to examine your nose, sinuses, and the top of your throat (where the opening of your eustachian tube lies).
• Hearing tests, often performed by an audiologist, assess your ability to hear different frequencies and can provide clues about the cause of ear pain.
• Vestibular tests, also performed by an audiologist, may be used to assess your inner ear if you are having balance problems or dizziness.
  

Imaging

Imaging is sometimes needed to sort out an ear pain diagnosis:

• X-rays can evaluate a dental problem, examine the jaw, or assess the temporal-mandibular joint.
• Computed tomography (CT) scans are used to assess for mastoiditis, cranial nerve deficits, or signs of meningitis.
• Magnetic resonance imaging (MRI) may be ordered to rule out cancer (e.g., brain tumor nasopharyngeal cancer, cholesteatoma) or multiple sclerosis, which can mimic symptoms of Meniere's disease.

Blood Tests

Blood tests may be used to help diagnose various ear pain conditions.

For instance, if your healthcare provider suspects a severe infection, especially mastoiditis, he may order a white blood cell count and inflammatory marker tests, namely erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Blood tests may also be used to rule out concerns like thyroid disease, diabetes, and syphilis, all of which may have symptoms similar to those of Meniere's.

Treatment

As there are many different causes of ear pain, there are similarly many possible treatments. The treatment of choice will specifically depend on the root cause of your ear pain.

Self-Care Strategies

Simple, at-home therapies can sometimes go a long way in easing your ear pain, especially if the pain is related to fluid build-up from a virus or allergies.

For instance, in order to ease the congestion of sinusitis, otitis media, or eustachian tube blockage, your healthcare provider may recommend taking an over-the-counter decongestant or using a nasal spray.

Other self-care strategies that may be helpful include:

• Hold a warm compress against your ear or sinuses
• Apply mineral oil or diluted hydrogen peroxide, followed by a warm shower to loosen congestion
• Yawn or chew gum in order to try "pop" your ears.
• Drink lots of water (six to eight glasses per day).

Self-care strategies also play an important role in managing TMJ syndrome:

• Perform simple jaw exercises.
• Avoid triggers of TMJ pain (e.g., chewing gum or grinding your teeth).
• Use a bite guard when you sleep.
• Engage in relaxation and stress management techniques.

Ear Flushing

Ear flushing is performed by a healthcare professional to remove impacted wax. The procedure is also used to remove debris, infected material, and dead skin cells in the treatment of otitis externa.

Medications

Several different medications may be used to treat your ear pain:

Ear Drops

Earwax-softening drops may be recommended by your healthcare provider if you have earwax buildup.

Likewise, ear drops are the primary treatment for external otitis. There are many different types of ear drops available, including antibiotics, acidifying solutions, and steroids.

Many of these ear drops work in combination to reduce inflammation, treat the infection, and ease pain.

Oral or Intravenous Antibiotics

Sometimes oral (by mouth) or intravenous (by vein) antibiotics are required to treat more serious causes of ear pain, such as:

• Bacterial sinusitis
• Severe cases of external otitis, including necrotizing (malignant) external otitis
• Perichondritis
• Mastoiditis
• Periauricular cellulitis

Severe infections, like perichondritis and cellulitis, may require IV antibiotics given in the hospital.

Pain Relievers

To soothe your ear pain, your healthcare provider may recommend over-the-counter Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen).

For the pain of TMJ syndrome, your healthcare provider may also prescribe a muscle relaxant or a tricyclic antidepressant.

Surgery

A surgical procedure called a myringotomy is sometimes needed to treat chronic middle ear infections or persistent eustachian tube dysfunction.

A small hole is made in your eardrum to ease pressure and let the fluid drain. An ear tube may then be placed in the eardrum to allow airflow into the middle ear and to prevent fluid from re-accumulating.

Surgery may also be indicated for other ear pain diagnoses like a tumor, severe mastoiditis, or abscess formation in perichondritis.

Prevention

Here are a few strategies that may help prevent certain ear pain diagnoses:

To prevent earwax buildup:

• Avoid chronic use of cotton swabs or earwax softening agents, such as Debrox (carbamide peroxide).
• If you suffer from frequent episodes of earwax buildup, consider regular use of topical emollients or a routine ear cleaning by a healthcare professional every six to 12 months.

To prevent external otitis ("swimmer's ear"):

• After swimming, blow-dry your ears. (Use a low setting and hold the hairdryer about a foot away.)
• Consider wearing special earplugs for swimming.
• Avoid sticking your finger or towel into your ears after swimming.

Summary

Ear pain can be caused by an infection like otis media. It can also result from trauma, a blockage inside the ear, or from the sinuses, teeth, or jaw.

Ear pain can sometimes be relieved with at-home treatment like a hot or cold compress, OTC pain relievers, and ear drops.

If home remedies do not help and the pain is worsening or persisting for two or more days, see your healthcare provider. Ear pain that is accompanied by a fever, sore throat, discharge, ringing in the ears, dizziness, or hearing loss should be evaluated by a healthcare provider. 

Prescription medications and ear drops may be needed to clear up ear infections. Severe infections, like perichondritis, may require hospitalization. In some cases, surgery may be needed to treat the cause of ear pain.