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.
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 hearing loss. 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.
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).
⚠️ 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)
- 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
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
Related topics
👂 Ear & hearing (hub)
🔊 Tinnitus
👶 Pediatric ENT
🔍 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.