What causes pain in the ear?

Ear pain (otalgia) is common and can have many causes. Pain originating from the ear is called primary otalgia and is more common in children. Pain originating from outside the ear is secondary otalgia and is more common in adults. An earache may be sharp, dull, or burning pain in one or both ears. The pain may last a short or long time.  

To determine a diagnosis, your doctor will consider the location and duration of your pain, aggravating factors (what makes it worse), alleviating factors (what makes it better), other symptoms, previous episodes, medical history, smoking status, and alcohol abuse. 

Common causes of pain in the ear include: 

• Infection 
• Ear wax buildup 
• Air pressure 
• Swimmer’s ear 
• Trauma or injury 
• Toothache- the nerves in your face and neck pass very close to your inner ear. Doctors call this type of pain that starts in one area but is felt in another “referred pain”.
• Temporomandibular disorders (TMD)-  disorders of the jaw muscles, temporomandibular joints (TMJ), and the nerves associated with chronic facial pain. The ache in your ears or face comes after you chew, talk, or yawn. People with TMD may experience sharp or dull jaw pain that radiates to the ears and temples. 

Other causes include: 

• Foreign object in the ear 
• Tumor or infected cyst 
• Ramsay Hunt syndrome- a rare neurological disorder  
• Virus or other underlying disease 

You should consider seeking emergency care if you experience the following symptoms with ear pain: 

• Stiff neck 
• Severe drowsiness 
• Nausea and/or vomiting 
• High fever 
• A recent blow to the ear or recent head trauma 

Geniculate neuralgia

Geniculate neuralgia is a rare type of nerve pain that happens when a branch of the facial nerve, the nervus intermedius, becomes damaged or compressed. Ear pain, ranging from mild to debilitating, is one of the most common symptoms. Geniculate neuralgia results in severe, deep ear pain which is usually sharp, often described as an “ice pick in the ear”, but may also be dull and burning. Ear pain can be triggered by stimulation of the ear canal, or can follow swallowing or talking, and can be accompanied by other facial pain. Treatment for geniculate neuralgia usually involves managing symptoms with medication and noninvasive therapies. In severe cases, surgery may be recommended to decompress the facial nerve. 

Glossopharyngeal neuralgia

Glossopharyngeal neuralgia (GPN) is a condition causing throat, ear, and neck pain. The characteristics of GPN are similar to trigeminal neuralgia with some differences, which must be identified for the correct diagnosis and treatment. Clusters of unilateral attacks of sharp, stabbing, and shooting pain localized in the throat radiating to the ear or vice versa are characteristic of GPN. The distribution of pain is diagnostic: the pain shoots from the pharynx (part of the throat behind the mouth and nasal cavity), tonsil, and the back of the tongue upwards to the eustachian tube (a canal that connects the middle ear to the nasopharynx, which consists of the upper throat and the back of the nasal cavity) and inner ear or to the jaw. Read more about glossopharyngeal neuralgia.