Ear pain — causes, acute and chronic
Ear pain (otalgia) is one of the most common reasons for visiting an ENT specialist. Although the cause is usually local and easily resolved, there are situations where the pain actually comes from elsewhere in the body — or signals a more serious infection that requires prompt intervention.
What is otalgia
Otalgia is the medical term for pain felt in the ear. We distinguish primary otalgia (pain originating from the ear itself) and secondary / referred otalgia (pain transmitted from another organ — teeth, jaw, throat). Distinguishing the two is key to proper treatment.
The most common causes of ear pain
Otitis externa (inflammation of the external ear canal)
Often called “swimmer’s ear”. Pain worsens when touching the auricle or pulling on the earlobe. The cause is bacterial or fungal infection. Characteristic findings include itching and/or pain, sometimes discharge and swelling. It is more common in summer, after swimming, and in people who clean their ears often or use in-ear headphones.
Otitis media (middle-ear infection)
The most common cause of ear pain in children, but it also affects adults. Pain is internal (not on external touch), often following a cold or nasal inflammation, and may include reduced hearing. Pain typically subsides after the eardrum “pops” and fluid drains.
Earwax (cerumen)
Buildup of earwax can press on the eardrum and cause pain, especially when you try to clean the ear with cotton swabs and only push the wax deeper. It is identified by otomicroscopy and removed in the clinic.
Foreign body in the ear
More common in children. Insects, small beads, seeds. Only a physician should remove them — attempts at home often push the object deeper.
Barotrauma
Pain occurring during a flight, diving, or large changes in altitude. The cause is the Eustachian tube’s inability to equalize pressure. If it happens frequently, an ENT consultation is needed.
Herpes zoster oticus (Ramsay Hunt syndrome)
A viral infection of the ear nerves (caused by the same virus as chickenpox). It starts with severe, burning ear pain, and a few days later blisters appear on the auricle or in the ear canal. It is often accompanied by weakness of one side of the face, and sometimes by hearing loss and vertigo. Treatment works best when started as early as possible, ideally within the first 3 days — so seek care right away.
Necrotizing (malignant) otitis externa
A rare but serious infection that spreads from the ear canal to the skull base. It occurs in people with diabetes, older adults, and people with weakened immunity. Signs include severe pain, especially at night, that does not ease with ear drops, purulent discharge, and changes in the ear canal. It requires urgent workup and treatment.
TMJ dysfunction (temporomandibular joint)
A typical example of referred otalgia. The pain feels “in the ear” but actually comes from the jaw joint. Patients often mention “clicking” when chewing, morning jaw stiffness, and pain when opening the mouth.
Dental problems
Chronic issues with the lower molars or impacted wisdom teeth can refer pain that the patient feels in the ear. It is often discovered only by a careful ENT and dental exam.
Head and neck tumors
Rare but important. Especially in smokers and patients with chronic alcohol use — persistent ear pain without a visible cause in the ear itself should be carefully worked up (endoscopic exam of the throat and larynx).
Ear pain with a normal ear exam
The ear receives nerve branches from several cranial nerves and from the cervical nerves. That is why pain from a completely different part of the head and neck can be felt as ear pain. If the ear itself looks normal, we look for the cause elsewhere:
- Throat — pharyngitis, pain on swallowing that “shoots” to the ear
- Larynx — especially in smokers and with hoarseness
- Teeth and jaw — wisdom teeth, decay in the lower teeth, TMJ
- Cervical spine — pain that worsens with neck movement
In adults, especially smokers, persistent one-sided ear pain with a normal ear exam is a reason for an endoscopic exam of the throat and larynx.
⚠️ When ear pain is an emergency
Go to the ER or an ENT consultation the same day if your ear pain is accompanied by:
- High fever (over 39°C / 102°F)
- Sudden hearing loss
- Bloody or purulent discharge
- Swelling behind the ear (could be mastoiditis)
- Vertigo, facial weakness (possible middle-ear complication)
- Blisters on the auricle or in the ear canal
- Severe pain in a person with diabetes or weakened immunity
- Pain that doesn’t ease with regular analgesics in 24 h
- In a small child — high fever, crying when the ear is touched, pulling at the ear
Ear pain in children
In children, the most common cause is a middle-ear infection, usually a few days after a cold. A small child cannot say that the ear hurts — the signs are irritability, crying when lying down, grabbing or pulling at the ear, poor sleep, refusing food, and fever.
For pain and fever you can give acetaminophen (paracetamol) or ibuprofen dosed by the child’s body weight — you can calculate the syrup dose with our calculators: acetaminophen calculator and ibuprofen calculator. If the child is younger than 6 months, has a high fever, discharge from the ear, or pain lasting more than 2–3 days — see a doctor.
Diagnostics
- Otomicroscopy — magnified examination of the external ear canal and eardrum. Cerumen, inflammation, perforation, and retraction are all clearly visible.
- Audiometry — hearing assessment (many causes of pain also affect hearing).
- Tympanometry — measures middle-ear and Eustachian tube function.
- Endoscopic exam of the throat and larynx — when referred pain or a tumor is suspected.
- Jaw and TMJ exam — when TMJ dysfunction is suspected.
How ear pain is treated
Otitis externa (external ear inflammation)
Topical antibiotic/antifungal with or without corticosteroid, dry-ear regimen, analgesic.
Otitis media (middle-ear inflammation)
Depending on the clinical severity and symptoms.
Cerumen
Otomicroscopic removal under direct view. Painless, short, effective. Never use cotton swabs.
TMJ and referred pain
Cooperation with a dentist / physiatrist. Ear pain will not resolve until the underlying jaw or dental cause is addressed.
💡 What to do at home until your appointment
- A standard analgesic (acetaminophen, ibuprofen) for pain
- A warm compress on the ear can help
- NEVER put anything in the ear (drops, oil, swabs) without ENT advice — this can worsen the situation if the eardrum is perforated
- If you suspect a foreign body — do not try to remove it yourself
- Keep the ear dry
Frequently asked questions
Can I put ear drops in myself?
Not without an exam. If the eardrum is perforated, some drops can damage the middle and inner ear. Exam first, then the drops your doctor prescribes.
Can a tooth or the jaw cause ear pain?
Yes. Wisdom teeth, decay in the lower teeth, and jaw-joint problems are common causes of ear pain in adults. If the ear looks normal on examination, we look for the cause in the jaw, teeth, throat, or neck.
Can I fly or swim when my ear hurts?
With a middle-ear infection or a blocked nose, flying can worsen the pain and cause barotrauma — if you cannot postpone the flight, talk to your doctor. With an external ear infection, keep the ear dry until the inflammation settles, with no swimming.
How long does an external ear infection last?
With proper drop treatment, pain usually eases within 2–3 days, and the inflammation clears in about 7–10 days. If there is no improvement after 2–3 days of treatment, a follow-up visit is needed.
Is ear pain in adults dangerous?
Usually not — the cause is inflammation, earwax, or the jaw. But persistent one-sided pain with a normal ear exam, especially in smokers, should be worked up with an exam of the throat and larynx.
Related topics
👂 Ear & hearing (hub)
🔊 Tinnitus
👶 Pediatric ENT
🧮 Calculators for children
🔍 All symptoms
Ear pain that won’t go away?
An ENT consultation lasts 30–45 minutes. In most cases, we identify the cause immediately and begin treatment the same day.