An earache is pain in or around the ear that can range from a dull pressure to a sharp, burning sensation. It’s one of the most common reasons parents bring children to the doctor, but adults get earaches too, and the causes aren’t always what you’d expect. About half of all ear pain actually originates somewhere else in the body, like the jaw, teeth, or throat, and is felt in the ear through shared nerve pathways.
Pain From the Ear Itself
When the pain comes directly from the ear, doctors call it primary otalgia. The three most common culprits are infections of the outer ear canal, infections of the middle ear, and problems with pressure equalization.
Middle ear infections are the classic earache, especially in children. The space behind the eardrum fills with fluid and becomes infected, creating pressure that pushes against the eardrum. In kids, this often shows up as ear tugging, irritability, restless sleep, poor feeding, or vomiting. About two-thirds of children with a middle ear infection develop a fever, usually low-grade. Adults typically feel a deep, throbbing pain and muffled hearing.
Outer ear infections, commonly called swimmer’s ear, involve the ear canal rather than the space behind the eardrum. The hallmark sign is pain that gets worse when you tug on your earlobe or press on the small flap of cartilage at the front of your ear. It often starts as itchiness before progressing to real pain, and the ear canal can swell enough to partially or completely block hearing. Retained water in the ears and humid climates raise the risk, which is why it peaks in summer.
Earwax buildup is another overlooked cause. When wax compacts against the eardrum, it can produce a feeling of fullness, pain, muffled hearing, ringing, and even dizziness. This tends to develop gradually rather than suddenly.
Pressure Changes and Eustachian Tube Problems
A narrow tube connects each middle ear to the back of your throat. Its job is to equalize pressure on both sides of the eardrum. When this tube doesn’t open properly, whether from a cold, allergies, or rapid altitude changes during flying or diving, negative pressure builds up in the middle ear. That creates the familiar plugged, painful feeling. Eustachian tube dysfunction affects roughly 1% of the population on a chronic basis, but temporary episodes during a head cold are far more common. Symptoms include a popping sensation, fullness, reduced hearing, ringing, and pain.
When the Ear Isn’t the Problem
Referred ear pain, where the source is somewhere else entirely, accounts for up to half of earache cases. Four cranial nerves and two upper cervical nerves supply sensation to the ear, and any inflammation, infection, or irritation along those nerve pathways can register as ear pain.
The trigeminal nerve is the most common pathway for referred ear pain because it covers so much territory: the teeth, lower jaw, tongue, floor of the mouth, hard palate, and the temporomandibular joint (TMJ). Dental problems are the single largest source of referred earaches within this group. TMJ disorders are another major contributor. Between 70% and 78% of people with TMJ problems list ear pain as a chief complaint.
Sore throats, tonsillitis, and infections in the back of the throat can also trigger ear pain through the glossopharyngeal nerve, which supplies sensation to both the inner ear and the back of the tongue. This is why a bad throat infection can make your ears ache even when the ears themselves are perfectly healthy. Less commonly, problems in the voice box, thyroid, or even the esophagus can cause ear pain through the vagus nerve.
Managing Ear Pain at Home
Most earaches from common infections improve within a day or two. Over-the-counter pain relievers like ibuprofen and acetaminophen are the first-line treatment for comfort. For children, dosing depends on age and weight, so check the packaging carefully. Aspirin should not be given to children or teenagers because of the risk of Reye’s syndrome, a rare but serious condition.
A warm compress held against the ear can ease discomfort. Some parents use onion wraps or infrared light on the affected ear. These haven’t been proven effective in studies, but some children find them soothing, and they’re unlikely to cause harm.
For earwax buildup, you can soften the wax with a few drops of baby oil, mineral oil, saline solution, or hydrogen peroxide-based ear drops. Gentle irrigation with a bulb syringe after softening can help. What you should never do is stick anything into the ear canal, including cotton swabs. They push wax deeper, can damage the eardrum, and may actually stimulate more wax production. Ear candles are ineffective and carry a real risk of burns or eardrum perforation.
Antibiotics: Not Always Necessary
If you or your child has a middle ear infection, antibiotics aren’t always the immediate answer. Current pediatric guidelines recommend a “watchful waiting” approach for children over 6 months with a mild, one-sided ear infection. This means monitoring symptoms for 48 to 72 hours before starting antibiotics, since many infections resolve on their own.
Immediate antibiotics are recommended in specific situations: infants under 6 months, children between 6 and 24 months with infections in both ears, and any child with severe symptoms like drainage from the ear, high fever, or visibly impaired well-being. Your child’s doctor will help determine which approach fits.
Signs That Need Prompt Attention
Most earaches are uncomfortable but not dangerous. A few warning signs point to something more serious. Mastoiditis, an infection of the bone behind the ear, is the most concerning complication of a middle ear infection. It’s most common in children under two. Signs include redness, swelling, warmth, and tenderness behind the ear, often with the outer ear pushed forward. High fever and intense pain typically accompany it.
In 6% to 23% of mastoiditis cases, the infection can spread toward the brain. Seizures, stiff neck, severe headache, and confusion are emergency signs. Persistent ear pain in an adult, particularly on one side and without an obvious cause like a cold, also warrants investigation. Tumors or inflammation in the throat, voice box, or nearby structures can present with ear pain as the only symptom, making it easy to overlook the real source.