When you have an earache, you may assume that you have an ear infection. But while middle ear infections are an extremely common cause of childhood ear pain, they’re much less common among adults, says Gayle Woodson, MD, former chair of ­otolaryngology at Southern Illinois University School of Medicine.

Here’s a look at nine other potential causes of adult ear pain…how to identify each one…and then what to do about it…

Temporomandibular joint (TMJ) disorders. The hinge of the jaw is directly in front of the ear, so inflammation of this joint or spasms of the jaw muscles can cause severe ear pain and potentially ringing in the ear.

Is this the source of your ear pain? Open and close your mouth—if your temporomandibular joint is the problem, you’ll likely feel discomfort when you do this and perhaps hear clicking or popping. Check your bite—when there’s a TMJ issue, the upper and lower teeth can feel like they’re not matching up quite right. Consider precisely where you feel pain—TMJ-related pain might feel focused in the ear but often radiates outward causing other parts of the head and neck to hurt as well.

What to do: Rest your jaw—avoid eating hard or chewy foods, and keep your jaw muscles relaxed rather than clenched. Take an anti-inflammatory drug such as naproxen or ibuprofen. If that doesn’t solve the problem, a dentist can provide additional options, such as wearing a mouthguard at night.

Eustachian tube dysfunction. When the tubes that connect the middle ear to the upper throat become clogged or swell shut, the result can include ear pain, a feeling of fullness in the ears, ringing or clicking sounds, and/or difficulty hearing. Eustachian tube blockages sometimes lead to middle ear infections—though such infections are much more common among children than adults.

Is this the source of your ear pain? Hold your nostrils shut and swallow—if your eustachian tubes are blocked, you won’t feel a change in your hearing and/or the pressure in the ear. When these tubes are working properly, doing this temporarily dulls the hearing and ­creates noticeable pressure inside the ear. Swallow again without shutting your nostrils to clear this.
What to do: Wait for the underlying infection to resolve—eustachian tube dysfunction usually is a symptom of an infection that isn’t in the ear, such as a common cold or sinus infection. It also can be caused by allergies or acid reflux. Once this underlying condition passes or is treated, the ear issue should resolve on its own. In the meantime—a decongestant nasal spray containing oxymetazoline, such as Afrin, might provide temporary relief. Caution: Using these nasal sprays for more than three consecutive days could trigger “rebound congestion.” If your eustachian tube blockage persists for more than two weeks, see a doctor.

Swimmer’s ear (otitis externa). This form of ear infection is in the outer ear, not the middle ear. The presence of moisture in the outer ear increases risk for these infections, but you can get swimmer’s ear without ever going swimming—even showering or being outside on a humid day can be sufficient. Having too much earwax increases the odds of getting swimmer’s ear, because the wax can trap moisture. Swimmer’s ear can cause significant pain and potentially also itchiness, mild fever, discharge from the ear and/or some temporary hearing loss.

Is this the source of your ear pain? Use your hand to wiggle your ear—if doing this is painful, swimmer’s ear is the leading suspect. But before you jump to this conclusion: Consider whether you’ve tried any new hair-care products recently or your hairdresser recently applied an unfamiliar product to your hair. An allergic reaction to a product can cause swelling in the outer ear that could be mistaken for swimmer’s ear.

What to do: Try over-the-counter ­eardrops for swimmer’s ear—that might be sufficient for mild cases. If you’re in great pain and/or are virtually unable to hear through the affected ear, see a doctor—he/she can prescribe eardrops that contain steroids or antibiotics. When swelling is severe, it may be necessary to place a wick in the ear canal to allow drops to track into the ear.

Air pressure change (ear barotrauma). Airline passengers know this feeling—ears popping with the changes in altitude. Swallowing or yawning pulls the eustachian tubes open to equilibrate middle ear air pressure with ambient air. Air flows out of the ears through the eustachian tubes during ascent and returns during descent. Eustachian tube dysfunction can block return of air during descent, resulting in painful negative pressure in the middle ear and diminished hearing. Sometimes the pressure differential becomes too great, and the tube essentially may lock closed for days. Eustachian tubes do not work well in the presence of nasal obstruction or inflammation of the nasal passages.

Is this the source of your ear pain? If the pain and diminished hearing began on an airline flight or while driving on steep mountain roads, this is the most likely cause.

What to do: Prevention is the best strategy—if you have a stuffy nose when you are planning to fly, use a nasal spray decongestant approximately 20 minutes before the flight lands. If you develop air-pressure–related ear pain, using a decongestant often will resolve the problem, and painkillers can reduce the discomfort. See a doctor if the situation doesn’t clear up in a few days.

Excessive earwax. Having greater-than-normal amounts of earwax can trap moisture, increasing the odds of swimmer’s ear, as noted above…but even if an infection does not develop, that wax could cause hearing loss by blocking the ear canal as well as pain if impacted wax presses against the eardrum.

Is this the source of your ear pain? If your ear feels oddly full and hearing has been diminished, it’s a possibility.

What to do: Use over-the-counter ­earwax-removal drops such as Debrox to flush away excess earwax. If that fails, see a doctor. Do not attempt to clear earwax using a cotton swab or a do-it-yourself earwax-removal device. Inserting things into the ear is likely to push earwax deeper into the ear or do other damage.

Hearing aid- or earbud-related pain. These devices often spend long hours inside your ears, and they can be very uncomfortable if they don’t fit properly.

Is this the source of your ear pain? If the discomfort dissipates when you remove the hearing aid or earbud, this likely is the issue.

What to do: Remove earwax on the hearing aid or earbud with over-the-counter earwax-removal drops—there’s a chance that earwax is preventing a proper fit or that inserting the hearing aid or earbud into the ear has created an earwax impaction. If that doesn’t solve the problem, ask the audiologist who supplied the hearing aid to have it adjusted, remolded or replaced. If earbuds are causing the problem, consider switching to a different type or over-the-ear headphones…or pay an audiologist to custom-make earbuds for you.

Dental infections. Pain from toothaches and other dental problems can radiate in such a way that the brain believes the ear is aching.
Is this the source of your ear pain? Use a fingernail to probe and tap each of your teeth as well as your gums—if you find a spot that’s highly sensitive to touch, there’s a good chance this is the source of what seems like ear pain.

What to do: Painkillers can provide temporary relief, but a trip to the dentist is likely necessary.

Eardrum damage. Eardrums can be ruptured by being near extremely loud noises, such as explosions…jabbing something deep into the ear, such as a cotton swab…or even by jumping into water or being hit on the side of the head by a wave. Eardrums sometimes rupture because of ear infections or rapid air pressure changes as well. Symptoms can include sudden-onset hearing loss, sharp pain, drainage from the ear, vertigo and/or a buzzing or ringing noise in the ear. Ironically, if you’ve been experiencing an ear infection or air pressure–related ear pain for some time, a sudden decrease in ear pain could signal a rupture.

Is this the source of your ear pain? If the pain was preceded by an event such as a cotton swab jabbed into the ear or a loud noise near your head, a ruptured eardrum is the leading suspect.

What to do: Take painkillers, avoid getting water in the ear…and see a doctor—eardrum damage often will heal on its own in a few weeks, but it can be prudent to take prescription antibiotic drops. Sometimes surgery or other treatments are required.

Tumors (acoustic neuromas, aka vestibular schwannomas). A tumor in the inner ear can cause headaches, a sense of fullness or uncomfortable pressure inside the ear, a buzzing noise and/or balance problems, but the most common symptom is hearing loss in the affected ear.

Is this the source of your ear pain? It probably isn’t—these tumors are rare. But if you experience hearing loss that’s exclusively in one ear and that persists for longer than a week, it’s a possibility that should be ruled out.

What to do: See a doctor—if you have a tumor in your inner ear, surgery might be required. Don’t let the word “tumor” cause undue fear—while these can cause serious issues if left untreated, they’re rare enough that this is probably not the source of your problem…and even if it is, acoustic ­neuromas are noncancerous.

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