As an Ear Nose and Throat doctor it certainly seems reasonable that I would have patients coming in to my office because of pain in the ear. And it is certainly a common problem. Most of us assume that the sensation of an earache automatically means there is an underlying ear infection. While ear infections are often seen and certainly can cause pain I wanted to take some time to talk about many other factors that can cause pain that ear region that may not have anything to do with infection.
First of all a little anatomy discussion is helpful. The ear itself can be divided into an outer ear that sticks out from your face and includes the ear canal, then a middle ear which is the air pocket behind the eardrum that connects to the nose, then the inner ear which is in the skull where nerve endings of hearing and balance are located. When we talk about pain however we need to look at the different nerves that go from these 3 ear parts to the brain that supply the feeling of sensation. It is only through this type of sensory nerve that are brain says that somewhere around our ear hurts.
The reason that this is important is that there literally nerves coming from the brain to the ear from several locations. For example one large nerve coming from between the first and second cervical vertebra (C1–C2) goes up from the neck right into the ear. Many people are aware that a pinched nerve a low in the neck can cause pain shooting down the arm but a pinched nerve high in the neck feels like it is right in your ear. Very frequently in people older than age 50 ear pain is due to arthritis muscle spasm or misalignment of vertebra in the upper neck.
Many of us have heard the term TMJ. It essentially means the jaw joint (temporo-–mandibular joint). It is important to realize that the front wall if the ear is this very complex joint. Arthritis, muscle spasm or damage to the cartilage disc in the joint all can be painful and all can be interpreted as coming from your ear.
One large area of nerve supply from the ear to the brain also is a nerve supplying sensation for most of the throat. A throat infection such as strep or tonsillitis may start as ear pain. Even problems or in the throat such as around the voice box may present as ear pain first.
Certainly common problems such as infection of the outer ear canal like swimmers ear or of the air pocket behind the eardrum (otitis media, which is usually meant by ear infection) will make someone’s ear hurt. But so many other problems are there that could be the source of the pain that need to be considered, especially before just getting a round of antibiotics and antihistamines.