Ear pain is a very common complaint regardless of age.
Although most people understand that an ear infection can cause ear pain, what many may
not realize is that there are numerous other problems that can also cause ear pain.
Overall, there are 6 basic causes of ear pain.
Obviously, an ear infection can cause ear pain, whether from an infection of the middle
ear behind the eardrum as shown in this animation or due to an infection of the ear canal skin
also known as swimmer’s ear.
This condition is treated with antibiotics.
Ear pain can also occur due to a problem with the temporomandibular joint or TMJ.
This joint is located immediately in front of the ear denoted by the green arrow.
Normally, a cartilaginous articular disc shown in purple allows for smooth jaw movement.
However, when this disc becomes displaced, it can cause clicking and significant ear
pain as well.
TMJ ear pain typically occurs or is worse with jaw movement.
Eustachian tube dysfunction causes a pressure type of ear pain.
Normally when the ear fills up with pressure, such as when going up in an airplane, the
eustachian tube can open allowing middle ear pressure release.
Such ear pressure release can be accomplished with valsalva or ear popping.
However, when the eustachian tube becomes inflamed causing the lining to swell, the
patient will be unable to pop the ear.
This leads to a situation where the middle ear becomes full of fluid or pressure causing
a clogged ear sensation or a pressure type of ear pain.
A related problem to eustachian tube dysfunction is ear pain attributable to nasopharynx pathology.
The nasopharynx is located in the very back of the nose which can be seen using an endoscope
as shown here.
The nasopharynx incidentally is also where the other end of the eustachian tube opens
Problems in this area that can cause ear pain include tumors and infections of the adenoids.
Occasionally, purulent drainage from the sinuses can irritate the nasopharyngeal lining leading
to ear pain as well.
Throat problems can also lead to ear pain.
Although the problem may seem like it is in the ear, in reality, the problem is actually
located in the throat with pain being referred to the ear.
Common locations of throat problems triggering referred ear pain include the tonsils and
the back of the tongue denoted by the red arrow.
Further down, mucosa around the voice box denoted by the blue arrow can also cause referred
Throat problems that may trigger ear pain include infection, ulcers, reflux, and abnormal
growths including cancer.
Finally, cervical spine problems can also cause ear pain.
Head movements often trigger ear pain in this situation.
Just as with sciatica which can cause severe leg pain due to pinched nerves in the lumbar
spine, pinched nerves in the cervical spine can cause ear pain as well.
There are two main nerves that provide sensation to the ear called the Great Auricular Nerve
in red and Lesser Occipital Nerve in purple.
Both these nerves are supplied by C2, C3, and C4 cervical spinal nerves.
Anything that compresses the cervical spinal nerves in this region can trigger ear pain,
mainly around the back part of the ear.
Although there are other potential causes of ear pain, these 6 are the most common.
So if you are wondering why ear pain is present and infection has been ruled out, consider
these other possibilities!