Ear Pain

Ear pain, medically termed otalgia, is a frequent symptom of diverse conditions affecting both children and adults. It is uncommon for discomfort to be bilateral; in most cases, the pain occurs in only one ear.

There are two types of ear pain depending on its underlying cause:

• Primary otalgia: manifestation of disorders of the ear itself; more common in children.
• Secondary otalgia: occurs as a consequence of disease in adjacent structures (jaw, throat, neck, teeth). It is the most common cause of ear pain in adults.

There are ways to relieve otalgia in order to improve the patient’s condition, but the prognosis of ear pain depends on the severity of the underlying cause. For this reason, it is essential to reach an accurate and early diagnosis in order to apply the most appropriate treatment in each case.

Symptoms

The characteristic symptoms of otalgia include:

• Ear pain: varies depending on the underlying cause. It may be mild or severe and can appear suddenly or gradually. In some cases, it worsens when touching the ear or chewing.
• Hearing loss: sounds may be muffled or hearing may be impaired. Except in very severe cases, this symptom is temporary.
• Tinnitus: noises or ringing in the ear.
• Otorrhea (discharge): it is common for the ear to discharge fluid or pus when pain is due to infection. In some cases, blood may be expelled.
• Itching in the ear canal.
• Redness of the external auditory canal.
• Inflammation.

Signs associated with ear infection, more common in children (in addition to otalgia), include:

• Fever.
• General malaise.
• Irritability, which in infants manifests as inconsolable crying.
• Nasal congestion.
• Sore throat.
• Cough.
• Referred pain: discomfort may also be felt in the jaw, head, or neck.
• Dizziness or vertigo.

Causes

Ear pain may have very diverse causes, including:

• Primary otalgia: due to ear conditions:
  • Otitis media: infection of the middle ear, located behind the eardrum and composed of the ossicular chain, Eustachian tube, tympanic cavity, and mastoid air cells.
  • Otitis externa: infection of the outer ear, the visible part of the auditory system. It consists of the auricle (pinna) and the external auditory canal.
  • Acute folliculitis: bacterial infection affecting hair follicles in the ear skin.
  • Bullous myringitis: viral or bacterial infection causing inflammation of the eardrum and formation of small fluid- or blood-filled blisters.
  • Aural herpes or Ramsay Hunt syndrome: infection caused by reactivation of the varicella-zoster virus, which damages the facial and auditory nerves.
  • Barotrauma: injury caused by a sudden pressure imbalance between the middle and external ear. It usually occurs during airplane takeoff and landing or diving ascent and descent.
  • Tympanic membrane perforation: a tear or hole in the membrane separating the middle and outer ear (eardrum). It may result from trauma, barotrauma, or infection.
  • Mastoiditis: bacterial infection of the mastoid bone, located behind the ear.
  • Chronic Eustachian tube dysfunction: obstruction of the canal connecting the throat to the middle ear. As a result, it does not properly regulate pressure between the inner and middle ear.
  • External auditory canal obstruction: may be caused by cerumen, soap, or water accumulation, as well as foreign bodies.
  • Ear tumors: most commonly basal cell carcinomas or squamous cell carcinomas. Pain usually indicates that the neoplasm is located in the external auditory canal.
  • Perichondritis: bacterial infection of the tissue covering the ear cartilage.
  • Chondritis: inflammation of the auricular cartilage, usually secondary to perichondritis.
• Secondary otalgia: consequence of pathology in a region sharing nerve pathways with the ear:
  • Temporomandibular joint disorders:
    • Arthritis: inflammation or degeneration of the joint limiting mouth opening and closing.
    • Bruxism: involuntary teeth clenching, especially during sleep.
    • Malocclusion: improper alignment of dental arches.
    • Trauma.
  • Dental infection: bacterial accumulation in the tooth pulp, gums, or bone.
  • Migraines: headache accompanied by nausea, vomiting, and increased sensitivity to light or sound.
  • Allergies: to dust mites, mold, animal dander, among others, which may cause inflammation blocking the Eustachian tube.
  • Severe cough.
  • Parotitis (mumps): inflammation of the parotid gland caused by viral infection.
  • Sinusitis: inflammation of the mucosa lining the paranasal sinuses due to infection or allergy.
  • Tonsillitis: inflammation of the tonsils caused by viral or bacterial infection.
  • Oral aphthae: painful ulcers in the oral mucosa.
  • Pharyngolaryngeal acid reflux: gastric acid ascends to the larynx and pharynx.
  • Thyroiditis: inflammation of the thyroid gland due to viral infection or autoimmune disorder.
  • Inflammatory adenopathy: lymph node inflammation in response to infection.
  • Cervical spondylosis: degenerative disease of the cervical spine causing wear of discs, vertebrae, and ligaments.

Risk Factors

The risk of developing ear pain is higher in the following cases:

• Age: children are more prone to otalgia due to more frequent infections.
• Frequent immersion bathing, which promotes water and cerumen accumulation.
• Tendency to accumulate earwax.
• Activities involving pressure changes (air travel, diving).
• Introduction of objects into the ear: cotton swabs or headphones may cause structural damage and facilitate bacterial entry.
• Allergies.
• Exposure to tobacco smoke.
• Direct exposure of the auricle to cold.
• Living in very cold climates.

Complications

Conditions causing ear pain may lead to the following complications:

• Permanent hearing loss.
• Chronic otitis: recurrent infections leading to persistent discharge.
• Vertigo due to inner ear infections.
• Facial paralysis when the facial nerve is affected.
• Meningitis: inflammation of the membranes surrounding the brain and spinal cord caused by infection.
• Brain abscesses: encapsulated pus accumulation in brain tissue.
• Speech delays in children with recurrent ear infections.
• Tympanic membrane damage: perforation or tear.

Which doctor treats ear pain?

Depending on the severity of the underlying condition, ear pain is managed in Family and community medicine, Pediatrics, Neurology, or Medical oncology.