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The Inside of My Ear Hurts, Why?

9 ear canal pain conditions

This list does not constitute medical advice and may not accurately represent what you have.

Middle ear infection

Middle ear infection, also called acute otitis media, is a bacterial or viral infection of the air-filled space behind the eardrum. An ear infection is usually secondary to a cold, allergy, or influenza.

Young children are most susceptible due to weaker immune systems and to the small size and shape of the Eustachian tubes in the ears. Children in group care settings are more exposed to colds and flu and therefore more prone to ear infections.

Symptoms include ear pain due to inflammation; drainage of fluid from the ear; and sometimes hearing difficulty. Children may cry, run a fever, and pull at the affected ear.

If symptoms last more than a day, a medical provider should be seen. Long-lasting or repeated ear infections can lead to hearing damage and to speech and learning problems.

Diagnosis is made through physical examination.

Middle ear infections often clear up on their own and antibiotics may only be needed for infants and severe cases. Warm compresses and over-the-counter pain relievers can be used. Do not give aspirin to children.

Rarity: Common

Top Symptoms: fatigue, sore throat, new headache, fever, ear canal pain

Symptoms that always occur with middle ear infection: ear canal pain

Symptoms that never occur with middle ear infection: vertigo (extreme dizziness), face weakness, facial numbness

Urgency: Primary care doctor

Swimmer’s ear (otitis externa)

Swimmer’s ear, or otitis externa, is an infection of the canal which runs from the eardrum to the opening of the ear.

It is caused by anything that introduces bacteria, fungus, or a virus into the canal. Water that stays inside the ear after swimming is a common cause, as are cotton swabs used for cleaning or earpieces that create irritation.

Most susceptible are children, because they have narrower ear canals that do not drain well.

Early symptoms include redness, itching, and discomfort inside the ear canal, sometimes with drainage of clear fluid.

Even mild symptoms should be treated because they can quickly get worse. The infection can spread and intensify, becoming very painful with increased drainage, swelling, fever, and loss of hearing.

Diagnosis is made through patient history and physical examination of the ear canal. Lab tests may be done on a sample of the discharge from the ear.

Treatment includes having a medical provider clean the ear canal of debris and discharge, and a prescription for antibiotic and/or steroid eardrops.

Rarity: Common

Top Symptoms: fever, ear canal pain, ear fullness/pressure, jaw pain, ear pain that gets worse when moving

Urgency: Primary care doctor

Temporomandibular joint (tmj) dysfunction disorder

Temporomandibular Joint Dysfunction is often caused by a variety of factors, including daily habits, your teeth alignment, and even stress. It usually affects one side of the jaw, but in some people it can affect both sides. People with TMJ dysfunction will typically experience pain on one side of the face that is worse with chewing, yawning, or other movements of the jaw. With some simple changes in your daily habits and other at-home treatments, most people with TMJ dysfunction will experience relief of their symptoms within weeks.

Treatment for temporomandibular joint dysfunction usually includes avoiding eating hard foods or foods that require a lot of chewing. Good posture and relaxation techniques may help relieve tension in the muscles that connect to your temporomandibular joint. In people who clench or grind their teeth, a mouth guard worn at night (and fitted by your dentist) may also help relieve your symptoms. Pain relievers, like ibuprofen (Advil, Motrin), can also help.

Rarity: Common

Top Symptoms: dizziness, pain, restricted movement, and clicking sounds from jaw, history of headaches, jaw pain, pain in the back of the neck

Symptoms that always occur with temporomandibular joint (tmj) dysfunction disorder: pain, restricted movement, and clicking sounds from jaw

Urgency: Primary care doctor

Earwax blockage

Ear wax production is a normal process, as the body makes wax to protect the ear from infection. Sometimes ear wax can build up and cover the eardrum, which is a thin layer of skin that stretches across the end of the ear canal and picks up sound from outside. Ear wax buildup has nothing to do with poor hygiene, and it is not possible to prevent a build-up by washing.

Rarity: Uncommon

Top Symptoms: dizziness, dry cough, ear canal pain, ear fullness/pressure, ringing in the ears

Symptoms that never occur with earwax blockage: swollen ear, fever

Urgency: Phone call or in-person visit

Chronic earwax blockage

Earwax production is a normal process, as the body makes wax to protect the ear from infection. Sometimes ear wax can build up and cover the eardrum which is a thin layer of skin that stretches across the end of the ear canal and picks up sound from outside.

Rarity: Common

Top Symptoms: dizziness, dry cough, ear canal pain, ringing in the ears, ear fullness/pressure

Symptoms that always occur with chronic earwax blockage: ear canal pain

Symptoms that never occur with chronic earwax blockage: swollen ear, fever

Urgency: Phone call or in-person visit

Cholesteatoma (a non-cancerous growth in the ear)

Cholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull. It can be a birth defect though more commonly occurs as a complication of chronic ear infection.

Rarity: Rare

Top Symptoms: ear fullness/pressure, ringing in the ears, pain in one ear canal, vertigo (extreme dizziness), hearing loss in one ear

Urgency: Primary care doctor

Burst ear drum

The ear drum is a thin membrane that vibrates as sound hits it, transmitting that vibration into signals that the brain understands! When it bursts, your hearing is affected. It typically happens after some force to the ear drum, such as a blow to the ear, an exploding firecracker, a fall onto water, or even a sharp object in the ear.

Rarity: Rare

Top Symptoms: ear canal pain, constant ear pain, ringing in the ears, vertigo (extreme dizziness), hearing loss

Symptoms that always occur with burst ear drum: ear canal pain, recent ear injury, constant ear pain

Urgency: Primary care doctor

Ear plug made of skin cells

Keratosis Obturans is a rare disease where materials that make up the skin create a plug in the ear, causing pain, discharge, and hearing changes.

Rarity: Rare

Top Symptoms: hearing loss, pain in one ear canal, ear discharge, hearing loss in both ears, severe ear canal pain

Urgency: Primary care doctor

Glue ear (otitis media with effusion)

“Glue ear” is caused by fluid built up in the middle ear (under the eardrum). It happens more frequently in kids than adults because of having frequent colds and less developed tubes in the ear. In adults, it’s caused by acute or chronic sinusitis in 66% of cases. It may also be caused by cigarette smoke, allergies, reflux, genetics, or bacteria, all of which stimulate the production of the fluid.

Rarity: Common

Top Symptoms: ear fullness/pressure, constant hearing loss, hearing loss in one ear, trouble hearing that is better in noisy environments, ear canal pain

Symptoms that always occur with glue ear (otitis media with effusion): ear fullness/pressure, hearing loss in one ear, constant hearing loss

Symptoms that never occur with glue ear (otitis media with effusion): ear canal pain, fever

Urgency: Wait and watch

Ear infections – Better Health Channel

The ear is made up of three parts. The outer ear includes the part you can see and the canal that leads to the eardrum. The middle ear is separated from the outer ear by the eardrum and contains tiny bones that amplify sound. The inner ear is where sounds are translated to electrical impulses and sent to the brain.

Any of these three parts can become infected by bacteria, fungi or viruses. Children are particularly prone to middle ear infections (otitis media). It is estimated that around four out of five children will experience a middle ear infection at least once.

Symptoms of ear infections

The symptoms of an ear infection depend on the type, but may include:

  • earache
  • mild deafness or the sensation that sound is muffled
  • ear discharge
  • fever
  • headache
  • loss of appetite
  • itchiness of the outer ear
  • blisters on the outer ear or along the ear canal
  • noises in the ear – such as buzzing or humming
  • vertigo (loss of balance).

The function of the Eustachian tube

The ear is connected to the back of the nose via the Eustachian tube. This tube equalises air pressure inside the ear, and funnels secretions from the middle ear into the throat. The walls of the Eustachian tube lie flat against each other to prevent the migration of bacteria or other germs into the ear from the nose and throat.

Whenever we swallow, a small muscle flexes and opens the tube, allowing air pressure equalisation and the drainage of secretions. If the Eustachian tube is blocked, secretions and associated bacteria build up inside the middle ear. This can cause ear infections, mild deafness and an increased likelihood of a ruptured eardrum. 

Causes of ear infections

Some of the many causes of ear infection and contributing risk factors include:

  • upper respiratory tract infections
  • sudden changes in air pressure – such as during airline travel
  • smaller than average Eustachian tubes, or a blocked Eustachian tube
  • cleft palate
  • young age – babies and children are more prone to ear infections
  • swimming in polluted water
  • failing to dry the outer ear properly after swimming or bathing
  • overzealous cleaning of the ears, which can scratch the delicate tissues.

Types of ear infections

Ear infections are diagnosed by physical examination and laboratory analysis of pus or discharge. In some cases, CT scans may also be taken.

Types of ear infection include:

  • otitis externa 
  • otitis media – acute or chronic
  • serous otitis media 
  • infectious myringitis 
  • acute mastoiditis 
  • vestibular neuronitis 
  • herpes zoster of the ear.

Otitis externa

Otitis externa is an infection or inflammation of the ear canal between the eardrum and the outer ear. It can be triggered by exposure to dirty water or by mechanical damage due to overzealous cleaning. The infectious agent can be either fungal or bacterial.

Treatment options include:

  • professional cleaning of the ear canal, although syringing the ear should usually be avoided
  • eardrops containing antibiotics and steroids, if the infection is bacterial in origin
  • oral antibiotics
  • ear drops containing antifungal medications and steroids, if the infection is fungal in origin
  • pain-relieving medications
  • keeping ears dry.

Otitis media

Otitis media is an infection of the middle ear, which can be either acute or chronic. Children are most commonly affected by acute otitis media because it is caused by colds and blocked Eustachian tubes – both typical ailments of childhood. The infectious agent can be either viral or bacterial, with research suggesting that viruses are responsible for most cases.

Sometimes the eardrum will burst, leading to pus in the ear canal, but usually the eardrum will heal up again by itself. Treatment options include:

  • pain-relieving medications
  • antibiotics – if the infection is bacterial in origin
  • eardrops – if there is pus in the ear canal.

Frequent bouts of acute otitis media or one lingering attack can lead to chronic otitis media. Without medical intervention, the chronic infection can burst the eardrum or damage the delicate structures within the middle ear.

Other possible complications of untreated chronic otitis media include meningitis, infection of the balance organs within the ear (labyrinthitis), sensorineural deafness (permanent hearing loss) and paralysis of the face.  

Treatment options include:

  • thorough cleaning of the ear and use of topical antibiotic drops (with or without steroids)
  • medication to treat the infection
  • surgical repair of the perforated eardrum
  • prevention strategies to reduce the risk of another infection.

Serous otitis media

Serous otitis media is known as glue ear. Children aged between six months and two years of age are most vulnerable to this type of ear infection. Glue ear commonly develops after a middle ear infection, and is characterised by the build-up of fluid and pus within the middle ear. Treatment options include antibiotics.

If antibiotics fail, or if the child is plagued by repeated attacks of glue ear, surgery to insert small drainage tubes (grommets) may be needed.

Infectious myringitis

Infectious myringitis is inflammation of the eardrum, caused by infection from either viruses or bacteria. The eardrum responds to the inflammation by forming small blisters. This can be quite painful. If fever is present, the infectious agent is almost certainly bacterial.

Treatment options include:

  • antibiotics
  • pain-relieving medications
  • professional rupturing of the blisters

Acute mastoiditis

The bone that can be felt immediately behind the ear is called the mastoid. Acute mastoiditis is infection of this bone, caused by prior acute otitis media. The symptoms include reddened and swollen skin over the mastoid, fever, discharge from the ear and intense pain.

This is a serious condition. Untreated, acute mastoiditis can lead to deafness, blood poisoning, meningitis and paralysis of the face. Treatment options include:

  • intravenous antibiotics
  • surgical drainage of the infected bone.

Vestibular neuronitis

The inner ear contains the organs of balance – the vestibular system. It includes three fluid-filled loops (semi-circular canals) which respond to the rotation of the head. Near the semicircular canals are the utricle and saccule, which detect gravity and back-and-forth motion. When the head is moved, signals from these organs are sent via the vestibular nerve to the brain where it is processed

Vestibular neuronitis is inflammation of the vestibular nerve, probably caused by a viral infection. The main symptom is sudden and dramatic vertigo, which may be accompanied by nausea and vomiting. The eyes may also involuntarily flutter towards the affected side of the head. 

Treatment options for vestibular neuronitis include:

  • medications, including antihistamines
  • anti-nausea medications
  • vestibular physiotherapy – to help your brain to compensate or retrain.

Herpes zoster of the ear

Sound is sent as electrical impulses to the brain via the cochlear nerve. Herpes zoster of the ear is an infection of this auditory nerve by the herpes zoster virus. Symptoms include ear pain, vertigo, and small blisters on the outer ear and ear canal and perhaps on the face and neck.

The main nerve that services the facial muscles may also become infected, leading to swelling and partial paralysis. Treatment options include:

  • antiviral medications such as steroids and acyclovir
  • pain-relieving medications.

Where to get help

Boil (Furuncle) in the Ear Canal. Symptoms and treatment

A small boil (furuncle) that occurs in the ear canal can be very painful. It usually clears without treatment. However, painkillers and antibiotic medicines are sometimes needed. Tips on how to help prevent further episodes are given below.

What are the symptoms of a boil in the ear canal?

Boil in the ear canal

The main symptom is pain. This pain may become quite severe even though the boil is usually small. This is because of the location of the boil.

Other symptoms may include itch, irritation and sometimes a temporary hearing loss whilst the infection is present.

If the boil bursts, you may have a sudden discharge from the ear. If this happens, the pain often eases dramatically and the symptoms soon settle.

What causes a boil in the ear canal?