Ear pain or otalgia may be caused by factors directly related to the ear, also called primary otalgia or may be referred from outside of the ear, also termed referred otalgia. So, not all ear pain is directly related to ear pain. Conditions that may cause ear pain outside of the ear include a strep throat or tonsillitis, an abscess in the throat (peritonsillar abscess), pain from a tooth (dental pain), pain from the lower jaw joint or TMJ (temporomandibular joint), sinus infection, trigeminal neuralgia, migraine headaches, tension headaches and inflammation of an artery in front of the ear also called temporal arteritis.
So, how does one differentiate between all these different types of pain.
When it comes to primary otalgia or ear pain related to the ear parts, the pain can emanate from either the outer or middle ear. Rarely, do problems with the inner ear present as ear pain although certain conditions may.
The outer ear may cause pain if something is stuck in the outer ear canal like wax, a foreign body, an insect or even your own hair. Otherwise, pain from an infection of the outer ear also called otitis externa is usually accompanied by other symptoms like itching, clogging, fullness of the ear and is related to swimming or over cleaning of the ear with q-tips or other objects. There may be discharge and flakiness or swelling of the skin in the entrance into the ear canal. This pain normally begins with an itch and slowly progresses to severe pain. The stereotypical finding with an outer ear infection is tenderness when touching the ear lobe specifically the tragus, a small tab like portion of the ear that projects out just in front of the ear canal opening. This ear pain should prompt a visit to your ENT specialist because is some cases, medication is not enough. If the ear canal is swollen shut, it is necessary to insert a small spongelike wick that allows the antibiotic ear drops to effectively reduce the infection.
Middle ear pain is most commonly caused when desceding in on an airline flight when the air pressure increases as the airplace goes down. If the pressure in the middle ear is not equalized naturally, by yawning, chewing gum, swallowing or even trying to pop the ears, slight temporary damage to the lining of the middle ear may cause continuing pressure or pain in ear for another few hours to days. Inflammation of the middle ear or otitis media is another cause of ear pain that is usually accompanied by clogging or an under water sensation. Occasionally when an ear infection develops infected mucous or pus, the era drum cannot tolerate the excess volume which will create a tear or perforation in the ear drum. In this case, the pain will usually increase to severe pain and immediately result in some relief as some discharge is seen coming out of the ear (the mucous or pus).
Chronic middle ear infections or infections of the mastoid bone that contains the inner ear can also cause ear pain. This is usually a dull ache for as long as the inflammation is in place.
Fractures of the bone containing the components of the ear (the mastoid bone) can cause lingering sharp to dull pain. These fractures are usually the result of a more severe trauma such as seen in automotive accidents. They may be accompanied by hearing loss, bleeding from the ear or dizziness.
Referred ear pain, or referred otalgia, can originate from several nerves that supply the ear. Pain coming from an irritation of the trigeminal nerve that gives sensation to the face and scalp is called trigeminal neuralgia. This pain is is normally very sharp with electric-like spasms that lasts for several seconds to minutes but may be constant. The pain may be triggered by touch or sounds.
Any pain originating from the upper molar teeth (wisdom teeth) can cause an ear ache that can be sharp and continuous if the teeth are inflamed or a shorter burst for up to a minute when drinking a cold liquid.
Ear aches may arise in the TMJ, the joint of the lower jaw which articulates with the base of the skull right next to the ear canal. Grinding your teeth, clenching the jaw or frequent gum chewing may lead to an inflammation or irritation of the join capsule that creates a sharp pain typically related to opening and closing the mouth or moving the jaw left and right. The pain can be easily elicited by pressing behind the ear lobe into the space that opens when the mouth is wide open (the TMJ space).
Another structure in the vicinity of the ear that can occasionally cause ear pain is a major salivary gland called the parotid gland. The parotid gland can become inflamed and cause ear pain that is typically associated with swelling in the side of the face or under the ear with tenderness to the touch over the angle of the lower jaw. This is called parotitis.
Inflammation, irritation and growths of the nose and sinuses, back part of the nose, called the nasopharynx and the throat all can cause ear pain. Pain related to these parts of the anatomy may be worst with swallowing or snorting.
Less commonly, ear pain may be cause by cancerous growths in the throat or in the esophagus.
Finally, pain in the ear may also arise the vertebrae in the neck, also called cervical neck pain.
If you are experiencing ear pain, please call our office to evaluate the source of your pain.