Pain in the ear

Ear pain and earache can be very painful. Pain in the ear can be caused by ear infections, eardrum damage, colds, muscle tension in the jaw (among other things chewing myalgia), TMD syndrome, dental problems and injuries. The condition affects both children and adults.

- The most common reasons

Some of the most common causes are ear infections and sinus infections, but can also be due to malfunctioning of the jaw muscles and the jaw joint, often called TMD (temporomandibular dysfunction) syndrome, it can also be due to trauma - which in turn can lead to jaw meniscus damage or meniscus irritation. In the case of major trauma, jaw fractures or facial fractures may also occur. Jaw tension can also be caused or worsened by malfunction of the neck og shoulder. Gum problems, poor dental hygiene, nerve problems, sinusitis, and infection are also conditions that can cause pain in the ear. More rare causes can be acoustic neuroma or major infections.

Our clinic departments at Vondtklinikkene (click here for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high level of professional competence in the investigation, treatment and rehabilitation of jaw complaints and referred muscle pain. Contact us if you want the help of therapists with expertise in these areas.

Did you know that malfunctions in the jaw and neck can cause pain in the ear, face, teeth and temple? Here shows chiropractor Alexander Andorff presented two good training videos with exercises that can help you with muscle-related problems in the neck and jaw.

VIDEO: 5 Clothes Exercises against Stiff Neck and Jaw Headache

Jaw headache is a relatively common cause of pain in and around the ear. Many people are surprised when they learn about the anatomical connection between the neck, jaw and ear - and how they can influence each other. Tight and tense muscles in the neck and jaw can refer pain towards the ear. These five movement and stretching exercises can help you loosen up tense neck muscles and relieve associated referred pain to the jaw and ear.

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VIDEO: Strength Exercises for the Shoulders with Elastic

The shoulders and shoulder blades serve as the platform for neck movements and functionality. Precisely for this reason, it may be the case that your neck and jaw problems (as well as associated referred pain in the ear - if that is the cause) originate from this anatomical area. Training with elastic bands is an excellent and effective way to strengthen both the shoulders and shoulder blades - as well as contributing to better mobility between the shoulder blades and the neck. In the video, one is used elastic, flat training jersey (click here to see the knitted version).

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Where and what is the ear?

The ear is responsible for human hearing, but is also essential when it comes to balance and perceived body position.It is an extremely advanced structure - which is incredibly important for good function in everyday life.

Anatomy of the ear

(Figure 1: Anatomy of the ear)

In the illustration above (figure 1) we see how the ear is constructed anatomically. The ear is divided into three main parts: the outer ear, the middle ear and the inner ear. Here we find, among other things, the structures called the ear canal, the eardrum, the anvil, the hammer and the stirrup - we also see the cochlea and the cochlear nerve. The anatomy of the ear is so extensive that it really deserves its own article, but in this particular article our focus will be on ear pain.

The muscles and joints of the jaw can give you an earache

(Figure 2: Referred pain from the jaw muscles)

The Four Main Muscles of the Jaw

The jaw consists of the jaw joint (temporomandibular joint), jaw disk and jaw muscles. The four main muscles of the jaw are:

• Masseter (large masticatory muscle)

• Digastricus

• Medial pterygoid

• Lateral pterygoid

Tension and tension in the lateral pterygoid in particular are known to be able to refer pain to the ear. At point D in Figure 2 above, you can see how the muscle knot can cause pain towards the ear. This can also occur with TMD syndrome or neck tension. Studies have also shown a higher incidence of tinnitus among those with reduced jaw function and jaw complaints.¹

Neck muscles that can cause referred pain to the ear

(Figure 3: Overview of several muscles that can refer pain to and near the ear)

In the illustration above, you can also see how several of the neck muscles can cause referred pain towards the ear. Among other things, it is particularly important to note the neck muscle sternocleidomastoid, which can contribute to pain in the ear and back of the head, as well as the forehead. Here we would also like to mention that the upper trapezius can also cause pain up towards the ear. Figure 4 below also shows how the joints of the neck can cause referred pain towards the back of the head - and the back of the ear.

Relief and relaxation for tight neck muscles and jaw tension

It is well documented that stress can lead to tension and reduced mobility in both the neck and jaw. And as we now know, after looking more closely at the pain patterns of both muscles and joints in the jaw and neck, these can contribute to discomfort and pain in or in the direct vicinity of the ear. Using self-measures to calm tense muscles, such as this one the neck hammock, is something many do in our modern society. The neck stretcher is shaped so that it stretches, in an adapted way, towards the muscles and joints of the neck. Other good relaxation measures include acupressure mat or reusable heat pack (to regularly dissolve tense muscles).

Tips: Neck hammock (The link opens in a new window)

Click on the image or link to read more about the neck hammock and how it can help your neck.

Some possible causes / diagnoses for ear pain

• Barotraumatic otitis (also known as Flyor - may occur due to errors with pressure equalization)
• Cerumenitis (earwax)
• Poor dental health - cavities or gum disease
• Cold
• Mastoiditis (infection of the bone behind the ear - is it swollen, reddish and pressure sore?)
• Middle ear infection (also known as otitis media)
• Mild infection
• Neck joint locking
• Neck tension
• Referred pain from the jaw and jaw muscles (i.a. masseter (gum) myalgia may cause referred pain or 'pressure' against the cheek / ear)
• sinusitis / sinusitis
• Explosive eardrum (do you have pus or blood residue in your ear and started the pain with a sharp, sudden pain?)
• TMD syndrome (temporomandibular syndrome – often composed of muscle and joint dysfunction)
• Trauma (biting, irritation, burns and the like)
• Pain in the teeth
• Otitis
• Ear canal eczema
• Ear canal infection (also known as otitis externus or swimmer's ear)
• Ear / tinnitus
• Earwax collection

Rarer causes of ear pain

• Acoustic neuroma
• Fibromyalgia
• Infection (often with high CRP and fever)
• Cancer
• Lupus
• Migraine
• Nervous pain (including trigeminal neuralgia)
• Polymyalgia rheumatica (PMR)
• Trigeminal neuralgia

Possible Symptoms and Pain Presentations for Earache

- Electrical pain in the ear (may indicate nerve irritation)

Itching in the ear

Numbness in the ear

- Stinging in the ear

- Pain in the ear (a pain or burning sensation in parts or the whole ear)

- Wounds on the ear (wounds in parts or the whole ear)

- Ear pain

- Sore jaw (do you have muscle or joint pain in the cheek or jaw joint?)

- Pain in the gums

- Pain in the teeth

Clinical signs of earache and earache

Swelling can occur around a trauma or through an infection. The ear canal may be reddish.

– Ringing in the ear (tinnitus)

- Dizziness may occur

- Pressure tenderness over the jaw joint close to the ear can indicate pain from the muscles and joint structure.

Investigation and Examination of Pain in the Ear

The initial examination for ear pain will usually be with your GP. First, the doctor will ask you questions about your symptoms. Among other things, she will look into your ear to look for earwax build-up or signs of inflammation. If nothing is found on the examinations here - and the patient also has pain in the neck and jaw, then there is a higher probability that the symptoms originate from the jaw and/or neck.

Conservative Physical Treatment and Rehabilitation Therapy for Pain in the Ear

If the examinations indicate that the symptoms originate from the jaw and/or neck, physical treatment by a physiotherapist or chiropractor will be the next step. Our clinicians at the Vondtklinikkene Tverrfaglig Helse are concerned with an evidence-based and holistic approach when it comes to such treatment. In addition to this, you will also receive specific exercises that help provide long-lasting results. Press here to see an overview of our clinic departments and contact details.

NEXT PAGE: Osteoarthritis in the Neck [A possible cause of pain in the ear?]

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References and Sources:

1. Edvall et al, 2019. Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress. Front Neurosci. 2019 Aug 22;13:879.

2. Images: Creative Commons 2.0, Wikimedia, WikiFoundry

- Pain clinics: Our clinics and therapists are ready to help you

Click on the link below to see an overview of our clinic departments. At Vondtklinikkene Tverrfaglig Helse, we offer assessment, treatment and rehabilitation training, for, among other things, muscle diagnoses, joint conditions, nerve pain and tendon disorders.

Frequently asked questions regarding ear pain (FAQ)

Feel free to use the comments section below to ask questions. Or send us a message via social media or one of our contact options.

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