Pain in the ears can be caused by a number of different problems. I see a lot of patients with ear pain who are convinced that they are having ear infections. Sometimes they have received several rounds of antibiotics with no help. Ear infections and problems inside the ear can certainly cause earache, but there are many other problems away from the ear that can cause referred pain to the ear.
Causes of earache:
A. Problems inside the ear:
1. Middle ear infection (otitis media). Caused by fluid buildup behind the eardrum which becomes infected. Will ALWAYS have associated muffled hearing because the fluid limits the normal transmission of sound to the inner ear.
2. Outer ear infection (otitis externa, a.k.a. “swimmers ear”). An infection outside the ear drum within the ear canal. Can be triggered by water that gets in the ear from swimming or bathing. Usually patients will notice drainage from the ear but not always. There is usually pain with manipulation of the ear.
3. Ear wax impaction can sometimes cause pain.
4. Eustachian tube dysfunction. Caused by blockage of the Eustachian tube between the middle ear and the back of the nasal cavity (usually due to allergy or upper respiratory infection). This causes the pressure behind the eardrum to become different from the atmosphere around you. This sometimes can lead to otitis media if fluid builds up behind the ear drum.
B. Problems in areas next to the ear:
1. TMJ pain (temporomandibular joint pain). Caused by arthritis or stress in the jaw joint which sits directly in front of the ear. This is very common.
2. Muscle pain: usually in the chewing muscles, the sternocleidomastoid muscle (below the ear), or the temporalis muscle (above the ear).
C. Problems in areas remote from the ear. All of these are due to referred nerve pain from other areas:
1. Tonsillitis/throat infection/sore throat
2. Sinus infection
3. Acid reflux
4. Tooth pain or infection
5. Teething in infants
6. Cervical spine problems in the neck
7. Cancers in the back of the nose or throat
D. Nerve pain
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