Prof. Dr. Gediz Murat Serin – Ear Nose Throat Specialist | Teşvikiye ENT Group
Ear pain is one of the most common ENT complaints in the community. However, the source of every ear pain is not directly the ear itself. Some problems in the neck, jaw, or throat region can be felt in the ear as “referred pain.” Therefore, the characteristics of the pain and accompanying findings must be carefully evaluated to make an accurate diagnosis.
1. Is the Pain Unilateral or Bilateral?
- Unilateral pain: Mostly caused by infections such as external ear canal inflammation (otitis externa) or middle ear inflammation (otitis media).
- Bilateral pain: May develop due to systemic or environmental causes such as allergies, sinusitis, pressure changes (barotrauma).
2. Is It Continuous or Intermittent?
- Continuous pain: Usually caused by infection or inflammation.
- Intermittent pain: Suggests temporomandibular joint (TMJ) disorders, dental-related pain, or neuralgic causes.
3. Accompanying Findings with Pain
- Discharge, pain increasing when touching the auricle or tragus → External ear canal infection (otitis externa).
- Pressure sensation, hearing loss, fever and restlessness in children → Middle ear inflammation (otitis media).
- Pain after swimming or diving → Water-related irritation or infection.
4. Did It Start After an Upper Respiratory Tract Infection?
If there is a feeling of blockage and pain in the ear after a cold, flu, or sinusitis, Eustachian tube dysfunction or secondary middle ear inflammation may have developed. In this case, not only the ear but also the nose and sinuses need to be evaluated.
5. If There Is No Visible Problem in the Ear: Referred Pain
Even if the ear examination is normal, the source of pain may come from other structures.
Common causes of referred pain include:
- Tooth decay or gum problems
- Temporomandibular joint (TMJ) disorders
- Neck muscle and joint tensions (cervicofacial syndrome)
- Nerve-related pain (neuralgias):
- Trigeminal nerve (auriculotemporal branch)
- Vagus nerve (Arnold’s neuralgia)
- Glossopharyngeal nerve (Jacobson’s branch)
- Tonsillitis or post-tonsillectomy period
- Tumors of the neck, tongue base, or pharynx region (especially in those over 40 years of age with a history of smoking or alcohol, detailed endoscopic evaluation is required)
- Eagle syndrome: Deep pain radiating to the throat and ear due to elongated styloid process.
What Is Eagle Syndrome?
Eagle syndrome is a rare but notable condition that occurs when the thin bone called the styloid process located in the neck and throat region is longer than normal or the surrounding connective tissue becomes calcified.
This anatomical change;
- Stabbing sensation when swallowing,
- Foreign body sensation in the throat,
- May manifest with complaints such as pain radiating to the ear, under the jaw, or head.
In some cases, due to its proximity to the carotid artery, pain may also radiate to one side of the head, eye, or face. Diagnosis is usually made incidentally while investigating long-standing facial/throat pain of unknown cause.
In patients with significant complaints, surgical shortening of the styloid process provides permanent relief.
When Should You See a Doctor?
- If ear pain lasts longer than 2 days
- If accompanied by fever, discharge, or hearing loss
- If pain increases with swallowing, chewing, or head movement
- If there is unilateral and persistent pain over 40 years of age, a detailed ENT examination is definitely required.
