Ear Pain, Earache – Causes of Painful Ears (Otalgia), Discomfort

Ear pain, often referred to as an earache, is one of the more common ear problems. The intensity can vary from mild discomfort o a dull ache or even severe pain. Common causes of earache usually result in acute pain although there are may causes of recurrent or persistent pain.  An earache may be insiduous – it may feel like a  minor ailment but can be related to very serious diseases. It may occur on its own or present with other ear-related signs and symptoms like :

  • Swollen and/or red pinna
  • Itching in the ear canal
  • Ear discharge
  • Loss of hearing (partial/complete)
  • Tinnitus
  • Vertigo or dizziness

Most cases of an earache are related to the outer ear or middle ear. Conditions affecting the inner ear is usually perceived as a headache.

Causes of Earache (Otalgia)

Earache may be a result of localized disorders, with trauma and infection being the main causes. Often, it may also be a result referred pain from inflammation and infections in other structures of the head , particularly the throat, jaw or teeth.

Otitis Externa

Also known as swimmer’s ear, otitis externa is a result of an irritation of the ear canal often leading to an infection. When the pinna is involved, it is known as perichondritis and is often a result of ear piercings. Most acute cases are bacterial in nature although chronic cases may be due to fungal infections. Otitis externa due to a fungal infection is more likely to cause a persistent itch rather than pain.


  • Mild discomfort to severe ache of the outer part of the ear and/or canal
  • Swelling and/or redness of the ear
  • Muffled hearing
  • Ear discharge ranging from watery (serous) secretions to purulent discharge
  • Swollen lymph nodes (around the ear and neck)

Otitis Media

A more common type of ear infection especially in children, otitis media affects the middle ear and may be due to a bacterial or viral infection. Inflammation of the eustachian tube either due to an upper respiratory tract infection or middle ear infection prevents drainage of fluid from the middle ear. This often results in an effusion.


  • Ear pain, sometimes severe
  • Difficulty hearing
  • Ear discharge
  • Loss of balance, fever and a headache is more often seen in children
  • A sore throat may often accompany otitis media in adults


Injury to the ear, especially to the ear canal is common as the lining is sensitive to chemical and mechanical irritants. This can range from water accumulation (especially chlorinated water) to the insertion of cotton swabs, matchsticks and other foreign objects. Other causes of trauma, particularly to the auricle, may be accidental. Loud noise and an ear slap may also cause pain, hearing loss and/or tinnitus.

Apart from pain, a blood tinged discharge may also be noticed and perforation of the eardrum may occur. In the event of a sticky discharge, a CSF leak needs to be excluded.

Other Common Causes

  • Tonsillitis and/or pharyngitis
  • Temporomandibular joint (TMJ) dysfunction
  • Dental disease like a tooth cavity, dental abscess, impacted molar (especially wisdom tooth)
  • Foreign object stuck in the ear (particularly in children)

Less Common Causes

  • Changes in air pressure – diving, flights
  • Ramsay Hunt syndrome – infection of the facial nerve by the varicella zoster virus.
  • Cervical spine diseases like osteoarthritis and spondylosis.
  • Tumors in the ear (benign or malignant)
  • Cancer of the oral cavity, pharynx or larynx

Related Articles

  1. Ear Problems
  2. Ear Discharge

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