What Causes Pain Behind the Ear?

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While it’s natural to think that “pain behind your ear” must be related to a problem within your ear, like an infection, this is not always the case. Your ear shares its nerve supply with several structures in your head and neck. Ailments like jaw joint inflammation, dental infection, or nerve-related headache may be the culprits producing pain.

When evaluating pain behind your ear—sometimes also described as a “headache behind my 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.

What Is This Sharp Pain Behind My Ear?

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Symptoms

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

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

Besides primary ear pathologies, 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, depending on the diagnosis, such as:

Seek Emergency Medical Attention

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

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

Diagnosis

In the absence of the above “alarm” symptoms, making an appointment with your primary care physician is a reasonable first step if you are 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 alternative ones.

Medical History

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

Example questions may include:

  • 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 vitals (temperature, heart rate, blood pressure), the doctor will examine the muscles/bones/tissues/nerves/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 dental malocclusion or signs of bruxism
  • 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 won’t confirm a diagnosis, but they can help your doctor put all of the pieces of the diagnostic puzzle together.

As an example, a high white blood cell count on a complete blood count (CBC) suggests an infection. Likewise, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) suggests that an infection or inflammatory process 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) 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 the muscle, respectively. 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 not an exhaustive list, here are some of the key diagnoses your doctor will consider.

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 (connecting the outside of your ear to your eardrum) becomes inflamed. Symptoms include tenderness of the outer ear especially when it is tugged on, itchiness of the ear, and hearing loss. Patients with otitis externa may also notice ear discharge.

Otitis externa can manifest as a result of an infection, allergy, or a chronic skin condition.

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 Q-tip)
  • Regularly swimming (allows bacteria that normally live in the ear canal to enter the skin)
  • Wearing devices in your ear (e.g., earplugs or hearing aids)

Foreign Objects

Foreign objects in the ear (e.g., insects, small toys, or peanuts) may cause otitis externa or symptoms of otitis externa without infection. This phenomenon occurs more commonly in young children.

Earwax Impaction

Cerumen, known as earwax, 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 earwax “clearing” process is compromised, cerumen can accumulate deep within the ear canal.

Factors that contribute to earwax impaction include:

  • Engaging in possible “ear irritating” behaviors, like using Q-tips regularly, sticking your finger in your ear canal, or wearing hearing aids
  • Being an overproducer of the waxy substance
  • Having a narrow or twisted ear canal
  • Producing “drier” than usual cerumen

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

Dental Problems

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

Interestingly, 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 the 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:

  • 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
  • Eye, neck, arm, or back discomfort

Several factors may contribute to the manifestation of a TMJ disorder, including arthritis or injury of the TMJ joint, chronic grinding of the teeth, dental malocclusion, 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.

Besides back of the head/neck/ear pain, other potential symptoms of occipital neuralgia include:

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

The culprit behind occipital neuralgia has not been fully teased out. 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 entrapment 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, and 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.

For example, infections like 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.

With earwax impaction, your doctor may recommend using special earwax-softening drops, or they may rinse out your ear. Sometimes, a special tool that has a hook or suction device is used to remove the wax.

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.

Lastly, occipital neuralgia may be treated with a combination of heat, pain medicine, and a nerve block, often performed by a neurologist or pain specialist.

Frequently Asked Questions

Are There Lymph Nodes Behind the Ears?

Yes, there are lymph nodes behind your ear; they’re known as postauricular lymph nodes. They most commonly become swollen or enlarged when a person has a bacterial or fungal infection of the scalp, such as tinea capitis, also known as scalp ringworm.

Why Is the Bone Behind My Ear Sore?

The bone behind your ear is called the mastoid bone, which is part of your skull. If this bone becomes painful and red, you may have a very serious infection called mastoiditis.

Mastoiditis is more common in children but can occur in adults and is usually caused by an untreated middle ear infection. Other symptoms of mastoiditis may include high fever, headache, and swelling behind the ear, causing it to stick out.

If you think you have mastoiditis, go to the nearest emergency room. This infection requires immediate treatment with intravenous antibiotics.

What Does a Pain Behind the Ear Mean? 

Pain behind your ear can mean one of several things. Perhaps you have an infection in or around your ear, nerve inflammation within your scalp, or a tooth or jaw joint problem.

The large range of possible diagnoses is due to the fact that your ear is in close proximity to many other structures within your head and neck. In the end, seeing a healthcare professional for a diagnosis will get you to the bottom of your pain the quickest.

How Do I Stop Pain Behind My Ear?

Your first step is to see a healthcare professional for a proper medical evaluation. Once a diagnosis is made, you can move forward with a treatment plan for alleviating your pain and addressing the underlying problem.

As an example, in addition to recommending pain medication, your doctor may prescribe an antibiotic for an ear infection or refer you to a dentist for a suspected tooth problem.

Summary

Pain behind the ear can have many possible causes. These include ear infections, impacted earwax, dental problems, jaw problems, and nerve problems. A healthcare professional can get to the bottom of your pain with a focused 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 and allow you to move forward with a treatment plan and feeling well again.

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11 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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