Merck Manual

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Some Causes and Features of Earache

Some Causes and Features of Earache

Cause

Common Features* †

Diagnosis‡

Middle ear

Acute eustachian tube obstruction (for example, due to a cold or allergies)

Mild to moderate discomfort

Gurgling, crackling, or popping noises, with or without nasal congestion

Decreased hearing in affected ear

Doctor’s examination alone

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

Recent middle ear infection

Redness and tenderness behind the ear

Often fever and/or ear discharge

Sometimes doctor’s examination alone

Sometimes CT scan

Otitis media (acute or chronic)

Severe pain, often with cold symptoms

Bulging, red eardrum

More common among children

Sometimes ear discharge

Doctor’s examination alone

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

Otitis externa (acute or chronic)

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)

Causes due to structures near the ear§

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

Infection (tonsils, peritonsillar abscess)

Pain much worse with swallowing

Visible redness of throat and/or tonsils

Sometimes doctor’s examination alone

Sometimes culture

Neuralgia (inflamed nerve, for example, inflamed glossopharyngeal nerve)

Very severe, frequent, sharp pains lasting less than 1 second

Doctor’s examination alone

Pain worsens with jaw movement

Lack of smooth TMJ movement

Doctor’s examination alone

* 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.

‡ 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.

§ A common feature is a normal ear examination.

CT = computed tomography; MRI = magnetic resonance imaging; TMJ =temporomandibular joint.