Pain behind the ear occurs in the area of the mastoid process, the prominent, dense bone portion of the skull located just behind the ear canal. Understanding the diverse origins of this pain is the first step toward appropriate care, as the source can be local to the ear structure itself or referred from distant nerves and joints. While many causes resolve quickly, others require prompt medical attention to prevent complications.
Infections and Inflammation of the Mastoid Bone
The most severe localized cause of pain in the bony area behind the ear is an infection known as mastoiditis. This condition involves the infection or inflammation of the mastoid air cells. Mastoiditis typically arises as a complication when an acute middle ear infection (otitis media) remains untreated.
Bacteria spread into these air cells, causing persistent, deep, and throbbing pain, often accompanied by fever and a creamy discharge from the ear. A defining physical sign is tenderness and swelling over the mastoid process, which can cause the external ear to appear pushed outwards or downwards.
Because the mastoid bone is positioned near vital structures, an untreated infection can progress to life-threatening complications, such as meningitis or a brain abscess. Prompt diagnosis and aggressive treatment, usually with intravenous antibiotics, are necessary to prevent these serious consequences.
Superficial Skin Conditions and Lymph Node Swelling
Pain behind the ear may also be caused by conditions affecting the skin or the underlying lymphatic system. The posterior auricular lymph nodes are situated directly in this area and serve to filter fluid from the scalp, ear, and surrounding tissues. When the body fights a local infection—such as a common cold, tonsillitis, or a minor ear infection—these lymph nodes swell as they work to contain pathogens.
This swelling often presents as a tender, movable lump that causes localized pain when pressed or touched. Superficial skin issues like folliculitis (where hair follicles become inflamed) or an infected sebaceous cyst can also cause discomfort in this specific area. These skin-related causes result in pain and tenderness that are confined to the soft tissue and skin, distinguishing them from the deep, throbbing pain characteristic of bone inflammation.
Pain Originating from the Jaw or Nerves
Temporomandibular Joint (TMJ) Disorders
Pain behind the ear can be referred pain stemming from structures like the jaw joint or nerves in the neck. Temporomandibular Joint (TMJ) disorders involve the joint connecting the jawbone to the skull, which is located immediately in front of the ear. Inflammation, misalignment, or muscle tension in this joint, often due to teeth grinding or clenching, can cause pain that radiates backward. This discomfort is often described as a dull ache or a sensation of fullness in the ear, frequently worsening with chewing or speaking. The proximity of the joint and shared nerve pathways facilitate this pain referral to the ear region.
Occipital Neuralgia
Another source of referred pain is Occipital Neuralgia, caused by the irritation or compression of the occipital nerves that travel up the neck to the scalp. This nerve irritation produces sharp, shooting, or electric shock-like pain. The pain usually begins at the base of the skull or upper neck and radiates upward, often extending over the top of the head and localizing behind the ear. This neuralgic pain can be triggered by simple head movements or light touch to the scalp.
Warning Signs Requiring Immediate Medical Care
While many causes of pain behind the ear are minor, certain accompanying symptoms signal a medical emergency that requires immediate attention. Seek immediate medical care if you experience:
- Pain accompanied by a high fever (above 102°F), which suggests a systemic infection that may be spreading quickly.
- The ear being visibly pushed outward or a noticeable bulging of the skin over the bony area, which is a significant sign of advanced mastoiditis.
- Sudden and severe hearing loss combined with intense pain, indicating potential damage to the inner or middle ear structures.
- Other neurological symptoms, such as facial weakness or paralysis on the same side, severe dizziness, or confusion.
- Copious, thick, or foul-smelling ear drainage, or if the pain becomes severe and unmanageable.