Why Do My Ears Hurt?

There are numerous causes of ear pain. Most are treatable, and some are serious. If you begin to develop ear pain, it's important to see a healthcare provider, who can talk to you about your symptoms and risk factors and examine your ears to identify the cause of your ear pain.

Causes of Ear Pain

Ear pain can affect the pinna, the ear canal, or the middle ear.

Otitis Media

Otitis media is the medical term for a middle ear infection. Otitis media is more common in children because of the size and angle of their auditory tubes, but it can also occur in adults.

The condition can cause significant ear pain, which may get worse when lying down. 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.

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.

Foreign Objects

When an object becomes stuck in the ear, pain can occur. This most often occurs when children place an object inside their ears. 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.

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.

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, it can cause 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 injuries or conditions that affect areas near the ears can cause ear pain. Ear pain that is caused by a condition elsewhere in the body can be described as referred pain if the injury or infection has not spread to the ear.

Rare Causes of Ear Pain

Some rare causes of ear pain include:

• Bell's palsy
• Cervical adenopathy
• Cricoarytenoid arthritis
• Eagle's syndrome
• Gastroesophageal reflux disease (GERD)
• Granulomatosis with polyangiitis
• Malignant otitis externa
• Myofascial pain
• Neuralgias
• Oral aphthous ulcers
• Ramsay Hunt syndrome
• Salivary gland disorders
• Spasms of the muscles involved in chewing
• Temporal arteritis
• Thyroid gland disorders
• Tumors
• Viral meningitis
• Mastoiditis
  

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 will need to know about any home remedies, over-the-counter (OTC) pain relievers, or other treatments you've already tried.

Your physical exam 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.

Imaging

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

• An X-ray 
• A computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

Imaging tests can often identify issues like a dental problem, an infection, or a tumor.

Blood Tests

Blood tests are not commonly helpful in diagnosing ear pain, but they may be used to help diagnose some ear pain conditions, especially if a severe infection may be involved.

Treatment

Treatment of ear pain 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.

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 congestion
• Yawn or chew gum in order to try "pop" your ears
• Drink lots of water (six to eight glasses per day)

Self-care strategies also play an important role in managing TMJ syndrome. 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. The procedure is also used to remove debris, infected material, and dead skin cells in the treatment of otitis externa.

Medications

Several different medications 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.

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 the pain.

Oral or Intravenous Antibiotics

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

• Bacterial sinusitis
• Severe cases of external otitis, including necrotizing (malignant) external otitis
• Perichondritis
• 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). For the pain of TMJ syndrome, your healthcare provider may also prescribe a muscle relaxant or a tricyclic antidepressant.

Surgery

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

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.