The SARS-CoV-2 virus, which causes COVID-19, is known for its wide and evolving range of symptoms, affecting not just the respiratory system but various parts of the body. The reported illness profile has broadened considerably, leading the public to question the significance of atypical symptoms, such as ear pain. This discomfort can be confusing for many who suspect a COVID-19 infection. This article clarifies the relationship between ear pain and the viral infection, detailing the physiological mechanisms that may link the two and exploring other common causes of this symptom.
The Status of Ear Pain as an Official COVID-19 Symptom
Ear pain is not typically listed among the most common symptoms of COVID-19 by major public health organizations. Official symptom lists focus on indicators like fever, cough, fatigue, and congestion. However, medical experts acknowledge that ear pain can manifest in a small percentage of patients, particularly with newer viral variants that affect the upper respiratory tract.
Clinical data suggests that ear-related complaints, including pain, a feeling of fullness, or ringing (tinnitus), are generally considered less common manifestations of the virus. When ear pain occurs, it is usually not an isolated symptom but appears alongside more recognized upper respiratory signs, such as a sore throat or nasal congestion. Therefore, ear pain remains a secondary or atypical symptom of the infection.
Physiological Reasons for Ear Discomfort During Viral Infection
The most frequent cause of ear discomfort during a COVID-19 infection stems from the body’s generalized inflammatory response. The upper respiratory tract becomes inflamed and congested, which directly impacts the function of the Eustachian tube. This narrow tube connects the middle ear to the back of the nasopharynx, equalizing air pressure and draining fluid from the middle ear cavity.
Inflammation and mucus buildup caused by the viral infection can lead to Eustachian tube dysfunction (ETD), blocking this connection. When the tube is blocked, pressure within the middle ear cannot equalize with the outside atmosphere. This causes a vacuum-like effect behind the eardrum, resulting in fullness, pressure, and pain. This mechanism explains why many respiratory viruses can lead to earaches.
Beyond this indirect mechanism, some studies suggest the SARS-CoV-2 virus may directly affect ear structures. Cells within the inner ear possess the ACE-2 receptors the virus uses to gain entry. While direct infection is not the established norm, the virus may cause inflammation or damage to sensory cells or blood vessels, potentially leading to symptoms like vertigo, tinnitus, or hearing loss. Furthermore, the inflammation and weakened immune response from a viral infection can sometimes lead to a secondary bacterial infection, such as acute otitis media, a common cause of severe ear pain.
Other Common Causes of Ear Pain
Ear pain is a common complaint with many non-COVID-19 related origins, most of which are more likely to be the source of discomfort. Beyond infections, pain can be referred, meaning the source of the discomfort is elsewhere but is perceived in the ear due to shared nerve pathways.
Common causes of ear pain include:
- Otitis media, or a middle ear infection, occurs when fluid builds up behind the eardrum, often following a cold or flu. The trapped fluid creates pressure, and if infected, causes significant pain and sometimes fever.
- Otitis externa, widely known as swimmer’s ear, is an infection of the outer ear canal. This condition typically causes pain that intensifies when the outer ear is tugged or pressed, and it may be accompanied by a watery discharge.
- Referred pain from the temporomandibular joint (TMJ), which connects the jawbone to the skull. Dysfunction caused by teeth grinding or jaw clenching can manifest as a persistent ache felt in the ear.
- Severe throat infections, such as tonsillitis or pharyngitis, often trigger ear pain through referred nerve connections.
- Sinusitis and allergies frequently cause pain by creating inflammation and congestion that block the Eustachian tubes, mirroring the mechanism seen in viral infections.
- Barotrauma is a pressure-related pain that occurs when rapid changes in altitude, such as during air travel or scuba diving, prevent middle ear pressure from equalizing quickly enough.
When Urgent Medical Consultation is Necessary
While many causes of ear pain, including those related to viral illnesses, often resolve on their own, certain signs warrant medical consultation. Persistent or severe ear pain that does not improve within 24 to 48 hours is a reason to seek professional help. This duration may signal a developing bacterial infection or another issue requiring specific treatment.
The presence of any fluid or discharge leaking from the ear, particularly if it is thick, yellow, bloody, or foul-smelling, indicates a ruptured eardrum or a severe infection. Other urgent symptoms include a high fever accompanying the ear pain, a stiff neck, or the sudden onset of hearing loss or dizziness. If you suspect a COVID-19 infection, consult a healthcare provider about all symptoms, ensuring any persistent discomfort is addressed for proper diagnosis and care.