Ear Pain

Ear pain, or otalgia, is a symptom with many possible sources. In about half of adults the cause lies in the ear itself, most often an infection of the canal or middle ear. In the rest the ear looks normal and the pain is referred from the jaw joint, teeth, throat or neck through shared nerves.

Most causes are minor and settle within days. The point of assessment is to find the source, treat it, and not miss the few serious causes, particularly in adults with persistent one-sided pain and a normal-looking ear.

Symptoms

• Sharp, dull or throbbing pain in one or both ears
• Pain on touching or pulling the ear, suggesting canal infection
• Pain with chewing or jaw clicking, suggesting the jaw joint
• Discharge, itching or reduced hearing
• Pain on swallowing that shoots to the ear, suggesting a throat source
• Fullness and popping after a flight, dive or cold
• In infants: crying, poor feeding, fever and ear rubbing

Causes and risk factors

Ear causes include otitis externa, acute otitis media, impacted wax, pressure injury from flying or diving, boils in the canal, foreign bodies, shingles of the ear and trauma from cotton buds. Referred causes include jaw joint dysfunction and tooth grinding, dental abscess and impacted wisdom teeth, tonsillitis and the days after tonsillectomy, neck arthritis, and neuralgia. Rarely, a tumour of the throat, tongue base or voice box presents as earache alone, which is why smokers and drinkers with lasting one-sided pain need a throat examination.

How it is diagnosed

• Otoscopy: A look at the canal and eardrum. If these are normal, attention turns to referred causes.
• Examination of jaw, teeth, throat and neck: Pressing over the jaw joint, checking the bite and teeth, and inspecting the tonsils often reproduces the pain and locates the source.
• Flexible nasendoscopy: A thin camera passed through the nose under local anaesthetic spray to view the throat and voice box when pain persists without explanation.
• Hearing test and tympanometry: Check middle ear function when fullness or hearing change accompanies the pain.
• Imaging: Dental X-rays, or CT or MRI of the neck and skull base, when examination suggests a deeper cause.

Treatment options

• Simple pain relief: Paracetamol or ibuprofen at regular intervals, with a warm compress. Often all that is needed while a viral infection passes.
• Treatment of ear infection: Cleaning and drops for canal infection. Observation or antibiotics for middle ear infection.
• Wax removal: Microsuction or irrigation after softening drops, if impacted wax is the cause.
• Jaw joint care: Soft diet, avoiding gum and wide yawning, a night bite guard from a dentist, and physiotherapy.
• Dental and throat treatment: Managing the abscess, wisdom tooth or tonsil problem resolves the referred pain.
• Pressure equalisation advice: Decongestant before flying, swallowing and gentle Valsalva on descent. Most barotrauma recovers by itself within days to weeks.

When it is urgent

Get emergency care locally for ear pain with swelling or redness behind the ear, a drooping face, blisters on the ear, high fever with neck stiffness, severe dizziness, sudden hearing loss, a button battery or sharp object in the ear, or bleeding or clear fluid from the ear after a head injury. In someone with diabetes, severe deep ear pain at night with discharge needs urgent ENT review.

Travelling to Türkiye for treatment

Earache is dealt with where you are and is not a reason to travel. If pain has persisted for weeks without a diagnosis, a visit can bring ENT, dental and jaw joint assessment together with endoscopy and imaging in a few days. Do not fly with an acutely painful or infected ear if you can avoid it.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions