Ear Pain

Ear pain can be due to infection of the ear or due to other causes. Infections of the ear can effect the ear canal (otitis externs) or middle ear (usually involving the ear drum). Non-infective causes include problems with nearby structures e.g. tonsil infection, wisdom tooth problems or jaw joint. In my opinion many of the cases of ear pain for which there is no clear cause are caused by a type of “migraine”. Unfortunately there is no agreed terminology for this condition hence the I use of the word migraine. It has feature in common with atypical facial pain (often wrongly diagnosed as sinusitis) and TMJ (jaw joint) problems. It can mimic many type of ear infection and can co-exist with the “typical” ear infections.

What is causing my problem?

Some specific symptoms would hint at where the problem may be.
If the ear is frequently itchy and/or there is a history of eczema/skin problems the problem may be a type of chronic eczema of the ear canal. In this case there is often only small amount of discharge. The pain can occasionally become severe if the external ear canal becomes infected. Any hearing loss tends to come later in the disease process. For information on infection involving the external ear canal please click here.
If the problem comes on after a cold and results in severe ear pain, hearing loss and later ear discharge (occasionally with blood) the ear drum may have perforated/become infected. Usually the ear drum will repair itself after a few weeks. Occasionally, however, the ear drum does not heal and this can result in recurrent bouts of ear discharge/infection. For information regarding infection of the middle ear and ear drum please click here.
In cases where there is significant ear pain which may last for short periods, for example seconds, minutes or hours without much ear discharge or hearing loss the problem may be type of “migraine”. Other conditions such as neuralgia can cause pain lasting seconds. People with a type of migraine may have other features of migraine such as headaches affecting the top of the head or pain over the front of the head, nausea,  flashing lights/zigzag lines in the visual field or a family history of migraine.  Certain conditions such Meniere’s disease typically have pressure, hearing loss, spinning business and tinnitus. Some cases however can start with pressure alone.  Eustachian tube dysfunction is a another condition characterised by a sensation of pressure or blockage in the ear due to problems with the function of the eustachian tube which connects the back of the nose with the middle ear.  In my opinion cases of unexplained ear pain, migraine, eustachian tube dysfunction and Menieres disease may in fact be due to the same underlying condition which manifests in different ways. Patients with these conditions often have other problems such as posterior neck pain, back pain and IBS (irritable bowel syndrome).  I treat unexplained “migraineous” ear pain the same way as I worked a treat migraine (click here).