Some Causes and Features of Earache
Cause | Common Features* † | Diagnostic Approach |
|---|---|---|
Middle ear | ||
Acute eustachian tube obstruction (for example, due to a cold or allergies) | Mild to moderate discomfort or fullness Gurgling, crackling, or popping noises, with or without nasal congestion, especially during yawning or swallowing Decreased hearing in affected ear | Sometimes a doctor’s examination alone Sometimes audiogram |
Pressure changes (barotrauma) | Severe pain History of recent rapid change in air pressure (such as air travel or scuba diving) Often blood visible on or behind eardrum | Sometimes doctor’s examination alone Audiogram if hearing is decreased |
Recent middle ear infection Redness, swelling, and tenderness behind the ear Often fever and/or ear discharge | Usually a doctor’s examination alone Sometimes CT scan | |
Severe pain, often with cold symptoms Bulging eardrum Decreased hearing in the affected ear More common among children Sometimes ear discharge | Sometimes a doctor’s examination alone Sometimes audiogram | |
Infectious myringitis (eardrum infection) | Severe pain Inflamed eardrum Small blisters on surface of eardrum | Doctor’s examination alone |
Severe pain Blisters or pustules on the outer ear May be accompanied by hearing loss or facial weakness | Doctor’s examination alone | |
External ear | ||
Visible during a doctor's examination Foreign objects almost always in children | Doctor’s examination alone | |
Usually in people who were attempting to clean their ear Visible during a doctor's examination | Doctor’s examination alone | |
Itching and pain (more itching and only mild discomfort in chronic otitis externa) Often history of swimming or recurrent water exposure Sometimes foul-smelling discharge Red, swollen external ear canal filled with pus-like material | Sometimes doctor’s examination alone CT scan if suspected necrotizing otitis externa (infection extending into the skull bone) | |
Causes due to structures in the head and neck‡ | ||
Cancer of the throat, tonsils, base of tongue, voice box (larynx), or nasal passages and upper throat (nasopharynx) | Chronic discomfort Often long history of tobacco and/or alcohol use Sometimes enlarged, nontender lymph nodes in the neck Usually in older adults | Gadolinium-enhanced MRI Fiberoptic endoscopy with examination and removal (biopsy) of visible lesions |
Infection (tonsils, peritonsillar abscess) | Pain much worse with swallowing Visible redness of throat and/or tonsils Voice changes due to swelling of upper airway ("hot potato voice") or difficulty breathing | Sometimes doctor’s examination alone Sometimes culture |
Recurrent headaches with normal otoscopy and physical examination Symptoms worsened by typical migraine triggers (such as stress, sleep deprivation, known dietary migraine triggers) | Usually a doctor's careful history and examination alone Sometimes MRI | |
Neuralgia (inflamed nerve, for example, inflamed glossopharyngeal nerve) | Very severe, frequent, sharp pains lasting less than 1 second | Doctor’s examination alone Gadolinium-enhanced MRI to assess for compression of nerves, by blood vessels or other mass |
Pain worsens with jaw movement Lack of smooth TMJ movement History of grinding teeth at night or a habit of clenching teeth | Doctor’s examination alone Occasionally CT or MRI to assess for chronic joint changes | |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Many people with middle and external ear disorders have some hearing loss. | ||
‡ A common feature is a normal ear examination. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||