Earache in Adults: What's Behind It and When to Get Checked

What are the most common causes of ear pain in adults?

Outer ear infection (otitis externa, or swimmer's ear) happens when the skin of the ear canal gets inflamed or infected — typically from moisture, scratching, or objects in the ear. The outer ear is very tender to the touch, and the canal may look red and swollen. This is the most common ear infection in adults.

Middle ear infection (otitis media) — the classic childhood ear infection — does occur in adults but less often. It usually follows a cold or upper respiratory illness, causing a deep, throbbing pain, sometimes with muffled hearing or a feeling of pressure.

Eustachian tube dysfunction happens when the tube connecting the middle ear to the back of the throat does not open and close properly. This causes ear pressure, muffled hearing, and sometimes pain — especially with altitude changes (flying, driving through mountains) or during a head cold. It is very common and is usually self-limited.

TMJ (jaw joint) disorder is a frequently overlooked cause of ear pain in adults. The temporomandibular joint sits very close to the ear canal; clenching or grinding (bruxism), jaw soreness, and pain with chewing are clues. TMJ-related ear pain often worsens in the morning from nighttime grinding and may come with a clicking jaw 1Ref 1Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.placeholder — not used; see grounding note.

Throat and tonsil problems — infections, pharyngitis, tonsil stones — can cause referred ear pain because the same nerve (the glossopharyngeal nerve) supplies both areas. Tooth infections, particularly in the back teeth, can also send pain to the ear.

What is referred ear pain and why does it happen?

In adults, a substantial portion of ear pain is *referred* — the sensation of pain originates in the ear even though the source of the problem is somewhere nearby. This happens because several cranial nerves that supply the ear also supply the jaw, throat, neck muscles, and teeth. A clinician uses the physical exam — looking in the ear (otoscopy), examining the jaw, and checking the throat — to distinguish referred pain from a primary ear problem. When the ear exam looks normal but pain is present, referred sources become the priority 1Ref 1Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.placeholder — not used; see grounding note.

What are the less common but important causes?

Ruptured (perforated) eardrum causes sudden sharp pain, often followed by decreased pain and sometimes drainage or reduced hearing. It can result from a sharp pressure change, a blow to the head, a severe middle ear infection, or inserting objects in the ear canal. Most perforations heal on their own, but a clinician should confirm this.

Shingles affecting the ear (Ramsay Hunt syndrome) is reactivation of the varicella-zoster virus (the chickenpox virus) in the nerve serving the ear. It causes ear pain, a blistering rash in or around the ear canal, and sometimes facial weakness or dizziness. This is uncommon but important to recognize because antiviral treatment is more effective when started early 2Ref 2Dooling KL, Guo A, Patel M, et al. (2018).Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines.Varicella-zoster virus reactivation (shingles / Ramsay Hunt syndrome) in adults with prior chickenpox history; importance of early treatment. Anyone with a history of chickenpox carries the varicella-zoster virus and is at risk for reactivation, particularly if older or immunocompromised.

Malignant (necrotizing) otitis externa is a serious, deep infection of the ear canal and surrounding bone that primarily affects older adults with diabetes or those who are immunocompromised. It requires urgent evaluation and specialist care.

Cholesteatoma is an abnormal skin growth in the middle ear that causes pain, hearing loss, and drainage and requires ENT evaluation.

What helps while you wait to be seen?

For mild ear discomfort without signs of infection:

• A warm compress held gently against the ear can ease pain
• Over-the-counter pain relievers (such as acetaminophen or ibuprofen) can help manage discomfort — ask a pharmacist or clinician what is appropriate for you 3Ref 3MedlinePlus / U.S. National Library of Medicine (2024).Ibuprofen: MedlinePlus Drug Information.Ibuprofen as an OTC analgesic option for ear pain management
• Avoid inserting anything into the ear canal, including cotton swabs, which can worsen infections or cause injury

Ear infections — particularly middle ear infections in adults — do not always clear without antibiotic treatment. If pain is worsening or accompanied by fever after more than a day or two, see a clinician rather than waiting.

What will a clinician check?

The cornerstone of ear evaluation is otoscopy — looking into the ear canal and at the eardrum with a lighted instrument. This reveals infection, fluid behind the eardrum, a perforation, or a normal-looking ear (which shifts attention to referred pain sources). A clinician will often also examine the jaw, throat, and neck. Hearing tests may follow if there is any change in hearing. Imaging (CT scan of the temporal bone) is reserved for suspected complications such as mastoiditis or cholesteatoma.