Why You May Have Pain Behind the Ear

Pain behind the ear could be related to the ear itself or nearby structures that share a nerve supply with the ear. There are several possible causes of pain behind the ear that may be considered, including jaw joint inflammation, a dental infection, or a nerve-related headache.

This article looks at eight common causes of pain behind the ear, their symptoms and treatments, and what to expect from the diagnostic process.

Occipital Neuralgia

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

Occipital means the back of the head. Neuralgia is pain from damaged nerves. The occipital nerves start in your neck and run along the back of your scalp to the top of your head.

Experts don't yet know what causes occipital neuralgia. One theory is that it's caused by chronic entrapment, irritation, or “pinching” of the occipital nerves.

This irritation may occur on its own or be associated with another medical condition, such as:

• Neck osteoarthritis
• Degenerative disc disease
• A blood vessel or inflammatory disorder
• A rare type of tumor called a schwannoma

Symptoms of Occipital Neuralgia

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

Treatments for Occipital Neuralgia

Occipital neuralgia is treated with a combination of:

• Heat
• Pain medicine
• Nerve blocks

Nerve blocks are often performed by a neurologist or pain specialist.

Otitis Media

Otitis media (or middle ear infection) occurs when the middle ear space, located between the eardrum and the inner ear, becomes inflamed and infected. This can cause pain behind the ear and inside of it.

Viral respiratory tract infections, like the common cold or flu, often trigger otitis media.

Symptoms of Otitis Media

In adolescents and adults, symptoms may include:

• Mild to severe earache or pain behind the ear
• Decreased or muffled hearing

If pressure in the middle ear space gets too high, the eardrum can rupture. That may lead to:

• Immediate pain relief
• Pus-like drainage from the ear

Young children with otitis media may pull on their ear and/or be feverish, fussy, and have difficulty eating and sleeping. They may also vomit or have diarrhea.

Treatments for Otitis Media

Pain behind the ear caused by otitis media is generally treated with medicines such as:

• Advil/Motrin (ibuprofen)
• Aleve (naproxen)
• Tylenol (acetaminophen)

Mild ear infections may not require antibiotics to clear up. If they do, the most common antibiotic prescribed is amoxicillin.

Mastoiditis

Mastoiditis is an uncommon, but possible cause of pain behind the ear. This is an infection of the mastoid bone, which is behind and below your ear.

It results from untreated or undertreated acute otitis media. It can occur at any age but is most common in children under 2.

Symptoms of Mastoiditis

In adults, symptoms of mastoiditis typically include:

• Severe pain behind the ear
• Fever
• Headache

Symptoms in young children are:

• Acting very sick
• Irritability
• Fever

Children may pull on their affected ear or, if they can talk, complain of ear pain.

Treatments for Mastoiditis

Mastoiditis is a serious infection that requires:

• Intravenous (IV) antibiotics
• Surgical drainage of the infected fluid

Untreated mastoiditis can lead to these serious complications:

• Meningitis
• Intracranial abscess
• Venous sinus blood clot
• Infection of the skull bone
• Hearing loss
• Facial nerve paralysis

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. There, it can become hardened and impacted, causing symptoms like pain behind the ear.

Factors that contribute to earwax impaction include:

• “Ear irritating” behaviors (e.g., regular use of cotton swabs, sticking your finger in your ear canal, or wearing hearing aids)
• Over producing cerumen
• A narrow or twisted ear canal
• Producing cerumen that is drier than usual

Symptoms of Earwax Impaction

If enough cerumen accumulates, symptoms may develop, including:

• Pain behind or within the ear
• A feeling of ear fullness
• Hearing loss
• Itching
• Tinnitus (ringing of the ears)

Treatments of Earwax Impaction

An earwax impaction may call for:

• Earwax-softening drops
• An ear rinse
• Wax removal with a special hooked tool or suction device

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.

Factors that increase your risk of developing otitis externa include:

• Excessive ear-canal cleaning (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)

Symptoms of Otitis Externa

Symptoms include:

• Tenderness of the outer ear, especially when it's tugged on
• Itchiness inside the ear
• Hearing loss
• Ear discharge

Treatments for Otitis Externa

Otitis externa is generally treated with:

• Cleansing the ear
• Antiseptic ear drops
• Pain management

Antibiotics are typically only prescribed if the infection spreads beyond the ear canal or if you're at high risk for further infection.

Ramsay Hunt Syndrome

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

Symptoms of Ramsay Hunt Syndrome

This rare condition is associated with:

• A painful, blistering rash within the ear canal or on the ear’s outer portion
• Sometimes, blisters in the mouth and/or the top part of the throat
• Intense ear pain that may spread to your neck
• Facial paralysis on the affected side
• Tinnitus
• Decreased hearing
• Vertigo
• Nausea and vomiting

Treatments for Ramsay Hunt Syndrome

To treat Ramsay Hunt syndrome, healthcare providers generally prescribe:

• Antiviral medication
• Steroids

Temporomandibular Joint Disorder

The temporomandibular joint (TMJ) is 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.

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
• Genetics

Symptoms of TMJ Disorder

Symptoms of TMJ disorder include:

• Dull pain near the ear on the affected side
• Pain that tends to worsen with chewing or opening and closing the mouth
• 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

Treatments for TMJ Disorder

TMJ treatment often involves a trial and error process. You may be given:

• Pain medicines (e.g., muscle relaxers, nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Aleve)
• Physical therapy
• Stress management
• Avoiding triggers like nail-biting or jaw clenching

Dental Problems

Many dental problems can manifest as pain behind the ear, especially if they're left untreated. Some examples are:

• Tooth decay
• Cavities
• Dental abscesses

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

Symptoms of Dental Problems

Associated symptoms may include:

• Tooth pain or sensitivity
• Swelling in the cheek
• Tender and enlarged lymph nodes ("swollen glands") under the jaw or in the neck

Treatment of Dental Problems

Treating dental problems varies by the specific type of problem. For tooth decay and cavities, it may include fillings. A dental abscess generally requires drainage and antibiotics.

Diagnosing Pain Behind the Ear

Because so many things can cause pain behind the ear, your healthcare provider may need to test you for several things before arriving at the right diagnosis.

Depending on how serious it is, they may refer you to a specialist, such as an:

• Otolaryngologist (ear-nose-throat specialist)
• Neurologist (nerve specialist)
• Pain management doctor
• Dentist

Medical History

The first step in the process is getting your medical history. Your healthcare provider will review your prior and current medical ailments and medications.

Next, they'll try to hone in on the exact nature of your pain. They may ask:

• Where does it hurt?
• 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 having (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.

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 have 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.