Ear pain or discomfort in one or both ears is common and usually not a cause for concern. However, persistent or severe ear pain that does not go away could signify an underlying condition that needs medical attention. This article will examine the common causes of inner ear pain, when it may indicate a problem, and when to see a doctor.
What causes pain inside the ear?
There are various reasons why the inside of your ear may hurt, including:
- Ear infection – One of the most common causes of inner ear pain is an ear infection, also known as otitis media. This occurs when fluid builds up in the middle ear, often due to congestion and swelling from a cold, flu, or upper respiratory infection. The pressure on the eardrum can cause an aching, throbbing sensation.
- Swimmer’s ear – Also known as otitis externa, swimmer’s ear is an infection or inflammation of the outer ear canal, which connects the outside of the ear to the eardrum. This can cause severe ear pain that worsens when pulling on the outer ear.
- Earwax blockage – A buildup of excessive or impacted earwax can press against the eardrum and inner ear, leading to mild pain and discomfort. Using cotton swabs to clean the ears can push earwax deeper inside.
- TMJ disorders – Problems with the temporomandibular joint (TMJ), which connects the jawbone to the skull, can sometimes radiate pain to the inner ear area.
- Foreign object – Objects that accidentally get lodged in the ear, such as insects, can cause inner ear pain. Attempting to remove the object at home could make matters worse.
- Pressure changes – Air travel, scuba diving, or rapid altitude changes can lead to unequal pressure inside the ear, resulting in dull ear pain known as barotrauma.
- Throat infections – In some cases, throat infections like strep throat or tonsillitis can radiate pain into the ears.
When is ear pain serious?
In most cases, minor ear discomfort resolves on its own or can be managed with over-the-counter pain medication and home treatment. However, you should contact your doctor if you experience:
- Severe, worsening, or persistent pain
- Sudden sharp pain or a feeling that your ear has “popped”
- Pus or fluid draining from the ear
- Hearing loss or ringing in the affected ear
- Dizziness, vertigo, or loss of balance
- Facial weakness or numbness
- Vision changes
- Fever along with ear pain or fluid from the ear
These symptoms could indicate a more serious problem, like a middle or inner ear infection, perforated eardrum, cholesteatoma growth, or nerve issue. Infection can spread from the ear to the brain in rare cases, requiring emergency medical care.
Causes of Inner Ear Pain
Let’s look at the most common causes of inner ear pain and discomfort:
Ear Infections
Ear infections are a frequent reason for earaches. An ear infection occurs when fluid builds up in the middle ear — the space right behind the eardrum. This buildup of fluid presses on the eardrum, causing pain.
Ear infections often arise from congestion, swelling and mucus buildup due to colds, flu, upper respiratory infections, or allergies. They are more common in infants and children, as their eustachian tubes are narrower and more easily clogged.
Some symptoms of an ear infection include:
- Throbbing, aching pain that comes on gradually
- Feeling of fullness or pressure in the ear
- Mild hearing loss
- Fever
- Drainage of fluid or pus from the ear
- Coughing, nasal congestion, or sore throat
- Trouble sleeping
- Loss of balance
- Vomiting or diarrhea in children
Ear infections often clear up on their own, but antibiotics may be prescribed if symptoms persist or worsen. Pain relievers like ibuprofen or acetaminophen can help ease aches and fever.
Swimmer’s Ear (Otitis Externa)
An infection or inflammation of the outer ear canal, swimmer’s ear causes severe ear pain that worsens when pulling on the outer ear. It’s often caused when water gets trapped in the ear after swimming or bathing, but excessive cleaning and irritation can also lead to swimmer’s ear.
Symptoms of swimmer’s ear include:
- Severe, persistent ear pain that gets worse when touching or pulling on the outer ear
- Itching in the ear canal
- Discharge of fluid or pus from the ear
- Feeling of fullness or blockage in the ear
- Muffled hearing
To treat swimmer’s ear, doctors may prescribe eardrops to fight infection and reduce swelling. Keeping the ears dry and avoiding irritation of the ear canal can help prevent further infection.
Earwax Blockage
Earwax (cerumen) serves to lubricate and protect the ear canal from damage and infection. In normal amounts, earwax naturally drains and exits the ear.
However, some people produce excessive earwax, which can harden and press against the eardrum, leading to blockage and pain. Using cotton swabs to try removing earwax can actually push the wax farther into the ear and worsen blockages.
Symptoms of impacted earwax may include:
- Feeling like the ear is plugged or full
- Partial hearing loss and ear discomfort
- Ringing in the ear (tinnitus)
- Itching, odor, or discharge from the ear
- Dizziness
- Coughing spasms when touching or pressing on the ear
To safely remove excess earwax, doctors can flush the ear canal with water or use suction to gently draw out the wax plugs. Over-the-counter earwax removal drops can help soften excess wax for irrigation.
TMJ Disorders
Temporomandibular joint and muscle disorders (TMJ or TMD) cause pain in the jaw joint and surrounding muscles. TMJ conditions can arise from jaw injury, teeth grinding, misalignment, arthritis, or tension and stress.
TMJ pain and dysfunction sometimes radiates to the ear area on the affected joint side. Some TMJ symptoms include:
- Dull aching pain in front of the ear
- Soreness or clicking when opening the mouth wide
- Pain or stiffness of the jaw muscles
- Difficulty opening the mouth fully
- Headaches or neck pain
Treatment focuses on addressing the root TMJ problem through bite realignment, physical therapy, anti-inflammatory medications, stress management, and sometimes surgery.
Foreign Object in Ear
Sometimes an insect, small toy or bead, or other foreign object can become lodged in the ear canal. Attempting to dig out the object can scratch the ear canal and worsen the problem. A foreign body pressing against the eardrum causes significant pain.
If an object becomes stuck in the ear, it’s important not to stick anything else in the ear in an attempt to try removing it. See a doctor, who can properly remove the object and check for any injury using specialized tools and magnification.
Pressure Changes
Sudden changes in air pressure can cause uncomfortable “popping” and pain in the ears. This occurs when the air pressure outside does not equal the pressure inside the ear.
Causes of pressure mismatches include:
- Airplane travel – The air pressure changes as a plane ascends and descends during a flight.
- Scuba diving – The surrounding water pressure increases the deeper one dives.
- Rapid altitude changes – When driving through mountains or riding elevators in skyscrapers.
Swallowing, chewing gum, yawning, or using nasal decongestant sprays can help equalize pressure between the middle ear and environment. Children are especially prone to airplane ear pain and may benefit from nasal decongestant drops before take-off and landing.
Throat Infections
Infections like strep throat and tonsillitis can sometimes refer pain to the ears. This occurs because throat nerves are located close to those of the ear. Especially with strep throat, the inner ear pain often affects only one side.
Other symptoms suggestive of a throat infection include:
- Pain or trouble swallowing
- Fever
- Swollen red tonsils
- White patches on the tonsils
- Swollen lymph nodes in the neck
- Sore throat
Treating the underlying throat infection with antibiotics provides relief from the associated ear pain.
When to See a Doctor
Schedule an appointment with your doctor if:
- Ear pain is severe or persistent
- You experience sudden, intense ear pain that seems different from past earaches
- Other worrying symptoms accompany the ear pain like high fever, trouble hearing, or fluid drainage from the ear
- Pain, numbness, or paralysis on one side of the face
- You have vision changes along with the ear pain
- Home treatment and over-the-counter pain medication do not relieve the discomfort
Seeking prompt medical care is crucial if your ear pain is accompanied by symptoms like a severe headache, mental confusion, difficulty speaking, loss of coordination, or seizure. These can indicate a serious problem like meningitis where infection spreads to the brain.
Chronic ear pain without any clear cause also merits an evaluation by an otolaryngologist (ENT doctor). People at increased risk for ear trouble who require timely assessment and treatment include those with:
- A weakened immune system
- Diabetes mellitus
- History of ear surgery or trauma
- Cochlear implant devices
Let your doctor know if ear pain persists after a course of treatment for an infection. This may signal a complicated or chronic infection or an unrelated issue like nerve damage or arthritis.
Is Ear Pain Serious?
While ear discomfort is rarely a medical emergency, severe or persistent inner ear pain should not be ignored. Here are some key points on when to seek urgent care:
- Sudden, severe throbbing pain indicates an acute ear infection that may require antibiotics. Drainage of blood or pus from the ear signals a possible ruptured eardrum.
- Intense pain that starts after an upper respiratory infection can mean an ear infection has spread to surrounding bones and tissues, requiring prompt treatment.
- Immunocompromised individuals are at risk for dangerous inner ear infections that can quickly advance.
- Headache and vertigo accompanying inner ear pain can be tied to inflammation around the brain, which needs rapid medical intervention.
- Facial weakness, drooping, numbness, or vision changes with ear pain can indicate a brain abscess or nerve damage.
Though rare, ear infections improperly treated can spread and cause sepsis, meningitis, hearing loss, dizziness, or brain abscesses. People with diabetes or immune system disorders are especially vulnerable to complications if ear infections are left unchecked.
Emergency Ear Infection Symptoms
Seek emergency care if ear pain is accompanied by:
- High fever with confusion or disorientation
- Sudden severe headache
- Seizures
- Trouble standing or walking
- Speech difficulties
- Vision trouble, light sensitivity, bulging eyes
These indicate emergency issues like meningitis, encephalitis, brain abscess, or mastoiditis. Chronic ear drainage or infections can damage the bones and nerves around the ears. Immunocompromised people, infants, elderly adults, and those with diabetes have increased risk of complications.
Home Treatment for Inner Ear Pain
For temporary mild ear discomfort from an infection or injury, some home care steps may provide relief:
- Over-the-counter pain medication like ibuprofen, naproxen, or acetaminophen
- Applying a warm (not hot) compress against the ear
- Using OTC nasal spray for congestion and pressure relief
- Avoiding sleep or rest with the affected ear down
- Gently massaging the outer ear and area around it
- Using a humidifier to moisten thick mucus
- Drinking plenty of water and warm fluids
- Saltwater nasal rinses to clear mucus
Do NOT attempt to remove discharge, scratch inside the ear, or put cotton swabs or other objects in the ear canal. This can worsen swelling and damage the sensitive eardrum. Avoid potential irritants like loud noises, smoky rooms, alcohol, and flying until the ear pain subsides.
Preventing Future Ear Pain
While occasional earaches are hard to prevent completely, some healthy habits make them less likely to occur:
- Get regular hearing evaluations to spot underlying infections or blockages
- Treat sinus congestion, colds, and allergies promptly to prevent ear infection spread
- Avoid swabbing inside the ear with cotton swabs or other objects
- Use earplugs and protective muffs when swimming or around loud machinery
- Quit cigarette smoking, which increases ear infection risk
- Manage health conditions like diabetes, TMJ, and immune deficiencies
- Use medication as prescribed following an ear infection to prevent recurrence
See your doctor at the first signs of an ear infection like fluid buildup and pain. Prompt antibiotic treatment can often clear up an ear infection before complications set in.
Conclusion
Moderate inner ear discomfort is common and typically resolves on its own or with simple home treatment. However, severe, persistent, or worsening ear pain should be evaluated by a doctor.
Seek urgent medical care if sudden symptoms like high fever, head pain, balance issues, or vision changes accompany the ear pain. This indicates a potential medical emergency like meningitis. While rare, complications from untreated infections can have permanent effects like deafness, facial muscle paralysis, or brain damage in severe cases.
Catching ear infections early, properly treating upper respiratory illness and allergies, and avoiding potential irritants to the ears can help prevent many cases of inner earaches. With appropriate medical care, most causes of inner ear pain can be managed without any long-lasting problems.