Pain behind the ear: causes and treatments.


While it is natural to think that "behind the ear" must be related to a problem inside the ear, such as an infection, this is not always the case. Your ear shares a nervous system with various structures in your head and neck. Diseases such as inflammation of the jaw joints, a dental infection, or a nerve-related headache can cause pain.

When evaluating pain behind the ear, sometimes also described as a "headache behind the ear," your doctor will examine your ear, jaw, mouth, neck, nerves, lymph nodes, and the skin around the face and skin. scalp. They will also ask about accompanying symptoms and may order various blood tests or imaging tests.

Once your doctor makes a diagnosis, they will formulate a treatment plan to ease your pain and address the underlying problem.

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Symptoms of pain behind the ear depend on the specific tissue affected (eg, ear, bone, muscle, nerve, or joint) and the underlying pathology (eg, infection, inflammation, or injury).

For example, a middle ear infection can cause a sharp, pressure-like pain inside or behind the ear. On the other hand, a bone infection behind the ear often causes severe throbbing pain and local redness / swelling just behind the ear.

In addition to primary ear problems, problems with a tooth or jaw joint can cause sharp pain or pulling in the ear. Similarly, inflamed nerves to the scalp can cause an abnormal burning or piercing sensation around the ear.

In most cases, pain behind the ear does not exist alone. There are usually accompanying symptoms, depending on the diagnosis, such as:

Seek emergency medical attention

Seek emergency medical attention if you experience pain behind your ear and one or more of the following symptoms:

  • Hot
  • Heavy drainage from the ear
  • Neck stiffness and photophobia (photophobia).
  • Swelling, warmth, and / or redness that extends behind the ear
  • Neurological symptoms (such as facial nerve paralysis or confusion)
  • Unintentional weight loss and / or neck mass


In the absence of the above "worrisome" symptoms, scheduling an appointment with your doctor is a smart first step if you experience pain behind your ear.

Depending on the quality and / or severity of your symptoms, and based on your doctor's initial suspicions or intuitions, you may be referred to a specialist. It can be an otolaryngologist , neurologist , pain reliever , or dentist.

Regardless of who you turn to, your diagnostic exam will begin with a medical history and physical exam. From there, additional tests can be ordered to confirm the diagnosis and exclude other alternatives.

History of the disease

During your medical history, your doctor will first look at past and current medical conditions and medications. Then your doctor will determine exactly how the pain feels.

Some sample questions may include:

  • Can you point to where you feel your pain?
  • Is your pain spreading ("radiating") somewhere?
  • How intense is your pain? (You may be asked to rate it on a pain scale of 1 to 10.)
  • Does the pain come and go or is it constant?
  • Has anything made the pain better or worse?
  • What other symptoms do you experience besides pain (for example, hearing problems, rash, fever)?

Physical exam

After receiving a detailed medical history, your doctor will perform a physical exam. In addition to recording your vital signs (temperature, heart rate, blood pressure), your doctor examines the muscles / bones / tissues / nerves / skin that make up your head, neck, and ear.

Specific steps may include:

  • Examine the outer ear and ear canal for redness, warmth, swelling, discharge, and a rash.
  • Using an instrument called an otoscope to look inside the ear for a buildup of wax or infection (such as a swollen or ruptured eardrum ).
  • An evaluation of your posture, neck range of motion, and bone or muscle pain.
  • Examination of the muscles / joints of the jaw for tenderness and range of motion.
  • Looking for a bad bite or signs of bruxism in the mouth.
  • Examine the cranial nerves
  • Pressure on the lymph nodes on both sides of the neck, behind the ear, and below the jaw.

Lab tests

Laboratory tests will not confirm the diagnosis, but they can help your doctor reconstruct all the pieces of the diagnostic puzzle.

For example, a high white blood cell (CBC) count indicates an infection. Similarly, an increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) suggests that an infection or inflammation is occurring in the body.


In some cases, the culture can be taken from the outer or middle ear. Culture results (which determine if any bacteria are growing) will help guide your treatment plan.

Visual tests

Imaging tests, such as X-rays or computed tomography (CT) , may be done to evaluate bone abnormalities in the skull bone near the ear or to detect arthritis in the joints of the neck or jaw.

If the diagnosis is still unclear, your doctor may order an MRI of the head and neck or jaw joint.

Diagnostic injections

If the source of your pain is suspected to be a nerve or muscle problem, your doctor may try injecting a local pain reliever (pain reliever) into the nerve or muscle, respectively. Temporary pain relief can help confirm the diagnosis.


There are many potential causes of pain or headache behind the ear, which is why it is important to see a doctor.

This is not an exhaustive list, but these are some of the main diagnoses that your doctor will consider.

Otitis media

Otitis media occurs when the space in the middle ear (located between the eardrum and the inner ear) becomes inflamed and infected. Viral respiratory tract infections, such as the common cold or flu , often cause otitis media.

In teens and adults, symptoms can include mild to severe earache and hearing loss or dullness. If the tympanic membrane ruptures as a result of increased pressure in the middle ear space, a person may feel immediate pain relief. They may also notice a pus-like discharge from the ear.

Young children with otitis media may pull their ears and / or experience fever, anxiety, difficulty eating and sleeping, and vomiting or diarrhea.

External otitis

Otitis externa , also known as swimmer's ear, develops when the ear canal (which connects the outer ear to the eardrum) becomes inflamed. Symptoms include pain in the outer ear, especially when pulled, itchy ear, and hearing loss. Patients with otitis externa may also notice discharge from the ears.

Otitis externa can result from infection, allergies, or chronic skin conditions.

Some factors that increase your risk of developing otitis externa include:

  • Excessive cleaning of the ear canal (such as removing wax with a cotton swab)
  • Regular swimming (allows bacteria that normally live in the ear canal to enter the skin)
  • Wearing devices in the ear (such as earplugs or hearing aids)

Strange objects

Foreign objects in the ear (such as insects, small toys, or peanuts) can cause external otitis or symptoms of external otitis without infection. This phenomenon is more common in young children.

Cerumen deposition

Sulfur, known as earwax , is a substance that protects the lining of the ear canal.

Sulfur dust generally discharges from the channel by itself. If this normal process of "cleaning" earwax is interrupted, the wax dust can accumulate deep in the ear canal.

Factors that contribute to earwax blockage include:

  • Engaging in possible "ear irritating" behaviors, such as using cotton swabs regularly, sticking a finger in the ear canal, or wearing hearing aids.
  • Waxy substance from overproduction
  • A narrow or twisted ear canal
  • Sulfur production "drier" than usual.

If enough sulfur builds up, symptoms can develop, such as pain behind or inside the ear, a feeling of fullness in the ear, hearing loss, itching, and tinnitus.

Dental problems

Dental problems, especially cavities and abscesses , can manifest as pain behind the ear, especially if left untreated. Associated symptoms may include toothache or tenderness, swollen cheek, and / or enlarged and painful lymph nodes under the jaw or in the neck.

Interestingly, in a study of nearly 100 patients with recurring earache, dental problems were the most common cause.

Temporomandibular joint disease

The temporomandibular joint (TMJ) is located at the front of your ear, where your jaw connects to the skull. Problems with this joint and the muscles around it can cause a so-called TMJ disorder .

The main symptom of a TMJ disorder is a dull ache near the ear on the affected side. The pain is worse when chewing or when opening and closing the mouth.

Other symptoms of TMJ disorder include:

  • Headaches that are worse in the morning and spread to the jaw, temples, or forehead.
  • "Heaviness" or "fatigue" of the jaw after eating
  • Jaw sounds like clicking, cracking, or cracking
  • Tinnitus
  • Discomfort in the eyes, neck, arm, or back.

Several factors can contribute to the manifestation of TMJ disorder, including arthritis or damage to the TMJ joint, chronic grinding of the teeth, malocclusion, poor head and neck position, stress, and genetic factors.

Occipital neuralgia

Occipital neuralgia causes sharp, stabbing, shooting, or electric shock-like pain that spreads across the upper neck, back of the head, and behind the ears.

Occipital neuralgia pain is sudden, usually on one side of the head, and can be caused by simple daily movements, such as brushing your hair or moving your neck.

Besides occipital / neck / ear pain, other potential symptoms of occipital neuralgia include:

  • Visual impairment or pain behind the eye, located on the same side as the headache.
  • Pressure pain in the back of the head / behind the ear
  • Tinnitus
  • Dizziness and nausea
  • Nasal congestion

The cause of occipital neuralgia is not fully understood. One theory is that the disease is caused by chronic pinching, irritation, or pinching of the occipital nerves that begin in the neck and run along the back of the skull to the top of the head.

This pinching can occur on its own or be associated with another medical condition, such as osteoarthritis of the neck , degenerative disc disease, inflammatory or blood vessel disease, or a rare type of tumor called a schwannoma.


Mastoiditis is an unusual infection of the mastoid process behind and below the ear. Mastoiditis occurs as a result of the progression of acute otitis media and can occur at any age, but is most common in children under 2 years of age.

In adults, symptoms of mastoiditis generally include severe pain behind the ear, fever, and headache. Young children are often quite painful, irritable, and have a fever. Children may pull on a sore ear or complain of an earache if they can speak.

If left untreated, mastoiditis can lead to very serious complications, such as meningitis , intracranial abscess, sinus venous clot, infection of the skull bone, hearing loss, and facial nerve palsy.

Ramsey Hunt syndrome

Ramsey Hunt syndrome is caused by reactivation of the virus that causes chickenpox (varicella-zoster virus).

This rare condition is associated with a painful, blistering rash inside the ear canal or on the outside of the ear. Sometimes the blisters are found in the mouth and / or in the upper part of the throat. The earache in Ramsey Hunt syndrome can be severe and spread to the neck.

Other possible associated symptoms include facial nerve palsy on the affected side, tinnitus, hearing loss, dizziness , nausea, and vomiting.

Watch out

Treatment for pain behind the ear depends on the specific diagnosis.

For example, infections such as otitis externa or otitis media often require a course of antibiotics in the form of ear drops or oral pills, respectively.

Mastoiditis is a more serious infection that requires intravenous (IV) antibiotics and surgical drainage of the infected fluid. Also, a tooth abscess requires drainage and antibiotic therapy.

If the earwax is blocked, your doctor may recommend using drops to soften the earwax or they may rinse your ear. Sometimes a special tool with a hook or suction device is used to remove the wax.

Treatment of TMJ disease often involves trial and error. Patients may benefit from a combination of pain relievers such as muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) , physical therapy, stress management, and avoidance of triggers such as nail biting or jaw clenching.

Antiviral medications and steroids are commonly prescribed to treat Ramsey Hunt syndrome .

Lastly, occipital neuralgia can be treated with a combination of heat, pain relievers, and a nerve block, often performed by a neurologist or pain specialist.

Frequently asked questions

Are there lymph nodes behind the ears?

Yes, there are lymph nodes behind the ear; These are known as posauricular lymph nodes. They are most often swollen or enlarged when a person has a bacterial or fungal infection of the scalp, such as ringworm of the scalp, also known as ringworm of the scalp.

Why does the bone behind the ear hurt?

The bone behind the ear is called the mastoid bone, which is part of the skull. If this bone becomes painful and red, you may have a very serious infection called mastoiditis.

Mastoiditis is more common in children, but it can also occur in adults and is usually caused by an untreated middle ear infection. Other symptoms of mastoiditis can include a high fever, headache, and swelling behind the ear that makes it protrude.

If you suspect you have mastoiditis, go to the nearest emergency room. This infection requires immediate treatment with intravenous antibiotics.

What does pain behind the ear mean?

Pain behind the ear can be one of several. You may have an infection in or around the ear, inflammation of the nerves in your scalp, or a problem with a tooth or jaw joint.

A wide range of possible diagnoses is due to the fact that your ear is in close proximity to many other structures in the head and neck. After all, consulting a healthcare professional for a diagnosis will help you resolve your pain more quickly.

How to stop earache?

Your first step is to see your doctor for a proper medical examination. Once a diagnosis is made, you can begin to develop a treatment plan to relieve pain and address the underlying problem.

For example, your doctor may not only recommend pain relievers, but may also prescribe an antibiotic for an ear infection or refer you to the dentist if they suspect you have a dental problem.


Pain behind the ear can have many causes. These include ear infections, damaged earwax, and problems with the teeth, jaw, and nerves. A healthcare professional can resolve your pain with a detailed history and examination. Treatment will depend on the origin of the pain.

Get the word of drug information

If you suffer from pain behind the ear or any type of this symptom, schedule a virtual or face-to-face appointment with your doctor. The diagnosis will calm you down and allow you to develop a treatment plan and feel good again.

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