Possible Causes of an Earache

There are many causes of an earache. This article talks about some of the common reasons you or your child might be suffering from ear pain. If you are unsure what is causing your earache and if ear pain doesn't subside in a couple of days, it's always best to see your healthcare provider for proper diagnosis and treatment.

Man holding his hand against his ear
IAN HOOTON / SPL / Getty Images

Middle Ear Infections

Earaches are often caused by a middle ear infection, especially in small children. It may be difficult to tell if a small child's earache is a result of an ear infection. While it is more common for a middle ear infection to be present in a child, some people do develop adult ear infections. Middle ear infections are usually caused by the eustachian tube not draining properly. Mucous and bacteria trapped inside the space behind the ear drum begin to thrive and cause an infection and fluid. Middle ear infections are often preceded by the common cold.

Symptoms of a middle ear infection may include:

  • ear pain (most common symptom)
  • infants and small children may pull or tug at their ears
  • pain might get worse at night or first thing in the morning after lying down for a period of time
  • pressure in the ears
  • hearing loss
  • fever
  • dizziness or loss of balance
  • drainage from the ears

Swimmer's Ear

This condition is aptly named because it sometimes occurs in swimmers. It is caused when water that has bacteria or other germs in it becomes trapped in the outer part of the ear. Characteristics of this infection include a red outer ear which may be dry and flaky. The ear might also itch and be painful. Swimmer's ear is commonly treated with antibiotic ear drops. If left untreated it can lead to a more serious condition called malignant otitis externa.

Fluid in the Ear

Fluid in the ear is a fairly common condition that can be present with or without an earache. In fact, fluid in the ear often goes undiagnosed (particularly in small children) because it has no symptoms at all. However, in some people the condition can be very symptomatic causing discomfort and even developmental delays (in kids). Fluid in the ear can be caused by an ear infection or a blockage of the auditory tube. It's often the result of a cold virus or allergies. In many small children it occurs because of the anatomy of their small auditory tubes. It sometimes has to be treated with the surgical placement of ear tubes (also called ventilation tubes).


This earache is caused by drastic changes in the atmospheric pressure, such as occurs when flying in an airplane or driving up a steep hill. You may experience severe pressure in your ears and they may feel like they need to "pop". This condition is also fairly common among scuba divers and sometimes results in a ruptured eardrum.

Ruptured Eardrum

This condition can be caused by any of the above conditions and also as a result of very loud noise such as a gunshot. Symptoms of an eardrum may include:

  • severe pain, which may suddenly subside
  • ear drainage
  • sudden hearing loss
  • dizziness

A ruptured eardrum will usually heal on its own but in severe cases may need to be surgically repaired.


Perichondritis is a less common cause of an earache which usually occurs as a result of trauma to the cartilage of the ear. It can be a result of ear piercing or trauma from contact sports such as boxing. There is also an autoimmune condition called relapsing polychondritis where the immune system attacks the cartilage of the ear.

7 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.
  1. Institute for Quality and Efficiency in Health Care (IQWiG). Middle ear infection: Overview. InformedHealth.org [Internet].

  2. Wade TJ, Sams EA, Beach MJ, Collier SA, Dufour AP. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort studyEnviron Health. 2013;12:67. doi:10.1186/1476-069X-12-67

  3. Karaman E, Yilmaz M, Ibrahimov M, Haciyev Y, Enver O. Malignant otitis externa. J Craniofac Surg. 2012;23(6):1748-51.

  4. Fluid in the ear (Middle Ear Effusion). Texas Children's Hospital [internet].

  5. Sogebi OA, Oyewole EA, Mabifah TO. Traumatic tympanic membrane perforations: characteristics and factors affecting outcomeGhana Med J. 2018;52(1):34–40. doi:10.4314/gmj.v52i1.7

  6. Lucerna A, Espinosa J. Acute atraumatic pinna (auricular) perichondritis. World J Emerg Med. 2018;9(2):152–153. doi:10.5847/wjem.j.1920-8642.2018.02.013

  7. Borgia F, Giuffrida R, Guarneri F, Cannavò SP. Relapsing Polychondritis: An Updated ReviewBiomedicines. 2018;6(3):84. doi:10.3390/biomedicines6030084

Additional Reading
  • Centers for Disease Control and Prevention ."Swimmer's Ear" (Otitis Externa).

  • MedlinePlus. Ear Infections.

  • Medline Plus. Otitis Media with Effusion.

  • Medline Plus. Perichondritis.

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.