Ear pain that occurs inside the ear can be caused by a variety of conditions, some more serious than others. The medical term for ear pain is otalgia. Some potential causes of inner ear pain include:
Ear infections
One of the most common reasons for pain inside the ear is an ear infection, also known as otitis media. This occurs when fluid builds up inside the middle ear, often due to congestion and swelling from a cold, flu, or allergy. The fluid buildup puts pressure on the eardrum, causing pain and discomfort. Typical symptoms of an ear infection include:
- Throbbing, sharp pain inside the ear
- Feeling of fullness or pressure in the ear
- Muffled hearing
- Fever
- Drainage of fluid or pus from the ear
Ear infections are more common in children than adults. However, adults can get them too, especially if they have a cold, flu, or allergies. Most ear infections clear up within a few days with rest and oral antibiotics. See a doctor right away if you think you may have an infected ear.
Swimmer’s ear
Swimmer’s ear, also called otitis externa, is an infection of the outer ear canal typically caused by water getting trapped inside the ear after swimming or bathing. This moist environment allows bacteria and fungi to multiply, leading to irritation and infection of the skin of the ear canal. Swimmer’s ear can cause:
- Severe pain that worsens when the outer ear is touched or pulled
- Itching and discomfort inside the ear
- Redness and swelling of the ear canal
- Fluid drainage
- Diminished hearing
To treat swimmer’s ear, doctors recommend using antibiotic ear drops to clear up the infection. Avoiding water in the affected ear until it heals can also help.
Earwax blockage
Earwax, also called cerumen, can sometimes build up inside the ear canal and harden, causing blockage and pain. The pain is often described as a feeling of fullness or pressure. Other symptoms may include:
- Ringing, itching or buzzing in the ear
- Sensation that the ear is plugged
- Partial hearing loss
- Dizziness
- Coughing
If excessive earwax is causing pain, it’s best to have it removed by a doctor. They can suction it out safely. Never try removing earwax yourself by inserting objects into the ear canal, as this can damage the eardrum.
Otitis externa
Otitis externa is an inflammation of the outer ear and ear canal, usually caused by infection. It can lead to swelling, itching, and a sharp, throbbing pain that worsens when the outer ear is tugged or touched. Additional symptoms may include:
- Fluid draining from the ear
- Decreased hearing
- Ear canal redness and swelling
This condition, sometimes called swimmer’s ear, can be triggered by water trapped in the ear after swimming. Bacteria, fungi, or irritation from objects like cotton swabs inserted in the ears can also cause otitis externa. Treatment involves antibiotic ear drops.
Eustachian tube dysfunction
The Eustachian tubes connect the middle ear to the back of the throat, helping regulate air pressure. If these tubes get blocked due to swelling from allergies or a cold, it can cause uncomfortable pressure and pain inside the ear. Symptoms may get worse when swallowing, yawning, or chewing.
This condition is usually temporary and often clears up on its own as nasal congestion improves. Over-the-counter decongestants and antihistamines may offer relief by reducing swelling in the tubes. Rarely, a minor surgical procedure to insert small tubes in the eardrums is needed for chronic Eustachian tube dysfunction.
TMJ disorders
Temporomandibular joint (TMJ) disorders affect the joints and muscles involved in jaw movement. TMJ dysfunction can lead to pain in and around the ear without direct injury to the ear itself. TMJ causes include:
- Grinding or clenching teeth
- Jaw injury
- Arthritis
- Poor bite alignment
In addition to ear pain, TMJ often causes soreness in the jaw muscles and clicking/popping jaw joints. See your doctor or dentist if TMJ is suspected, as treatment may involve appliances, exercises, or surgery in severe cases.
Less Common Causes of Inner Ear Pain
While ear infections, swimmer’s ear, and earwax blockages are more frequent reasons for interior ear pain, other less common causes include:
Otitis media with effusion
Also called serous otitis media, this condition involves a buildup of fluid deep inside the ear without active infection. It usually occurs after an ear infection and causes a vague feeling of inner ear fullness and hearing loss. Muffled hearing may come and go. Medications or surgery can help drain the fluid if it persists.
Accurate barotrauma
Also known as airplane ear, barotrauma refers to ear pain caused by rapid changes in air pressure, such as when ascending or descending during air travel. It can cause sharp inner ear pain and a feeling of fullness or pressure. Yawning, chewing gum, and swallowing can help relieve the discomfort by opening the Eustachian tubes.
Foreign bodies
Small objects like beads, cotton swabs, or insects that get lodged in the ear canal can cause internal ear pain along with symptoms like itching, discharge, and hearing loss. Never try removing the object yourself, as you may push it deeper into delicate ear structures. See a doctor to have the foreign body safely extracted.
Herpes zoster oticus
Also called Ramsay Hunt syndrome, this condition occurs when shingles affects the facial nerve near the ear. It can cause severe piercing ear pain along with blisters inside the ear canal and on the outer ear, facial paralysis, and hearing loss. Antiviral drugs like acyclovir can help treat it.
Labyrinthitis
The labyrinth refers to the inner ear structures involved in hearing and balance. Labyrinthitis is inflammation of these structures, often stemming from a viral infection. Symptoms include vertigo or dizziness, ear pain, and muffled hearing. Medications can relieve nausea and antivirals may be prescribed.
Otosclerosis
This condition causes abnormal bone growth around the tiny bones of the middle ear, which transmit sound vibrations. This leads to gradually worsening hearing loss and sensations of pressure or pain inside the ear. It is usually treated with surgery if hearing aids are no longer effective.
When to See a Doctor
In most cases, interior ear pain resolves on its own or with simple home treatments like applying warm compresses and taking over-the-counter pain relievers. However, you should be evaluated promptly if you have:
- Moderate to severe ear pain that persists for more than a day or two
- Drainage of fluid, blood, or pus from the ear
- Hearing loss, ringing, buzzing, or dizziness
- Fever over 101 F
- Swelling or redness in or around the ear
- A foreign object stuck in the ear canal
- Pain along with facial weakness or numbness
Seeing a doctor promptly when appropriate can help diagnose and treat the underlying cause and prevent complications like chronic ear problems or permanent hearing damage.
Diagnosing the Cause of Inner Ear Pain
To find out why your ear hurts internally, the doctor will begin with a medical history and physical exam. They will use an otoscope to visually examine the ear canal and eardrum. Tests that may be performed include:
Hearing test
Audiometry evaluates your hearing by having you respond to tones at varying volumes and frequencies. This can help identify conductive hearing loss that may stem from middle or outer ear problems.
Tympanometry
This test assesses your eardrum’s flexibility and response to pressure changes. It can detect fluid buildup, perforation, scar tissue, or blockage in the middle ear space.
CT or MRI scans
Imaging studies of the ear structures can reveal problems like inflammation, bone growths, tumors, or damage to delicate structures. Dye may be injected to enhance visualization.
Blood tests
Blood work may be ordered to check for inflammation or to identify viral or bacterial causes of ear pain.
Treatments for Inner Ear Pain
Treatments for interior ear pain depend on the underlying cause but may include:
Antibiotics
If a bacterial infection is causing the ear pain, such as with otitis media or swimmer’s ear, antibiotics taken by mouth or ear drops may be prescribed. These can include penicillins, fluoroquinolones, aminoglycosides, or cephalosporins.
Over-the-counter pain medication
For mild to moderate ear pain, OTC analgesics like ibuprofen(Advil, Motrin), naproxen (Aleve) or acetaminophen (Tylenol) can provide relief. They help reduce inflammation as well.
Antihistamines and decongestants
Allergy medications that dry up excess mucus and reduce swelling can help if Eustachian tube dysfunction or allergies are to blame for the ear pain.
Corticosteroid ear drops
Steroid ear drops containing drugs like hydrocortisone help decrease swelling and inflammation associated with conditions like swimmer’s ear or autoimmune inner ear disorders.
Surgery
For chronic conditions that affect the small ear bones, like otosclerosis and superior canal dehiscence syndrome, surgery may be needed to correct structural problems in the ear.
Earwax removal
If excessive buildup of earwax is causing clogging and pain, the doctor may gently flush the ear canal with water, suction out the wax, or use small tools to scoop it out carefully.
Foreign body removal
Small objects lodged in the ear must be taken out by a professional to avoid damage. Various methods and tools can be used such as irrigation, microsuction, or specialty forceps.
Antiviral medication
For viral infections like herpes zoster oticus and labyrinthitis, drugs that fight viruses like acyclovir may provide some relief and shorten the course of infection.
Home Remedies to Relieve Pain Inside the Ear
In addition to medical treatment, these self-care tips can help ease ear discomfort at home:
- Apply a warm compress – Place a clean, warm washcloth over the affected ear to ease pain and swelling.
- Use OTC ear drops – Products containing ingredients like glycerin and propylene glycol help soften earwax and relieve minor discomfort.
- Try over-the-counter pain medication – Ibuprofen, naproxen, and acetaminophen can all help reduce internal ear pain.
- Use a humidifier – This can moisten and loosen thick mucus, helping open blocked Eustachian tubes.
- Avoid aggravating the ear – Don’t insert cotton swabs or fingers into the painful ear as this can worsen swelling.
- Stay hydrated – Drink lots of water, as this thins mucus and enables drainage.
- Elevate your head – Use extra pillows while sleeping to facilitate mucus drainage.
See your doctor promptly if home treatments don’t sufficiently relieve your ear pain within a day or two. Leaving inner ear issues untreated can sometimes lead to complications.
Preventing Future Ear Pain
Once your current ear pain resolves, you can take measures to avoid recurrence:
- Practice ear hygiene – Clean only the outer ear gently. Never insert cotton swabs or other objects into the ear canal.
- Avoid overusing earphones – Constant use can irritate the ear canal and eardrum.
- Use earplugs when swimming – This keeps water out of the ear canal and helps prevent swimmer’s ear infections.
- Treat allergies – Managing allergies can reduce chronic congestion and associated Eustachian tube dysfunction.
- Quit smoking – Smoking increases the risk of inner ear fluid buildup and infection.
- Get vaccinated for shingles – The shingles vaccine lowers your risk of developing Ramsay Hunt syndrome.
- Use OTC nasal sprays – Saline sprays keep nasal passages moisturized, while medicated decongestants can reduce Eustachian tube swelling.
- Manage stress – Chronic stress may exacerbate problems like TMJ ear pain.
Seeing an otolaryngologist, also called an ear, nose and throat (ENT) doctor, for regular checkups can help spot potential problems early as well. Be sure to seek prompt medical treatment if ear pain arises to avoid complications.
When to Seek Emergency Ear Pain Care
Most causes of internal ear pain don’t constitute medical emergencies. However, you should seek immediate medical attention if you experience:
- Sudden complete hearing loss
- Dizziness, vertigo, loss of balance
- Bleeding or fluid drainage from the ear
- Facial weakness or numbness
- Ear pain after a head injury
These symptoms can indicate serious conditions like skull fractures, ruptured eardrums, or damage to inner ear structures that require urgent evaluation and treatment.
Conclusion
Ear pain stemming from inside the ear is quite common and usually results from benign conditions like ear infections, swimmer’s ear, or earwax blockages. More serious causes like tumors are relatively rare. See a doctor promptly if you have moderate to severe pain lasting over a couple days, drainage from the ear, hearing changes, or other concerning symptoms. Delicate structures within the ear could suffer permanent damage if left untreated. With proper diagnosis and management, inner ear pain can usually be treated effectively. Be sure to follow up with your doctor as directed until the pain resolves.
