5 most common causes
Why do your ears hurt?
It’s not unusual to experience pain behind the ear. This is because the ears and mastoid bone (the part of your skull that’s behind the ear) have a lot of blood vessels and nerves. This makes the area sensitive to pain. So even a slight irritation behind the ears can hurt a lot.
Pain behind the ears can feel like a headache. It can be dull and throbbing or sharp and painful. It may spread to your jaw and cheeks. Your ears may feel full. Other symptoms may include ear discharge, ringing in the ears, and trouble hearing.
Ear pain may be caused by an ear infection such as swimmer’s ear, or teeth or jaw joint issues.
The most common treatments range from ear drops, having the wax cleared out, or taking over-the-counter pain medication.
1. Swimmer’s ear
- Ear pain
- Redness around the ear canal
- Clear or yellow-green discharge
- Swelling of the ear canal
- Ear and jaw discomfort
- A full or clogged sensation in the ear
Swimmer’s ear is an infection of the outer ear. It occurs when bacteria or a virus enter the ear canal. This often happens when you swim, which is why the condition is called swimmer’s ear. However, you can also develop it from inserting cotton swabs or other objects in your ear canal.
Swimmer’s ear always requires treatment from your doctor. It may get worse quickly and potentially cause hearing loss.
Your doctor will likely prescribe ear drops to clear the infection and ease pain. These drops may include an antibiotic. If your infection is severe, you may be prescribed an oral antibiotic too.
Sometimes, your doctor may need to clean your ear. When you have an outer ear infection, the ear canal may fill with debris and wet discharge. Removing it can speed your recovery and lessen pain.
A small amount of trauma to the ear canal can cause a great amount of pain. Using cotton swabs can cause microtrauma to the canal and eardrum. Over time, it can actually cause problems or infections. My rule is, “Nothing in your ear that is smaller than your elbow.” —Dr. David Lee
2. Temporomandibular joint disorders (TMJ)
- Pain in one or both ears
- Pain on one or both sides of the face
- A clicking or popping sound when opening or closing the mouth
- Pain that’s worse in the morning and/or when you chew, yawn, or make other jaw movements
Temporomandibular joint (TMJ) disorders are an inflammation of the temporomandibular joint and the muscles that control jaw movement. The temporomandibular joint connects your jaw to your skull. Because it’s located very close to the ear, TMJ pain feels like it’s coming from your ear instead of your jaw.
TMJ is often caused by clenching and grinding your teeth at night. If this is causing your TMJ, your ear pain may feel worse when waking up in the morning.
TMJ disorders can also develop from an injury to the jaw or misalignment of the teeth or jaw. Arthritis, autoimmune disease, dental surgery, or infection can also cause TMJ. Sometimes the cause is unclear.
Pain relievers such as non-steroidal anti-inflammatories (Advil, Aleve) can decrease inflammation and ease pain. Applying warm compresses to the joint can also be helpful.
If your TMJ is caused by clenching or grinding your teeth, your dentist may fit you with a mouth guard, which helps relieve symptoms.
Your doctor may also recommend some lifestyle changes that will limit pain, such as avoiding hard and very chewy foods. Relaxation techniques can help relieve tension in the muscles that connect to the temporomandibular joint.
3. Otitis media (middle ear infection)
- Pain or fullness behind your ear
- Respiratory or sinus infection
- Difficulty hearing
- Ringing in your ears
Otitis media develops when bacteria or viruses infect the middle ear, causing pain and swelling.
It may happen from having a cold, flu, or other respiratory infection. The back of the throat and nose is connected to the middle ear by a tube called the eustachian tube. This allows germs in the back of your throat and nose to travel to and infect the middle ear.
While anyone can get a middle ear infection, it’s much more common in children. Their Eustachian tubes are smaller than an adult’s.
Otitis media may get better on its own, but your doctor may decide to prescribe an antibiotic, especially if the infection is painful or is affecting your hearing.
4. Earwax buildup
- Pain behind the ear
- Feeling of fullness or clogging in the ear
- Difficulty hearing
- Ringing in the ear
Earwax may seem like an annoyance, but it has an important role—removing debris (like dead skin cells and dirt) from your ear canal. However, earwax can sometimes build up and cause ear pain and affect your hearing.
Never try to remove earwax with cotton swabs or other foreign objects. You may end up pushing the earwax deeper into the ear canal. Excess earwax can fall out of your ear on its own, but it won’t be able to do that if you make it go too deep.
Some people naturally have more earwax that require frequent removals by a doctor. If you think you have excess earwax, see your doctor. They can remove it with special tools that won’t push it deeper into your ear.
If you can’t always get to the doctor, there are special ear drops available that help the wax fall out naturally. Or you can ask your doctor about trying a hydrogen peroxide solution.
- Redness behind and around the ear
- Ear sticks out and feels red and painful to the touch
- Pus-like white or yellow ear discharge that may smell bad
- Throbbing, persistent pain in and around the ear
- Hearing loss
Mastoiditis is a dangerous bone infection in the mastoid bone, the bone behind and around the ear. You may notice swelling behind the ear or a proptotic ear (ear sticking out more than normal). It is often caused by an untreated ear infection that worsens. Children and adults who have had multiple ear infections are at higher risk.
If you think you may have mastoiditis, go to the ER. It needs immediate treatment, generally with intravenous (IV) antibiotics. In some cases, the infection creates an abscess in the bone that requires surgery.
The ear canal and inner ear have many different nerves that connect with other areas of the head and neck—including the sinuses, mouth, teeth, tongue, and throat. It is not uncommon for a problem in one of those areas to cause pain in or around the ear. —Dr. Lee
6. Dental causes
- Pressure or fullness in jaw and ear
- Jaw pain or cheek pain
- Ear pain
- Painful chewing
- Foul smelling breath
Sometimes, pain felt behind the ear could be caused by problems with your teeth. This is an example of referred pain, which is when the brain mistakenly thinks pain that is coming from one area is originating from another part of the body. In this case, the brain decides that the pain is from your ear when it is actually from your teeth. Two potential issues could be a tooth abscess or a tooth impaction.
- A tooth abscess is an infection from untreated tooth decay. Pain may radiate from the teeth, or you may feel sharp pain in your mouth by the affected tooth that radiates toward your jaw. The treatment may start with an antibiotic, but you will need to see a dentist. In some cases, the tooth may need to be pulled.
- Tooth impaction is when teeth—either wisdom teeth or adult teeth in children—don’t grow out of the gums in the right way. It’s often because they don’t have enough space. This can lead to pain and need treatment. Regular dental screenings can pinpoint problems before they occur.
In general, when you have mouth or tooth pain, go to a dentist first.
Other possible causes
A number of conditions can cause pain behind the ear, but the pain may not be the main symptom. These can include nerve issues, bacterial infections, migraines, and traumatic head or ear injuries.
When to call the doctor
It’s important to monitor your symptoms and to see a doctor. Even minor infections can get worse. A doctor can also rule out any tumor or growth that may be causing the pain. Call your doctor in these situations:
- Pain doesn’t go away or gets worse
- You’re having trouble hearing
- You have bloody or foul-smelling discharge from the ear
- You also have throat pain or difficulty swallowing
- You also have any type of neck lump or mass
If you have any other medical conditions, discuss these with your doctor when diagnosing your ear pain. If you have diabetes or high blood sugar and ear pain, it could be a more dangerous type of infection. If you have eczema or psoriasis and ear pain, it could be the skin of your ear canal that is causing the pain. —Dr. Lee
Should I go to the ER for pain behind the ear?
You should go to the emergency department if you have any of these signs of a more serious problem.
- You’ve had an impact injury to your head, such as a car accident
- Excruciating pain
- High fever
- Problems moving your neck
- Changes to your vision, light sensitivity, or worsening headaches
- Any swelling around or behind your ear
- Redness or a rash with swelling
- Avoid putting anything (including swabs) in ears
- Monitor symptoms
- Over-the-counter pain relievers can help, especially NSAIDs like ibuprofen
- Avoid eating hard or difficult to chew foods, which can make jaw and ear pain worse
- A warm compress on the ear can soothe pain
- Relaxation techniques can help you relax your jaw and keep you from grinding your teeth
Other treatment options
- Ear examination and cleaning by a doctor
- Topical ear drops
- Mouthguard or other dental interventions
- Dental work for tooth inflammation or impaction
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