Ear pain (otalgia) can be caused by many conditions. Some causes of otalgia are not related to infections or conditions of the ear. However, the conditions described below are associated with infections or conditions of the ear or structures near the ear.

1.Otitis externa: (Swimmer's Ear) A painful infection of the external ear canal associated with retained water in the ear canal after showering, bathing, or swimming. This can cause severe and painful swelling of the ear canal. If severe and untreated, it may require debridement of the ear canal and placement of an ear wick which is a compressed hard cellulose tube that is inserted deep into the ear canal and which expands once soaked with antibiotic drops. This is kept in the ear canal for 3-5 days and usually will extrude out of the ear when the infection subsides. Swelling of the face and lymph nodes around the ear can occur with severe otitis externa that requires systemic or injectible antibiotics and steroids. Strong pain medications are often required due to the severe pain seen with severe otitis externa.
2.Otitis media: An infection involving the accumulation of fluid in the middle ear space. This fluid can be clear or straw colored serous fluid, frank pus, or blood. The middle ear infection results from obstruction of the eustachian tube that is located in the back of the nose on each side. This tube allows equalization of middle ear pressure with the act of swallowing. Nasal congestion from allergies or viral infection, thick mucus or sinus drainage from allergies, purulent secretions from sinus infections, or unrelieved pressure (barotitis media) after airtravel, snorkling, and scuba actvities can all cause otitis media.
3.Otomycosis: A fungal infection that accumulates in the ear canal due to moisture retained in the ear canal. This retained water changes the acidity of the ear canal skin and creates a perfect dark, warm, and moist environment for fungal growth. Two types of fungi are usually seen in this condition: Aspergillus niger and Candida albicans species. This infection usually causes itching and hearing loss before it becomes painful. Microscopic debridement of the fungal elements and topical antifungal powder or antifungal drops are usually curative. 
4.Cerumen impaction: Ear wax (cerumen) can be quite painful if it hardens in the middle portion of the ear canal which is smaller than the entrance and the area just before the canal meets the eardrum. Chronic Q-tip users or frequent use of the wax removal drops can cause wax impaction as the ear wax can tempoarily soften and flow deeper into the ear canal. Repeated Q-tip and wax removal solution use then forms a long plug that hardens and is now near the ear drum where it can cause discomfort. The hardened wax is now larger than the narrow middle ear canal and becomes difficult to remove by the ENT physician and painful for the patient
5.Ramsey Hunt Syndrome: (Herpes Zoster Oticus). A very painful outbreak of the same virus that causes Shingles that can involve the ear drum, ear canal, and external ear. It often starts with a burning or itching sensation that rapidly progresses to characteristic blebs of fluid filled blisters that rupture and turn crusted and black in appearance. Microscopic ear examination often allows diagnosis early before the outer ear skin is involved. Aggresive anti herpetic treatment with large doses of Acyclovir is essential for resolving this infection. Sometimes this infection can cause hearing loss, vertigo (dizziness), and tinnitis (ringing in the ear). Topical anesthetic ointments and strong pain medications are often required for this infection.
6.Perichondritis: A condition of the external ear that is commonly seen in contact sports, especially in wrestling. Blunt force trauma to the ear causes painful swelling within the layers of tissue that cover the cartlage framework of the external ear (auricle). Initial collection of clear fluid collects under the skin covering the ear . This is called a seroma and can be aspirated from the space with a needle and syringe. Thicker fluid and blood however, can not be aspirated and often requires a surgical incision and drainage procedure for resolution. If undrained the fluid leads to bacterial infection of the layers of tissue (perichondrium) between the cartilage and external skin of the auricle. If not treated aggresively this can cause deformation of the external ear ( Cauliflower Ear) due to disruption of the cartilage that shapes the ear.

Referred otalgia is ear pain that is not due to actual ear infection or trauma. Causes of referred earpain are

1.TMJ: (temporal mandibular joint syndrome) ear pain that rediates into the deeper ear canal and radiates down into the lateral neck. The upper end of the jaw bone (condyle) fits into the cavity located in front of the external ear canal. Dental malocclusion (ill fitting of the upper and lower teeth), grinding of the teeth while sleeping (bruxism), or blunt trauma to the jaw or chin can cause severe ear pain due to inflammation of the various sensory nerves that innervate the cartilage and ligaments surrounding the ear opening. A soft or liquid diet, warm moist compresses, and nonsteroidal anti-inflammatory medications for 7-10 days will usually treat mild or moderate inflammation from TMJ.
2.Nasal and eustac
hian tube obstruction: Nasal congestion and obstruction of the opening of the eustachian tube located at the back of the nose can cause ear pain due to inability to equalize the pressure behind the ear drum. Usually the eustachian tube opens after every 2-3 swallows of liquids or saliva. Medicated nasal sprays, oral decongestant medicines, and swallowing exercises that open the blocked eustachian tube are usually effective in improving nasal airflow and eustachian tube dysfunction.
3.Ulcerative lesions: and infections of the tonsils, posterior tongue, and mucus membranes of the mucus membranes of the posterior throat, larynx, and esophagus can also cause severe ear pain that is worse with swallowing. 
4. Postoperative ear pain: is often seen with surgeries such as tonsillectomy, biopsies of the tongue, epiglottis, larynx, and pharynx due to irritation of sensory nerves that are located in those areas.

Call our office for an appointment with Dr. Sciacca if you are experiencing acute, chronic, or reoccuring ear pain for a thorough ENT and microscopic ear exam.

For more information about ear pain


4501 Southlake Pkwy
Suite #200
Hoover, AL 35244