What Causes Pain Behind the Ear?

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It makes perfect sense to assume that “pain behind your ear” must be related to a problem within your ear, like an infection.

But you know what can happen when you assume.

Your ear shares its nerve supply with several structures in your head and neck. Ailments like jaw joint inflammation, a dental infection, or a nerve-related headache may be the real culprit producing the pain.

Potential Causes of Pain Behind the Ear - Illustration by Danie Drankwalter

Verywell / Danie Drankwalter

To evaluate pain behind your ear—sometimes described as a “headache behind the ear”—your doctor will examine your ear, jaw, mouth, neck, and the nerves, lymph nodes, and skin around your face and scalp.

They will also ask you about associated symptoms and may order various blood or imaging tests. Once your doctor has a diagnosis, they will formulate a treatment plan to soothe your pain and treat the underlying problem.

This article explains the symptoms of ear pain and how a medical professional goes about the complex process of forming a diagnosis. It also explains the eight most likely causes of ear pain as well as treatment options.

Symptoms

The symptoms of pain behind the ear depend on the specific tissue that is being affected (i.e., ear, bone, muscle, nerve, or joint) and the underlying problem (i.e., infection, inflammation, or injury).

For instance, a middle ear infection may cause a pressure-like, aching pain inside or behind your ear. An infection of the bone behind your ear often causes intense throbbing pain and local redness/swelling just behind the ear.

Problems with a tooth or your jaw joint may cause sharp or nagging ear pain. Likewise, inflamed nerves that lead to your scalp may cause abnormal burning or piercing sensations around your ear.

In most cases, pain behind your ear does not exist alone. There are usually accompanying symptoms, such as:

Emergency Symptoms

Seek emergency medical attention if you are experiencing pain behind your ear as well as one or more of the following:

  • High fever
  • Neck stiffness and sensitivity to light (photophobia)
  • Neurological symptoms (such as facial paralysis or confusion)
  • Profuse ear drainage
  • Swelling, warmth, and/or spreading redness behind the ear
  • Unintended weight loss and/or a neck mass

Diagnosis

In the absence of the above emergency symptoms, making an appointment with your primary care physician is a reasonable first step if you're experiencing pain behind your ear.

Depending on the quality and/or severity of your symptoms, or based on your doctor’s initial suspicion or gut instinct, you may be referred to a specialist. This may be an otolaryngologist, neurologist, pain management doctor, or dentist.

Regardless of the specific provider you are seeing, your diagnostic workup will begin with a medical history and physical examination. From there, additional tests may be ordered to confirm the diagnosis and rule out possible causes.

Medical History

During your medical history, your doctor will review your prior and current medical ailments and medications. Next, your doctor will home in on exactly what your pain feels like.

You may be asked:

  • Can you point to where you feel your pain?
  • Does your pain spread (“radiate”) anywhere?
  • How severe is your pain? (You may be asked to rank it on a pain scale of 1 to 10.)
  • Does the pain come and go or is it constant?
  • Has anything made the pain better or worse?
  • What other symptoms are you experiencing besides the pain (e.g., trouble hearing, rash, fever)?

Physical Examination

After obtaining a detailed medical history, your doctor will move forward with a physical exam. In addition to recording your vital signs (temperature, heart rate, blood pressure), the doctor will examine the muscles, bones, tissues, nerves and skin that make up your head, neck, and ear.

Specific steps may include:

  • Examining your outer ear and ear canal for redness, warmth, swelling, discharge, and rash
  • Using an instrument called an otoscope to look inside your ear for signs of wax buildup or infection (e.g., swollen or ruptured eardrum)
  • Assessing your posture, neck range of motion, and whether any bony or muscle tenderness is present
  • Examining your jaw muscles/joint for tenderness and range of motion
  • Looking in your mouth for bite problems or signs of teeth grinding
  • Performing a cranial nerve exam
  • Pressing on the lymph nodes on either side of your neck, behind your ear, and underneath your jaw

Laboratory Tests

Laboratory tests alone can't make a diagnosis, but they can help your doctor put all the pieces of the puzzle together.

As an example, a high white blood cell count suggests an infection. Likewise, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) suggests that an infection or inflammatory reaction is occurring in the body.

Culture

In select cases, a culture may be taken from your outer or middle ear. Results of the culture (which determine whether any bacteria are growing) will help guide your treatment plan.

Imaging Tests

Imaging tests, like an X-ray or computed tomography (CT) scan, may be ordered to assess for bony abnormalities in the skull bone near the ear or to look for arthritis of the neck or jaw joints.

If a diagnosis is still uncertain, your doctor may order a magnetic resonance imaging (MRI) scan of the head and neck or the jaw joint.

Diagnostic Injections

If a nerve or muscle problem is the suspected source of your pain, your doctor may try injecting a local anesthetic (numbing) medication into the nerve or muscle. A temporary improvement in the pain can help confirm the diagnosis.

Causes

There are many potential causes of pain or a headache behind the ear, which is why seeing a healthcare professional is important.

While this is not an exhaustive list, your doctor is likely to consider these eight common problems:

Otitis Media

Otitis media occurs when the middle ear space, located between the eardrum and the inner ear, becomes inflamed and infected. Viral respiratory tract infections, like the common cold or flu, often trigger otitis media.

In adolescents and adults, symptoms may include mild to severe earache or pain and decreased or muffled hearing.

If the eardrum ruptures—resulting from the pressure buildup in the middle ear space—a person may experience immediate relief from their pain. They may also notice pus-like drainage from their ear.

Young children with otitis media may pull on their ear and/or experience fever, fussiness, difficulty eating and sleeping, and vomiting or diarrhea.

Otitis Externa

Otitis externa, a.k.a. “swimmer’s ear,” develops when the ear canal becomes inflamed. It can be a result of an infection, allergy, or a chronic skin condition.

Symptoms include tenderness of the outer ear, especially when it's tugged on, itchiness inside the ear, and hearing loss. Patients with otitis externa may also notice ear discharge.

Certain factors that increase a person’s risk for developing otitis externa include:

  • Excessive cleaning of the ear canal (e.g., removing wax with a cotton swab)
  • Regular swimming (which allows bacteria that normally live in the ear canal to enter the skin)
  • Wearing devices in your ear (like earplugs or hearing aids)

Foreign Objects

Foreign objects in the ear may cause otitis externa symptoms. This phenomenon occurs more commonly in young children, who have been known to harbor insects and tiny toys in their ears.

Earwax Impaction

Earwax, also called cerumen, is a substance that protects the lining of the outer ear canal.

Cerumen normally clears out of the canal on its own. If this normal process is compromised, cerumen can accumulate deep within the ear canal. It can become hardened and impacted.

Factors that contribute to earwax impaction include:

  • Engaging in possible “ear irritating” behaviors, such as using cotton swabs regularly, sticking your finger in your ear canal, or wearing hearing aids
  • Being an over-producer of the waxy substance
  • Having a narrow or twisted ear canal
  • Producing cerumen that is drier than usual

If enough cerumen accumulates, symptoms may develop, including pain behind or within the ear, ear fullness, hearing loss, itching, and tinnitus.

Dental Problems

Dental problems, most notably tooth decay, cavities, and dental abscesses, can manifest as pain behind the ear, especially if they're left untreated. Associated symptoms may include tooth pain or sensitivity, swelling in the cheek, and/or tender and enlarged lymph nodes under the jaw or in the neck.

In one study of nearly 100 patients with referred ear pain, the most common cause was a dental problem.

Temporomandibular Joint Disorder

The temporomandibular joint (TMJ) is located in front of your ear, where your jaw connects to your skull. Problems with this joint and the muscles surrounding it may cause what is known as a TMJ disorder.

The primary symptom of a TMJ disorder is dull pain near the ear on the affected side. The pain tends to worsen with chewing or opening and closing the mouth.

Other symptoms of TMJ disorder include:

  • Eye, neck, arm, or back discomfort
  • Headaches that are worse in the morning and spread to the jaw, temple, or forehead
  • Jaw “heaviness” or “fatigue” after eating meals
  • Jaw sounds like clicking, popping, or grating
  • Tinnitus

Several factors may contribute to a TMJ disorder, including arthritis or injury of the TMJ joint, chronic grinding of the teeth, dental misalignment, poor head and neck posture, stress, and genetics.

Occipital Neuralgia

Occipital neuralgia causes a severe stabbing, shooting, or electric shock-like pain that spreads through the upper neck, back of the head, and behind the ears.

The pain of occipital neuralgia is sudden, usually occurs on one side of the head, and can be triggered by simple, everyday movements like brushing your hair or moving your neck.

Other potential symptoms of occipital neuralgia include:

  • Dizziness and nausea
  • Nasal congestion
  • Tenderness when the back of the head or area behind the ear is pressed
  • Tinnitus
  • Vision impairment or pain behind the eye located on the same side as the headache

The culprit behind occipital neuralgia has not been pinpointed. One theory is that the disorder is caused by chronic entrapment, irritation, or “pinching” of the occipital nerves, which start in your neck and run along the back of your scalp to the top of your head.

This irritation may occur on its own or be associated with another medical condition, like neck osteoarthritis, degenerative disc disease, a blood vessel or inflammatory disorder, or a rare type of tumor called a schwannoma.

Mastoiditis

Mastoiditis is an uncommon infection of the mastoid bone, which is located behind and below your ear. Mastoiditis results from the progression of acute otitis media and can occur at any age, but is most common in children under the age of 2.

In adults, symptoms of mastoiditis typically include severe pain behind the ear, fever, and headache. Young children tend to be quite sick, irritable, and have a fever. Children may pull on their affected ear or complain of ear pain, if they can talk.

If left untreated, mastoiditis can lead to very serious complications including meningitis, intracranial abscess, venous sinus blood clot, infection of the skull bone, hearing loss, or facial nerve paralysis.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome is caused by the reactivation of the virus that causes chickenpox (the varicella-zoster virus).

This rare condition is associated with a painful, blistering rash within the ear canal or on the ear’s outer portion. Sometimes, the blisters are found in the mouth and/or the top part of the throat. The ear pain of Ramsay Hunt syndrome can be intense and spread to your neck.

Other potential associated symptoms include facial paralysis on the affected side, tinnitus, decreased hearing, vertigo, nausea, and vomiting.

Treatment

Treatment of pain behind the ear depends on the specific diagnosis:

  • An earwax impaction may call for special earwax-softening drops or an ear rinse. Sometimes, a special tool that has a hook or suction device is used to remove the wax.
  • Occipital neuralgia may be treated with a combination of heat, pain medicine, and a nerve block, often performed by a neurologist or pain specialist.
  • Otitis externa or otitis media often require treatment with an antibiotic in the form of ear drops or oral pills, respectively.
  • Mastoiditis is a more serious infection and requires intravenous (IV) antibiotics and surgical drainage of the infected fluid. Likewise, a dental abscess requires drainage and antibiotic therapy.
  • The treatment of temporomandibular joint disorder often involves a trial and error process. Patients may benefit from a combination of pain-easing medications, like muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, stress management, and avoiding triggers like nail-biting or jaw clenching.
  • To treat Ramsay Hunt syndrome, antiviral medication and steroids are usually prescribed.

Summary

Many things can cause pain behind the ear, including infections, impacted earwax, dental problems, TMJ disorder, and nerve irritation. A healthcare professional can get to the bottom of your pain after conducting a medical history and examination. The treatment will depend on the source of the pain.

A Word From Verywell

If you are suffering from pain behind your ear or some variation of this symptom, schedule a virtual or in-person appointment with your doctor. A diagnosis will put your mind at ease, allow you to move forward with a treatment plan, and help you feel like yourself again.

Frequently Asked Questions

  • Why is my ear throbbing?

    Ear throbbing can be caused by pulsatile tinnitus, a condition that is characterized by a rhythmic thumping, throbbing, or whooshing that is often in synch with a person's heart beat. There are many causes of pulsatile tinnitus, such as hyperthyroidism and anemia, so treatment will focus on addressing the underlying condition.

  • Why does my ear hurt when I chew?

    A temporomandibular joint (TMJ) disorder can cause the ear to hurt while chewing. Other signs of a TMJ disorder include headache, dizziness, lockjaw, the jaw clicking or popping, ear ache or ringing in the ear, teeth clenching and grinding, finger numbness and tingling, and pain that spreads to the eyes, face, neck, and shoulders. These symptoms can appear in other medical conditions, so the only way to know the specific cause is by visiting a healthcare provider to receive a diagnosis.

  • What is the bone behind the ear?

    The mastoid bone is located behind the ear. While uncommon, if it becomes infected, it is known as mastoiditis. This infection can cause fever, ear pain, ear drainage, headache, hearing loss, redness, and swelled skin behind the ear. Mastoiditis is treated using an antibiotic injection alongside oral antibiotics. If this treatment does not work, surgery may be required.

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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