Some Causes and Features of Earache
Some Causes and Features of Earache
Cause |
Common Features* † |
Diagnosis‡ |
Middle ear |
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Mild to moderate discomfort Gurgling, crackling, or popping noises, with or without nasal congestion Decreased hearing in affected ear |
Doctor’s examination alone |
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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 |
Doctor’s examination alone |
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Recent middle ear infection Redness and tenderness behind the ear Often fever and/or ear discharge |
Sometimes doctor’s examination alone Sometimes CT scan |
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Severe pain, often with cold symptoms Bulging, red eardrum More common among children Sometimes ear discharge |
Doctor’s examination alone |
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Infectious myringitis (eardrum infection) |
Severe pain Inflamed eardrum Small blisters on surface of eardrum |
Doctor’s examination alone |
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Severe pain Blisters or pustules on the outer ear May be accompanied by hearing loss or facial weakness |
Doctor’s examination alone |
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External ear |
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Visible during a doctor's examination Foreign objects almost always in children |
Doctor’s examination alone |
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Usually in people who were attempting to clean their ear Visible during a doctor's examination |
Doctor’s examination alone |
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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 malignant external otitis (infection extending into the skull bone) |
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Causes due to structures near the ear§ |
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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 people |
Gadolinium-enhanced MRI Fiberoptic endoscopy with removal and examination (biopsy) of visible lesions |
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Infection (tonsils, peritonsillar abscess) |
Pain much worse with swallowing Visible redness of throat and/or tonsils |
Sometimes doctor’s examination alone Sometimes culture |
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Neuralgia (inflamed nerve, for example, inflamed glossopharyngeal nerve) |
Very severe, frequent, sharp pains lasting less than 1 second |
Doctor’s examination alone |
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Pain worsens with jaw movement Lack of smooth TMJ movement |
Doctor’s examination alone |
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* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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† Many people with middle and external ear disorders have some hearing loss. |
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‡ Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. |
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§ A common feature is a normal ear examination. |
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CT = computed tomography; MRI = magnetic resonance imaging; TMJ =temporomandibular joint. |
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