Ear pain can be uncomfortable and scary, especially because it’s not exactly something you can examine yourself in the mirror. And when it happens, you probably find yourself wondering: Why does my ear hurt? While you’re not alone in imagining the worst, most ear pain is treatable, won’t permanently affect your hearing, and may not even stem from the ear in the first place, says ear, nose, and throat (ENT) doctor Dr. Zan Mra, MD, an assistant professor at Mount Sinai Hospital: “There are other reasons why you may feel pain in the area,” he says. Pain that does originate in the ear typically stems from the outer or middle ear; the inner ear, which holds nerves that contribute to hearing and balance, is rarely the culprit, says Dr. Mra, who explains that ringing, loss of hearing, vertigo, or dizziness are symptoms of an inner ear issue. But back to ear pain: Here’s what you should know about it.
Why does my ear hurt?
Ear pain isn’t always easy for non-specialists to diagnose, Dr. Mra says. After all, symptoms that affect the ears, which are connected to the nose and throat and situated near the jaw, can be nuanced or even red herrings. Here are some of the most common reasons why your ears might be hurting.
Cerumen impaction
To clean your ears or not to clean your ears, that is the age-old question. Dr. Mra (and most ear, nose, and throat doctors) agree that the ear canal is meant to make cerumen, more commonly known as earwax; the stuff has protective qualities and is best left alone. Attempts to clear such wax can backfire quite literally since going to town with a Q-tip can push wax further into the ear and slough off skin, stuffing both substances into the tight space at the end of the ear canal. “In some cases, this can hurt enough to send a patient to the emergency room,” Dr. Mra warns. “But once residue is wedged in deep enough to cause pain, there’s not much a primary care physician can do to remove it.” An ENT doctor can prescribe special drops or manually remove the build-up without injuring the ear, but your best bet is to avoid such pain in the first place by stepping away from the cotton swabs.
Temporomandibular joint (TMJ) syndrome
In some cases, ear pain stems not from the ear, but from the TMJ, the joint that enables movement in the jaw: “You can feel it near the ear canal when you open your mouth,” says Dr. Mra of its proximity. In some people, the TMJ can click or grind, causing wear and tear and pain that radiates throughout the area. That’s not to say the pain you feel in your ears doesn’t feel very real. “Explain to a patient that there is no wax or infection in the ear, and they just don’t believe you,” Dr. Mra says. The first line of defense is to rest the joint; a bite plate can help. Otherwise, you’d be better off visiting a dentist or an oral surgeon than an ENT doctor for relief.
Otitis externa
Believed to be caused by believed to be caused by a bacterial infection triggered by pH disruption, otitis externa involves inflammation of the external auditory canal, or the area one might access with a Q-tip (tsk, tsk!). Swimming, humidity, trauma from earplugs, hearing aids, or cotton swabs, and eczema or psoriasis can all increase the risk of infection, as can narrow external ear canals, cerumen obstruction, radiotherapy or chemotherapy, and stress, particularly among immunocompromised patients. Topical antibiotic treatment in the form of drops can help reduce swelling and things up.
Fungus infection
Another potential reason why your ear(s) might be hurting is a fungal infection, which presents as little black dots inside the external auditory canal, Dr. Mra says. “It burns a little more than a bacterial infection and itches a lot,” he notes. Antifungal drops can typically address the issue, which plagues people who are immunocompromised, have diabetes, or are on steroids—particularly following bacterial infections.
Otitis media
Most common in children, this middle ear infection involves inflammation of the tympanic membrane (aka eardrum) due to a bacterial or viral infection that travels through the bloodstream. Ear pain may be accompanied by fever and hearing loss, which typically can be reversed, Dr. Mra says. Viral infections may go away on their own while bacterial infections require antibiotics. Particularly among children with recurrent cases, some ENTs may recommend surgical insertion of ventilation tubes or removal of the adenoid tissue above the roof of the month, since infection can enlarge the area and contribute to uncomfortable inflammation.
Ear pressure
While you might not even know you have a Eustachian tube, this small passageway connects the back of the nose and sinuses to the middle ear to equalize pressure in your ears; it’s particularly helpful when you fly. When the Eustachian tube’s muscle gets inflamed or malfunctions, you might experience a build-up of pressure that can suck in the eardrum and cause pain for some patients, says Dr. Mra. Decongestants or steroid nasal spray can help.
Referred pain
Sometimes, ear pain doesn’t stem from the ear at all: Thanks to a variety of shared nerves that line the ear canal, a toothache or throat soreness can send patients to their doctors complaining of chronic ear pain. “It’s important to see an ENT doctor if other doctors can’t diagnose where the pain is coming from,” Dr. Mra says. After all, they are trained to look for rare “hidden” triggers like cancer in the back of the throat or tongue, he explains.
Sinus congestion
The sinus pressure you feel when you get a cold or sinus infection can also cause pressure to build up in the ear, says Dr. Mra, explaining that this sensation can sometimes be interpreted as pain. In some cases, the virus you’re suffering from can travel from the back of the nose to the ear, where it can cause an infection, he adds. But not to worry: This pressure should clear up naturally as soon as your cold or infection goes away.
When to see a doctor
If you’ve experienced ear pain in conjunction with a fever or facial pain that doesn’t go away after three days, see a doctor, says Dr. Mra. You can begin with your primary care physician or urgent care, who can refer you to a specialist for treatment if necessary. Next up: 7 Things Your Doctor Wants You to Know
Sources
Dr. Zan Mra, MD, ear, nose, and throat (ENT) doctor and assistant professor at Mount Sinai HospitalOtis Externa. StatPearls.Otitis media. Nature Public Health Emergency Collection.Otalgia. StatPearls. Enlarged Tonsils and Adenoids. Boston Children’s Hospital.
