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Earache (cont.)

Causes of middle ear (otitis media) earache

The middle ear is separated from the external ear canal by the eardrum, and this is the location of nerves involved with hearing. It is a relatively closed space and anything that increases pressure in the middle ear will cause pain.

  • Middle ear infections are a common cause of otitis media especially in children. These are commonly caused by a virus or bacteria that invades and infects stagnant fluid in the middle ear.
  • Serious otitis media describes fluid collection within the middle ear and is usually due to Eustachian tube dysfunction. This is the tube that drains fluid and equalizes pressure between the middle ear and the back of the throat. Increased pressure may cause pain and fullness but usually resolves over time. However, this fluid may also become infected, causing pain and fever.

Causes of inner ear earache

  • The inner ear is adjacent to the middle ear. The inner ear is the site of the labyrinth system that sends messages to the brain to help with balance. Inflammation of the inner ear is associated with vertigo but not necessarily pain.

Eardrum (tympanic membrane) and earache

The eardrum, or tympanic membrane, separates the external ear canal from the middle ear. It vibrates when sound hits it and transmits that vibration to allow the sense of hearing. Myringitis describes inflammation of the eardrum.

  • Bullous myringitis causes inflammation and blistering of the tympanic membrane and can be very painful. Then infection may be due to bacteria, virus, or fungus.
  • Myringitis may be due to extension of an infection from the external canal or from the middle ear
  • Traumatic myringitis may occur from a direct injury like poking a sharp object into the ear canal.
  • Trauma may also cause increased pressure in the area of the eardrum, causing it to rupture. This may include a blow to the ear with the palm of the hand, change in air pressure within an airplane, an explosion or other situations in which air is forced into the ear canal.
  • Electrocution injury is often associated with perforation of the eardrum.

Other causes of earache or ear pain

Ear discomfort may be due to pain from a nearby structure that that radiates to the ear:

  • TMJ pain. The temporomandibular joint, where the jaw attaches to the skull, is located adjacent to the external ear canal, and inflammation of this joint may be associated with ear pain. TM joint pain may be due to trauma or arthritis. Teeth grinding may cause irritation and ear pain as well.
  • Sinusitis may be associated with increased pressure within the middle ear, causing pain.
  • Dental problems and toothaches may radiate pain to the ear area.
  • Mastoiditis. The mastoids are bony prominences of the skull filled with air cells and are located behind the ear. Infection of these areas may cause ear pain.
  • Pharyngitis (throat inflammation) and tonsillitis may cause pain that radiates to the ear. A peritonsillar abscess will often result in ear pain in addition to difficulty opening the mouth and difficulty swallowing.
  • Thyroid inflammation and carotid artery pain (carotidynia) may also be associated with ear pain
  • Trigeminal neuralgia. Inflammation of the fifth cranial nerve may cause significant facial pain including ear pain.
  • Tinnitus. While not truly pain, ringing in the ear may cause significant discomfort
  • Barotrauma describes injury to the ear because an acute change in pressure within the middle and inner ear. This may include changing pressures from flying in an airplane, scuba diving or snorkeling, or trauma due to a blast injury. Damage may occur to any or all of the eardrum, middle and inner ear.
Medically Reviewed by a Doctor on 8/23/2016

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