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 |
A doctor's examination |
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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 |
A doctor's examination |
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Recent middle ear infection Redness and tenderness behind the ear Often fever and/or ear discharge |
A doctor's examination Sometimes CT scan Sometimes audiometry |
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Severe pain, often with cold symptoms Bulging, red eardrum More common among children Sometimes ear discharge |
A doctor's examination Sometimes audiometry |
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Infectious myringitis (eardrum infection) |
Severe pain Inflamed eardrum Small blisters on surface of eardrum |
A doctor's examination |
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Severe pain Blisters or pustules on the outer ear May be accompanied by hearing loss or facial weakness |
A doctor's examination |
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External ear |
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Visible during a doctor's examination Foreign objects almost always in children |
A doctor's examination |
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Usually in people who were attempting to clean their ear Visible during a doctor's examination |
A doctor's examination |
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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 |
A doctor's examination CT scan if malignant external otitis suspected |
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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 |
A doctor's examination Sometimes culture |
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Neuralgia (inflamed nerve, for example, inflamed glossopharyngeal nerve) |
Very severe, frequent, sharp pains lasting less than 1 second |
A doctor's examination |
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Pain worsens with jaw movement Lack of smooth TMJ movement |
A doctor's examination Sometimes panoramic x-rays or CT scan |
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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 only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed. |
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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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