Outer Ear Pain: Causes and Remedies for Discomfort

Pain in the outer ear?

Hello, doctor.
I would like to ask you a question.
I have been experiencing mild pain on the outer part of both ears, specifically on the upper outer area and near the inner side close to the head.
The pain is not severe enough to require medication, but it is particularly noticeable after waking up.
The pain does not occur daily; it is intermittent and has been ongoing for about two months.
Occasionally, my right ear makes a sound similar to something crawling inside, but my hearing is normal.
When I visited a doctor, I underwent a nasal endoscopy, which showed no issues, but I had mild swelling of the tonsils and edema of the vocal cords, along with gastroesophageal reflux.
I also rarely experience headaches, but when I feel fatigued or have a cold, I sometimes have a sharp pain in the upper right side of my head.
Could you please explain why the outer part of my ears might be painful, especially after waking up? Thank you.

Mi Mi, 40~49 year old female. Ask Date: 2020/11/01

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the issues you mentioned could potentially be due to the following conditions: 1) Otitis externa 2) Migraine 3) Trigeminal neuralgia 4) Otitis media: a) Acute otitis media: often occurs alongside upper respiratory infections (colds), sinusitis, etc., and in severe cases, there may be ear discharge.
b) Chronic otitis media with acute exacerbation: usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.
5) Temporomandibular joint disorder: the joint located in front of the ear, often confused with ear pain, usually caused by poor bite habits, which can be managed with medication and adjustment of bite habits.
6) Eustachian tube dysfunction: the most common cause, which can occur not only during flying, climbing, or diving but also when forcefully blowing the nose or bending over.
7) Other less common diseases.

Since you mentioned "an occasional sound in the right ear that resembles something crawling," if you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where you press a button in response to sounds, rather than just using a tuning fork), and this test confirmed that there is no sudden sensorineural hearing loss, then medication may suffice.
However, if you have not undergone pure tone audiometry, it is advisable to visit a hospital for evaluation to rule out sudden sensorineural hearing loss, as the optimal treatment window for this condition is two weeks, and early treatment yields better results.
If symptoms persist, it is best to consult an otolaryngologist.
Wishing you safety and good health.
Ministry of Health and Welfare Taichung Hospital.

Reply Date: 2020/11/01

More Info

Outer ear pain can be a perplexing issue, especially when it occurs intermittently and is not severe enough to warrant medication. Based on your description, there are several potential causes for the discomfort you're experiencing in the outer ear area, particularly the upper part of the ear and the area near the head.

1. External Ear Canal Inflammation (Otitis Externa): This is one of the most common causes of outer ear pain. It can occur due to water exposure, irritation from ear cleaning, or infections. Symptoms may include pain, itching, and sometimes a sensation of fullness or noise in the ear, which could explain the "crawling" sensation you described.

2. Temporomandibular Joint (TMJ) Disorders: The TMJ is located near the ear, and issues with this joint can lead to referred pain in the ear area. If you have any jaw clenching or grinding habits, especially during sleep, this could contribute to your symptoms. TMJ disorders can also cause clicking sounds or discomfort when moving the jaw.

3. Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and helps equalize pressure. If this tube is not functioning properly, it can lead to a feeling of fullness or discomfort in the ear, particularly when waking up or during changes in altitude.

4. Sinus Issues: Given that you mentioned having a slightly swollen tonsil and a history of gastroesophageal reflux disease (GERD), sinus congestion could also play a role. Sinus pressure can lead to referred pain in the ear area, especially upon waking when mucus may accumulate overnight.

5. Nerve Irritation: The area around the ear is innervated by several nerves, including the trigeminal nerve. Irritation or inflammation of these nerves can lead to pain that may feel like it’s coming from the ear.

6. Referred Pain from Other Conditions: Conditions such as migraines or tension headaches can sometimes cause referred pain to the ear area. If you experience headaches or tension in your neck or shoulders, this could be a contributing factor.

Recommendations for Management
- Warm Compress: Applying a warm compress to the affected area may help alleviate discomfort. This can promote blood flow and reduce inflammation.

- Avoid Irritants: If you suspect that water exposure or ear cleaning is contributing to your pain, try to minimize these activities. Avoid inserting objects into the ear canal.

- Jaw Relaxation Techniques: If TMJ issues are suspected, consider practicing relaxation techniques for the jaw, such as gentle stretching or using a mouthguard at night if you grind your teeth.

- Hydration and Humidification: Staying well-hydrated and using a humidifier can help keep the mucous membranes moist, potentially alleviating sinus-related issues.

- Consultation with an ENT Specialist: Since your symptoms have persisted for two months, it may be beneficial to consult an Ear, Nose, and Throat (ENT) specialist for a thorough examination. They may recommend imaging studies or further evaluations to rule out any underlying conditions.

- Monitor Symptoms: Keep track of when the pain occurs, any associated symptoms, and potential triggers. This information can be helpful for your healthcare provider in determining the cause of your discomfort.

In conclusion, while outer ear pain can arise from various causes, understanding the underlying issues is crucial for effective management. If symptoms persist or worsen, seeking professional medical advice is essential to ensure proper diagnosis and treatment.

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