Why Do My Ears Hurt?

There are many possible causes of ear pain

There are numerous causes of ear pain. First, differentiate between inner ear pain and outer ear pain. Then, recognizing the other associated symptoms may help you narrow down the cause of your pain.

Ear Pain Causes
Verywell / Gary Ferster

Causes of Inner Ear Pain

Pain inside the ear may be from any of several common conditions.

Otitis Media

Otitis media is the medical term for a middle ear infection. The condition can cause significant ear pain which may get worse when lying down. Otitis media occurs when the auditory tube becomes blocked and is unable to drain. This may occur following a cold or congestion caused by allergies.

Otitis media is more common in children because of the size and angle of their auditory tube but can also occur in adults. Other symptoms of otitis media may include fever, nausea and vomiting, loss of balance, or in severe cases, drainage from the ear. Small children who are unable to talk may become irritable and may touch or pull at their ears.

Mastoiditis

Mastoiditis is an uncommon condition that occurs when a middle ear infection spreads to the mastoid bone. In addition to the symptoms of a middle ear infection symptoms of mastoiditis include redness or swelling behind the ear, headaches, and if the infection progresses long enough, abscesses in the neck.

Foreign Objects

Foreign objects in the ear commonly occur in children. When the object becomes stuck in the ear, pain can occur. If an object is pushed too far inside of the ear it can actually rupture the eardrum.

Auditory Tube Dysfunction

Auditory tube dysfunction is the abnormal opening or closing of the auditory tube. Under normal circumstances, the auditory tube opens and closes in response to changes in atmospheric pressure. This allows the air inside of the middle ear to equalize.

Any condition that causes the auditory tube to become clogged or prevents it from opening and closing can be referred to as auditory tube dysfunction. This can result in pressure and pain in the ear when the atmospheric pressure changes rapidly and the pressure in the middle ear is unable to equalize.

Examples of situations that might cause this are taking off or landing in an airplane, scuba diving, or driving up a steep mountain. In some cases, you may experience ear pain for a moment which then subsides as the pressure in the middle ear stabilizes.

In severe cases, pressure in the middle ear becomes too great and the eardrum may rupture. This is called barotrauma of the ear.

Ruptured Eardrum

Ruptured eardrums can cause severe pain initially. However, the pain may quickly subside after the rupture.

The most common cause of a ruptured eardrum is barotrauma due to auditory tube dysfunction and atmospheric pressure changes. A ruptured eardrum can also be caused by extremely loud noises or trauma when foreign objects such as bobby pins or Q-tips are inserted into the ear.

Besides pain that may last only a short period of time, other symptoms of a ruptured eardrum include sudden hearing loss, dizziness, and drainage from the ear which may be bloody.

Causes of Outer Ear Pain

There are several possible causes of pain felt outside of the ear canal.

Otitis Externa

Otitis externa is the medical term for swimmer's ear. Swimmer's ear is an infection of the outer ear caused by contaminated water. It is common among swimmers but can also occur when the ears do not completely dry out after baths or showers.

Swimmer's ear occurs in both children and adults. In addition to ear pain can result in ear redness, itchy ears, dry flaky skin, drainage from the ear, and fevers.

Ear Trauma

Ear trauma refers to any kind of injury to the outer portion of the ear. This type of injury can commonly occur in certain contact sports such as mixed martial arts, but the risk is reduced if headgear is worn. If an injury becomes infected it can lead to perichondritis.

Perichondritis

Perichondritis is an infection of the cartilage which makes up the outer ear and is usually the result of trauma to the ear from surgery, ear piercing, or accidental injury.  In addition to ear pain, symptoms include redness and swelling. In severe cases, you may experience fever, purulent drainage, or even deformation of the ear.

Referred Ear Pain

Sometimes ear pain results even though the source of the pain is not in the ear but elsewhere in the body. This is especially true since the ears are connected to other parts of the head and neck.

For example, the auditory tube drains into the back of the throat. The ears are also connected to the sinuses, which are connected to the nasal passageways and nasolacrimal duct. Ear pain that is caused by a condition elsewhere in the body is called referred ear pain.

Known causes of referred ear pain include:

Rare Causes of Ear Pain

Some other causes of ear pain which are very rare include:

Diagnosis and Treatment of Ear Pain

An ear pain diagnosis and treatment will depend on what condition is suspected, and the results of any physical exam and tests your healthcare provider orders to identify the reason for why your ears hurt.

Diagnosis

A physical exam typically will begin with questions about your ear pain. Your healthcare provider will want to know when it started and what other symptoms you've experienced, such as whether your ears hurt when you blow your nose or if your ears hurt when you swallow.

They also may ask what (if any) home remedies, over-the-counter (OTC) pain relievers, or other treatments you've already tried. They will consider this information in light of your overall age, health, medical history, and medications you may take.

The exam itself will involve a close look at the outer ear, the inner ear canal, and the eardrum with an otoscope, a special lighted tool for looking inside the ear. Your healthcare provider may also feel for pain or swollen lymph nodes in your neck, and examine your jaw, nose and mouth.

Additional tests won't always be necessary, but some cases may require a referral to an otolaryngologist (ENT specialist) for procedures such as imaging tests or a nasal endoscopy to diagnose more serious conditions beyond an infection or earwax blockage.

Imaging

Imaging may be needed in order to diagnose ear pain. These images may include:

Blood Tests

Blood tests also may be used to help diagnose various ear pain conditions, especially if a severe ear infection may be involved. They can help to rule out other conditions that may contribute to ear pain, such as diabetes.

Treatment

Once the ear pain cause has been diagnosed, treatment will focus on the specific cause. In most cases of ear infection, in both adults and children, that may involve:

  • Over-the-counter (OTC) pain relievers
  • Antibiotic ear drops or other prescription medications
  • Steroid ear drops, or a combination product

Earwax solutions also may be used if your ear pain is caused by a buildup of earwax.

In some cases, ear pain causes may be more serious. For example, ear pain or tinnitus (ringing in the ear) may be a sign of nasopharyngeal cancer. So are ear infections that keep coming back.

Treatment for ear cancer or other more serious ear pain causes may involve surgery, radiation, and therapy drugs.

Self-Care Strategies

Simple, at-home therapies can sometimes go a long way in easing your ear pain, especially if the pain is related to fluid build-up from a virus or allergies.

For instance, in order to ease the congestion of sinusitis, otitis media, or eustachian tube blockage, your healthcare provider may recommend taking an over-the-counter decongestant or using a nasal spray.32

Other self-care strategies that may be helpful include:

  • Hold a warm compress against your ear or sinuses
  • Apply mineral oil or diluted hydrogen peroxide followed by a warm shower to loosen congestion33
  • Yawn or chew gum in order to try "pop" your ears34
  • Drink lots of water (six to eight glasses per day)

Self-care strategies also play an important role in managing TMJ syndrome.35 These strategies include:

  • Performing simple jaw exercises
  • Avoiding triggers of TMJ pain (e.g., chewing gum or grinding your teeth)
  • Using a bite guard when you sleep
  • Engaging in relaxation and stress management techniques

Ear Flushing

Ear flushing is performed by a healthcare professional to remove impacted wax.36 The procedure is also used to remove debris, infected material, and dead skin cells in the treatment of otitis externa.

 Find out the Pros and Cons of Earwax

Medications

Several different medications32 may be used to treat your ear pain:

Ear Drops

Earwax-softening drops may be recommended by your healthcare provider if you have earwax buildup.37

Likewise, ear drops are the primary treatment for external otitis. There are many different types of ear drops available, including antibiotics, acidifying solutions, and steroids. Many of these ear drops work in combination to reduce inflammation, treat the infection, and ease pain.

Oral or Intravenous Antibiotics

Sometimes oral (by mouth) or intravenous (by vein) antibiotics are required to treat more serious causes of ear pain,32 such as:

  • Bacterial sinusitis
  • Severe cases of external otitis, including necrotizing (malignant) external otitis
  • Perichondritis
  • Mastoiditis
  • Periauricular cellulitis

Pain Relievers

To soothe your ear pain, your healthcare provider may recommend over-the-counter Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen).38 For the pain of TMJ syndrome, your healthcare provider may also prescribe a muscle relaxant or a tricyclic antidepressant.

 How to Relieve Ear Pain

Surgery

A surgical procedure called a myringotomy is sometimes needed to treat chronic middle ear infections or persistent eustachian tube dysfunction.39

With a myringotomy, a small hole is made in your eardrum to ease pressure and let the fluid drain. An ear tube may then be placed in the eardrum to allow airflow into the middle ear and to prevent fluid from re-accumulating.

Surgery may also be indicated for other ear pain diagnoses like a tumor, severe mastoiditis, or abscess formation in perichondritis.

 What's Involved in Ear Tube Surgery

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6 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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  2. Pascoto G, Abreu C, Silva ML, Weber R, Pignatari SS, Stamm A. The impact of acute loss of weight on eustachian tube function. Int Arch Otorhinolaryngol. 2014;18(4):376–379. doi:10.1055/s-0034-1382097

  3. Llewellyn A, Norman G, Harden M, et al. Interventions for adult Eustachian tube dysfunction: A systematic review. Southampton (UK): NIHR Journals Library; 2014 Jul. (Health Technology Assessment, No. 18.46.) Chapter 1, Background.

  4. Mayo Clinic. Ruptured eardrum (perforated eardrum).

  5. U.S. National Library of Medicine, MedlinePlus Medical Encyclopedia, "Perichondritis"

  6. American Cancer Society. Signs and Symptoms of Nasopharyngeal Cancer.