Does Your Ear Hurt With Strep Throat?

Ear pain often comes along with strep throat, and in most cases the ear itself is fine. The hurt is usually starting in the throat and only being felt in the ear.1PubMed. Diagnosis of ear pain Sometimes the same bacteria do reach the ear, though, and a few patterns of pain point to a problem that needs a doctor soon.

Why Your Throat Can Make Your Ear Hurt

Pain can be felt in one place even though it starts somewhere else. One nerve serves the tonsils, the back of the tongue and the side walls of the throat, and it also has a branch that reaches the ear.2American Journal of Neuroradiology. A Pain in the Ear: The Radiology of Otalgia So inflamed tonsils from strep can send pain signals that the brain places in the ear.3American Journal of Neuroradiology. A Pain in the Ear: The Radiology of Otalgia A second nerve, which serves the lower throat and voice box, has its own small branch to the ear.4American Journal of Neuroradiology. A Pain in the Ear: The Radiology of Otalgia

Because the brain gets ear and throat signals along shared routes, it can’t always tell where a pain really began. That’s why someone can have a sore throat that seems mild while the earache is what bothers them most.

This kind of ear pain often flares when you swallow, because swallowing moves the inflamed tonsils. It tends to be on the same side as the worse side of the throat. It is usually an ache or a jab, without hearing loss or fluid draining, and it eases as the throat improves.

When the ear is the true source of pain, a doctor looking inside usually sees something abnormal.5PubMed. Diagnosis of ear pain When the pain is referred from the throat, the ear exam is typically normal.6PubMed. Diagnosis of ear pain One more clue: pressing gently on the little flap in front of the ear canal, or tugging the outer ear, usually doesn’t worsen referred pain, while it often hurts with an infection of the outer ear canal.

Muffled or clogged ears are a separate matter. A narrow tube links the middle ear to the back of the nose and throat, and its job is to let air in so pressure stays equal on both sides of the eardrum. When infection swells the tissue where that tube opens, it can stay shut, and the ear feels full, plugged or muffled, a bit like after a flight. This is a different mechanism from nerve-referred pain, but the two can happen together, so you can feel both an ache and a plugged ear. Fluid trapped behind the eardrum by a stuck tube can sometimes become infected, which is one way a throat illness leads to a real ear infection.

When Strep Actually Infects the Ear

Group A strep, the bacteria behind strep throat, can also cause middle ear infections, particularly in children.7PubMed. Acute otitis media caused by Streptococcus pyogenes in children Compared with ear infections from other germs, these were less often in both ears and less often accompanied by fever.8PubMed. Acute otitis media caused by Streptococcus pyogenes in children Most children with a strep ear infection came in with fluid suddenly draining from the ear.9PubMed. Acute otitis media caused by Streptococcus pyogenes in children A single ear leaking fluid during or after strep throat is a reason to be checked.

Pain often drops suddenly once drainage starts, because a burst eardrum releases the pressure that was building behind it. The relief doesn’t mean the infection is gone. An eardrum that has burst from infection usually heals by itself, but a doctor should still check the ear and decide on treatment. Don’t put drops in a draining ear unless a doctor says they are safe, since some drops can harm the inner ear when the eardrum has a hole.

Ear fluid can be tested for strep. In children whose eardrum had burst and was draining, a rapid strep test on the ear fluid identified strep in about 97 of 100 cases.10PubMed Central. Diagnostic Accuracy of Group A Streptococcus Rapid Antigen Detection Test on Middle Ear Fluid in Children With Acute Otitis Media With Spontaneous Perforation: A Prospective Multicenter Evaluation

Getting Relief From Throat and Ear Pain

For confirmed bacterial tonsillitis that is making someone miserable, a penicillin-type antibiotic is the standard treatment.11PubMed Central. Tonsillitis and sore throat in children It lowers fever and pain, most clearly by the third day, and shortens the illness by about a day on average.12PubMed Central. Tonsillitis and sore throat in children Most people feel noticeably better within 24 to 48 hours, with fever going first.13AFC Urgent Care Denver Park Hill. Strep Throat Timeline: Symptoms, Duration, and Recovery Finishing the full course, usually 10 days, is needed to clear the bacteria.14AFC Urgent Care Denver Park Hill. Strep Throat Timeline: Symptoms, Duration, and Recovery Referred ear pain should fade along with the throat, so ear pain that keeps building after 2 days of antibiotics deserves a call to the doctor.

Ibuprofen or acetaminophen can ease both throat and ear pain.15CareNow Urgent Care. Managing an earache and sore throat: Tips for relief and when to get help They work well for mild to moderate pain while you wait for a test result or for antibiotics to act.16MD Now Urgent Care. What to do when you have an earache and sore throat

For children, dose by the weight on the label rather than guessing from age, and use the measuring device that comes with the product. Many cold and flu products already contain acetaminophen, so taking one along with plain acetaminophen can lead to an accidental double dose. Children and teens should not be given aspirin, because of the risk of a rare but serious illness called Reye syndrome. Giving a dose 30 to 60 minutes before a meal or drink can make swallowing easier, which helps when a child is refusing to drink.

At home, warm drinks, cold treats such as ice pops, or salt-water gargles (in older children and adults) can soothe a raw throat. A warm compress held over the ear can ease the aching, though it won’t treat an infection. Rest and plenty of fluids help the body cope, especially with a fever and the risk of dehydration. Ear drops won’t help when the pain comes from the throat.

Strep spreads through saliva and droplets. People are generally considered no longer contagious after about a day of antibiotics without fever. Avoid sharing cups, and replace the toothbrush.

Warning Signs That Need Prompt Care

A peritonsillar abscess (quinsy) is a pocket of pus beside a tonsil. Signs include:

Among teens and adults seen by family doctors for sore throat, pus-forming complications such as quinsy, ear infection or sinusitis showed up in about 1 in 100.23First10EM. Should I treat Strep throat? – First10EM Rarely, a middle ear infection spreads into the bone behind the ear, and strep is one of the usual causes.24Slack Incorporated. Acute Mastoiditis Caused by Streptococcus pneumoniae In rare adult cases a strep ear infection has spread toward the brain and needed hospital IV antibiotics.25PubMed Central. Group A streptococcus acute otitis media progressing to neuroinvasive disease in adults Redness, swelling or tenderness behind the ear, an ear that is pushed out, severe headache, stiff neck or confusion need emergency care.

A mild sore throat and earache with no fever can reasonably be watched at home for a day or two, since many are viral and settle on their own. Fever, white patches on the tonsils or tender swollen neck glands without a cold-type cough call for a clinic visit and a strep test. Trouble breathing, drooling, or being unable to swallow saliva means going to the emergency room.

Young children may tug at the ear or refuse food rather than describe pain. Unusual drowsiness or not drinking needs a prompt check, and drainage from the ear warrants a visit within a day.

Other Causes of Sore Throat With Ear Pain

Viral infections like the flu can also cause throat pain, clogged ears and fever.26Next Level Urgent Care. Sore Throat and Ear Pain: Causes, Signs, and Remedies Antibiotics don’t help viral throats, which is why a strep test matters.

Cough, runny nose, sneezing and hoarseness point toward a virus, because strep typically doesn’t cause them. Sudden fever, tender swollen neck glands and swollen tonsils with white patches fit strep better, though they are clues rather than proof. Even doctors can’t reliably tell strep from a viral throat by looking, so only a throat swab confirms it. Strep is most common in school-age children and less common in children under three, and a sore throat in a child who has been around classmates with strep makes it more likely.

Jaw joint problems can mimic an ear infection. Earache is the most common ear-related complaint in people with jaw joint problems, and it is usually on one side and mostly mild.27PubMed Central. Incidence of Otolaryngological Symptoms in Patients with Temporomandibular Joint Dysfunctions Ear pain without a throat illness that worsens with chewing or jaw clenching may come from the jaw.

Earache that lasts after the throat has recovered, with a normal ear exam, calls for a doctor to look at the throat, teeth and jaw. Ongoing one-sided ear pain in an adult, especially a smoker, deserves a thorough throat examination, since persistent referred pain can occasionally come from a growth in the throat. A dental infection, such as an abscessed back tooth, can also send pain to the ear and is easy to mistake for an ear problem. If ear pain has no clear explanation after a couple of weeks, raise it with a dentist or doctor.