What causes an earache?

In children, an earache is most likely due to a middle ear infection, but it can also be caused by irritating substances in the ear and other conditions. A middle ear infection (otitis media) often follows an upper respiratory infection, such as the common cold.

In adults, ear pain is often due to disorders and conditions in another area that spread to the ear. This is due to the variety of nerves and connective tissues that are shared by other head and neck structures. Ear pain when swallowing is often caused by a blocked eustachian tube, sore throat, or sinusitis. In some cases, an earache is a symptom of a serious infection or other condition that should be evaluated as soon as possible or in an emergency setting.

Infectious causes of earache

Earaches are associated with different types of infections:

  • Blocked eustachian tube, often from a cold

  • Ear cellulitis (skin infection)

  • Eardrum infection (myringitis)

  • External (outer) ear and ear canal infection (otitis externa), often called swimmer’s ear

  • Mastoiditis (infection of the bone behind the ear that is often caused by spread of a middle ear infection)

  • Middle ear infection (otitis media)

  • Ramsay Hunt syndrome (varicella-zoster virus infection of the facial nerve , also called shingles and herpes zoster oticus)

Other causes of an earache

Earaches can be caused by other disorders including:

  • Foreign body, such as ear wax or cotton-tipped swab. It is fairly common for toddlers and preschoolers to put small objects, such as beads, beans, and small parts from toys, into their ears.

  • High altitudes or other pressure changes (barotrauma)

  • Irritating substances, such as shampoo or soap

  • Ear trauma or other injury

Causes of referred earache (secondary earache)

Earaches can be caused by disorders, diseases and conditions that do not originate in the ear, such as:

  • Acoustic neuroma (benign tumor)

  • Arthritis of the temporomandibular joint

  • Cancer of the head or neck

  • Infant teething

  • Infected tooth or other dental condition

  • Laryngitis (infection or inflammation of the voice box)

  • Recent tonsillectomy (removal of tonsils)

  • Sinusitis (from infection or inflammation)

  • Sore throat 

  • Teeth clenching or grinding (bruxism)

  • Tonsillitis or peritonsillar abscess

  • Trigeminal neuralgia

Questions for diagnosing the cause of an earache

To diagnose the underlying cause of an earache, your doctor or licensed health care practitioner will ask you several questions related to your symptoms. Questions for diagnosing the cause of an earache include:

  • When did the pain start?

  • What does the pain feel like?

  • Is the pain getting worse?

  • Has there been discharge or bleeding from the ear?

  • Have you had any change in hearing or hearing loss?

  • What other symptoms do you have? 

What are the potential complications of an earache?

Complications associated with an earache can be progressive and vary depending on the underlying cause. Because an earache can be due to serious diseases, failure to seek treatment can result in complications and permanent damage. It’s important to visit your health care provider when you experience any persistent symptoms that concern you. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:

  • Hearing  loss (temporary or permanent)

  • Recurrent ear infections

  • Ruptured eardrum

  • Spread of infection to the base of the skull and other surrounding structures and tissues


  1. Ear infection – acute. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001662/.
  2. Earache.  Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm.
  3. Orofacial pain and headache, p. 92-94, Sharav and Benoliel, 2008.
  4. Swimmer’s ear. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm.

What is an earache?

An earache is pain or discomfort of the ear. Ear pain is also called otalgia. Your ear is divided into three sections: the outer ear (includes the external ear and ear canal), the middle ear (includes the eardrum, three tiny bones called ossicles, and the eustachian tube), and the inner ear. The eustachian tubes are responsible for equalizing air pressure in the middle ear and allowing mucus to... Read more about earacheintroduction


What other symptoms might occur with an earache?

An earache may occur with a variety of other symptoms depending on the underlying disease, disorder or condition. Possible symptoms that occur with an earache include:

Medical Reviewer: Cynthia Haines, MD Last Annual Review Date: Aug 1, 2013 Copyright: © Copyright 2014 Health Grades, Inc. All rights reserved. May not be reproduced or reprinted without permission from Health Grades, Inc. Use of this information is governed by the HealthGrades User Agreement.

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