Forms

In principle, primary ear pain is distinguished from secondary ear pain. Primary ear pain is caused by a disease of the ear. Secondary ear pain can occur when not the ear but adjacent organs and structures are affected, and the pain is transmitted into the ear via corresponding nerve fibers.

The following nerves can cause such a transmission:

Trigeminal nerve
Facial nerve
Glossopharyngeal nerve
Vagus nerve

For example, diseases of the teeth, parotid gland and temporomandibular joint can trigger secondary earaches. In many cases, the primary ear pain has inflammation of the middle ear (otitis media) as its underlying disease. This is a painful inflammation of the mucous membrane of the middle ear, which often follows an inflammation of the upper respiratory tract. If the eardrum is ruptured, pathogens can also enter the middle ear from outside and also cause inflammation of the middle ear.

Frequency

While adults usually go to the doctor for secondary ear pain that is not directly related to the ear, children in most cases complain of otitis media as a causative factor. 3-6% of all visits to a family doctor’s office are caused by earache. Over the past 30 years, the frequency of middle ear infections has almost tripled.

By the third month of life, every tenth child has experienced an episode of middle ear infection. The peak of the disease is between the 6th and 15th month of life. By the age of 10, about 40% of children have experienced an episode of middle ear infection.

Causes

There are a number of diseases that can cause earaches. In the case of an acute inflammation of the middle ear, earache sets in suddenly and unexpectedly. Patients usually also complain of exhaustion, fever and irritability.

Children in particular are very often affected by acute middle ear infections. They often experience several episodes of recurring middle ear infections. This is usually also caused by a previous or still existing infection of the upper respiratory tract.Swelling of the ducts (tubas) causes hearing disorders and an outwardly bulging and reddened eardrum.

If only one ear is affected, a bacterial cause could be the cause. The most common pathogens causing middle ear inflammation are the bacteria Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Viral pathogens are also discussed as causes.

Especially the viruses respiratory syncytial virus, parainfluenza virus, influenza virus and enteroviruses seem to be triggering pathogens. If there are three middle ear infections in half a year, this is referred to as a recurrent middle ear infection. If a middle ear infection lasts for weeks or even months, it is called chronic middle ear infection.

Bacteria can also cause pain in the earlobe by penetrating an open wound there. Another cause of ear pain can be a so-called seromucotympanum. This is an accumulation of serous or mucous fluid in the middle ear cavity without any signs of a purulent inflammation.

In most cases, a feeling of pressure often occurs on both sides with hearing loss. In children, there is a risk of linguistic developmental disorder. The cause is assumed to be mechanical constriction by the pharyngeal tonsils.

But infections of the upper respiratory tract are also discussed as a triggering factor. The so-called tube catarrh is caused either by infections of the upper respiratory tract or by rapid ascent to high altitudes (airplane) or descent to depths (diving). This leads to a closure of the auditory canals, resulting in reduced ventilation, retraction of the eardrum and influx of fluid into the middle ear.

Inflammation of the external auditory canal and the outer ear can also cause ear pain. They are usually caused by bacteria, fungi or allergies. Toxic substances can also cause an inflammation of the outer ear (otitis externa).

Patients who frequently go to the swimming pool often complain about this disease. Certain cosmetics, hair shampoo or nickel can cause toxic otitis externa, and the improper use of cotton swabs can cause minor trauma and thus ear pain. Ear canal furuncle (caused by bacterial Staphylococcus aureus infections) can also lead to ear pain, as can the erysipelas of the skin in the area of the ear caused by streptococci.

While the patient usually also complains of a bad general condition and fever, perichondritis (inflammation of the ear cartilage) is only manifested by a painful redness and swelling. Mastoiditis also causes severe general health problems as well as fever and redness of the ear. Here, a bacterial infection of the mastoid behind the ear occurs.

In extreme cases, the swelling causes the ear to be displaced. This leads to the protruding ear, which is an absolute emergency. Ear pain can also be caused by inflammation of the tonsils, parotid glands, thyroid glands, arteritis temporalis or Pfeiffer’s glandular fever.

In cases of untreated earache, the presence of tuberculosis of the ear or so-called Wegener’s granulomatosis must also be taken into consideration. By continuing pain transmission, diseases of the intervertebral discs and muscular tensions in the back of the neck can also trigger ear pain. The so-called zoster oticus is caused by varicella zoster viruses, often caught several years earlier.

Only a long time after the first infection, blisters appear on and around the ear, earache can result. Suddenly shooting and lightning earache could be caused by a trigeminal neuralgia. This is a nerve irritation of the trigeminal nerve with often very severe pain in this area.

Foreign bodies in the ear, such as the remains of cotton swabs or excessive production of earwax (cerumen) can lead to ear pain in addition to hearing disorders. Furthermore, eardrum injuries after improper use of cotton swabs are frequent causes of earache. After corresponding accidents with subsequent severe earaches, there must always be a suspicion of a fracture of a bone in this area.

A fracture of the petrous bone would not only cause hearing problems and earaches but also bleeding from the ear. Sialolithiasis is a salivary dysfunction that can also cause earaches.In the case of non-treatable and long-lasting ear pain, suspicion of a malignant tumor in the area of the ear must always be raised. The most frequent tumors in this area are:

Nasopharyngeal carcinoma
Basal cell carcinoma
Squamous cell carcinoma
Spinalioma
Acoustic neuroma