Types of Otalgia That Affect Ear Canal, Cartilage, Tissue, and More
Ear pain (otalgia ) can affect the outer ear or middle ear. Also known as an earache, otalgia can be caused by an infection, injury, or blockage in different parts of the ear (primary) or from a sinus, dental, or jaw issue (secondary). Log Tire
For example, ear cartilage pain can be from an injury or infection of the outer ear. Ear canal pain is commonly due to swimmer's ear. Deeper ear pain can be related to an infection, a blockage, or a ruptured ear drum.
How ear pain feels (aching, sharp, dull, etc.), its intensity, location, and other symptoms (e.g., fever, dizziness) can help your healthcare provider diagnose your ear pain. Treatment may include ear drops, oral medications, and at-home treatments to ease the pain.
This article discusses ear pain. It explains the different causes of ear pain and how ear pain is treated.
Primary causes of ear pain originate within the middle ear or outer ear. The following conditions can cause primary ear pain.
Otitis media describes a middle ear infection in which fluid and inflamed tissue build up in the middle ear space—the area between your eardrum (tympanic membrane) and the oval window of your inner ear.
Besides moderate to severe aching pain felt deep in the ear, you may experience several days of nasal congestion and/or a cough preceding the ear pain. Sometimes, a fever may occur.
If the eardrum ruptures as a result of the pressure buildup, purulent (containing pus) ear drainage may result.
External otitis—an infection of the ear canal—causes a feeling of ear fullness, itchiness, and significant ear pain when the earlobe is pulled. Yellowish or clear-colored ear discharge may also occur, along with decreased hearing and swelling of the ear canal.
The reason external otitis is commonly called "swimmer's ear" is that it often develops when water gets trapped in the ear canal.
Another common culprit behind external otitis involves the frequent use of cotton swabs. Inserting them into the ear can create small cuts in the ear canal that serve as a breeding ground for bacteria.
A severe complication of external otitis is necrotizing (malignant) external otitis, in which the ear canal infection spreads to the base of the skull. This condition is more common in older people with diabetes mellitus.
Perichondritis arises from an infection of your ear cartilage, resulting in pain, swelling, and redness over the skin.
A bacterial infection, often caused by Pseudomonas aeruginosa, Staphylococcus aureus, or Streptococcus pyogenes, perichondritis can also cause a fever and an abscess (collection of pus) forms.
Without treatment, perichondritis can lead to ear deformity (called cauliflower ear) as the infection cuts off the blood supply to the cartilage, thereby destroying it. The infection can become quite severe and require hospitalization.
Perichondritis is most likely in people with certain autoimmune conditions, such as granulomatosis with polyangiitis . It can also be caused by trauma to the ear cartilage from an accident, burn, contact sport, or piercings.
Cartilage piercings carry an increased risk of perichondritis due to infection. While it can occur with piercings of the helix (the outer rim) or antihelix (inner ridge), post-piercing perichondritis commonly affects the scapha (flat surface between the helix and antihelix).
Otitis media with effusion (OME) describes the presence of middle ear fluid without signs of infection.
In other words, there is fluid buildup without tissue inflammation. Overall, the ear pain of OME is generally mild and associated with a feeling of ear fullness and/or decreased hearing.
Typically, OME follows acute otitis media, but it may also occur as a result of barotrauma (injury caused by air or water pressure) or allergy.
Rarely, OME occurs as a result of tumor blockage of the eustachian tube—a tunnel that connects the middle ear to the upper throat and back of the nose.
A perforated eardrum is a hole, or tear, in the eardrum.
The eardrum is a delicate structure within the ear and can be torn easily by an injury, a change in pressure, or explosively loud noise. It is also commonly associated with middle ear infections (otitis media).
Aside from sharp ear pain, people who have a perforated eardrum may experience sudden hearing loss, fluid leaking from the ear, or a ringing or buzzing sound in the ear.
The purpose of earwax (cerumen ) is to protect your ear canal from water, bacteria, and injury.
Sometimes though, too much earwax is produced or the wax gets pushed back too deep into the ear canal (which is why healthcare providers recommend not using cotton swabs to clean out your ears).
If an earwax blockage occurs, ear discomfort—often reported as a full or congested sensation—may occur. Problems hearing and ringing in the ear (tinnitus) may also result from earwax blockage.
Removing earwax with cotton swabs, fingers, or other objects can make your ear blockage worse and damage the eardrum.
The eustachian tube is a narrow tunnel that connects your upper throat to your middle ear. It regulates the air pressure in and drains excess fluid from your middle ear.
If the eustachian tube becomes blocked, often as a result of allergy, infection, or a rapid altitude change, the following symptoms may occur:
Sometimes ear pain originates from the skin of the ear.
There are three related conditions:
Cellulitis and perichondritis are both infections that can affect the outer ear. While cellulitis can affect skin anywhere on the body, perichondritis only affects ear cartilage and does not spread to the ear lobe.
Meniere's disease is caused by excess fluid buildup in the inner ear, although the precise reason behind this fluid retention is unknown.
In addition to the classic triad of symptoms—vertigo, ringing in the ears, and hearing loss—some people with Meniere's disease report ear pressure.
Although not common, a cancerous or noncancerous tumor may be the source of a person's ear pain.
For example, nasopharyngeal cancer (a type of head and neck cancer) may cause ear fullness, along with hearing loss, ringing in the ears, and recurrent ear infections.
Two examples of noncancerous tumors or growths that may develop in the ear and cause pain include:
These conditions may cause ear pain, though they originate outside of the ear.
Sinusitis refers to infection or inflammation of the sinuses, which are hollow spaces located behind your nose, between your eyes, and within your cheekbones and lower forehead.
Sinusitis may cause a variety of symptoms, such as:
Most cases of sinusitis are caused by a viral illness or allergy; only a small percentage of cases are due to a bacterial infection.
Dental problems, such as a cracked tooth, decayed tooth, or tooth abscess, may refer pain to the ear. Usually, the pain is worsened by hot or cold stimuli or biting or eating.
The temporomandibular joint (TMJ) connects your lower jaw to the temporal bone of your skull. Arthritis or erosion of the joint or stress/overuse of the surrounding muscles may cause TMJ disorder.
The pain of TMJ disorder is often described as a constant and dull jaw joint pain that worsens with opening or closing the mouth. Headaches and tenderness around the ear canal are also common.
Giant cell arteritis (GCA) refers to inflammation of the branches of the external carotid artery, a large artery located in your neck.
This inflammation may cause pain in the ear canal or outer ear, along with temple and/or forehead pain, fever, fatigue, and a loss of appetite. Vision changes and pain with chewing may also be present.
If a middle ear infection remains untreated, the infection may spread to the mastoid bone—a spongy, air-filled bone that is part of your skull.
A mastoid bone infection (mastoiditis) causes pain, redness, and swelling behind the ear.
If mastoiditis is not recognized and treated promptly, it can lead to complications like a brain or skull bone abscess, meningitis, facial nerve paralysis, or hearing loss.
If you are experiencing ear pain that is worsening, severe, or persisting for two or more days, it's important to seek medical attention.
Other examples of situations that warrant a healthcare provider's attention include:
Diagnosing ear pain often only requires a medical history and physical examination by a primary care provider or an ear, nose, and throat (ENT) specialist.
Imaging and blood tests are less commonly needed.
When you see your healthcare provider for ear pain, expect them to ask several questions related to the details of your pain:
During your physical exam, your healthcare provider will inspect the outer ear, ear canal, and tympanic membrane (eardrum) with an otoscope.
They will also inspect your nose, mouth, and sinuses, press on your TMJ, look at your back molars to check for signs of grinding or frequent clenching of the teeth, and examine your neck to look for enlarged lymph nodes or other masses.
ENTs are able to examine your ear pain and its effects using specific in-office tests:
Imaging is sometimes needed to sort out an ear pain diagnosis:
Blood tests may be used to help diagnose various ear pain conditions.
For instance, if your healthcare provider suspects a severe infection, especially mastoiditis, he may order a white blood cell count and inflammatory marker tests, namely erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Blood tests may also be used to rule out concerns like thyroid disease, diabetes, and syphilis, all of which may have symptoms similar to those of Meniere's.
As there are many different causes of ear pain, there are similarly many possible treatments. The treatment of choice will specifically depend on the root cause of your ear pain.
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:
Self-care strategies also play an important role in managing TMJ syndrome:
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.
Several different medications may be used to treat your ear pain:
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 pain.
Sometimes oral (by mouth) or intravenous (by vein) antibiotics are required to treat more serious causes of ear pain, such as:
Severe infections, like perichondritis and cellulitis, may require IV antibiotics given in the hospital.
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.
A surgical procedure called a myringotomy is sometimes needed to treat chronic middle ear infections or persistent eustachian tube dysfunction.
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.
Here are a few strategies that may help prevent certain ear pain diagnoses:
To prevent external otitis ("swimmer's ear"):
Ear pain can be caused by an infection like otis media. It can also result from trauma, a blockage inside the ear, or from the sinuses, teeth, or jaw.
Ear pain can sometimes be relieved with at-home treatment like a hot or cold compress, OTC pain relievers, and ear drops.
If home remedies do not help and the pain is worsening or persisting for two or more days, see your healthcare provider. Ear pain that is accompanied by a fever, sore throat, discharge, ringing in the ears, dizziness, or hearing loss should be evaluated by a healthcare provider.
Prescription medications and ear drops may be needed to clear up ear infections. Severe infections, like perichondritis, may require hospitalization. In some cases, surgery may be needed to treat the cause of ear pain.
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By Kristin Hayes, RN Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.
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