Ear pain does not always originate from the ear itself. In some cases, the ear appears completely normal, but the person feels severe pain. The reason for this is that the nerve network in the head and neck is shared. “The nerve is the body’s cable system. Think of it like an electrical cable; it carries the message from one place to another.”
A problem originating from the teeth, jaw joint, throat, or neck can create pain referred to the ear through the same nerve pathways. This condition is called “referred otalgia.”
Below, you can find the most common causes of referred pain when no disease is detected in the ear, in a detailed and understandable way:
1. Dental Caries and Gum Diseases
The dental nerves in the mouth are connected to the trigeminal nerve that supplies the area around the ear.
Therefore:
- Deep cavities
- Advanced gum inflammation
- Dental abscesses
- Wisdom tooth problems
can cause throbbing, stabbing, or diffuse pain in the ear.
Pain usually increases at night, is triggered by hot-cold, and can radiate to the jaw.
When should you suspect?
Sensitivity when opening and closing the mouth, pain when pressing on a specific tooth, discomfort while chewing.
2. Jaw Joint (TMJ) Disorders
The jaw joint is anatomically very close to the ear.
Stress, teeth clenching/bruxism, sleep disorders, and bite problems in dental structure can lead to joint wear or muscle spasm.
Symptoms:
- Deep and dull pain near the ear
- Increase while chewing, during yawning
- “Click” or “catching” sound when opening and closing the jaw
- Jaw stiffness in the morning
In this case, the ear appears completely normal, but the pain can be felt very strongly.
3. Neck Muscle Tension and Posture Disorders
When the muscles surrounding the cervical vertebrae, especially the trapezius and sternocleidomastoid muscles, become tense, pain can radiate to the ear.
Who experiences it frequently?
- Those working long hours at the computer
- Those using the phone for long periods while leaning forward
- Those experiencing stress-related muscle clenching
- Those with overload after sports
Clinical feature:
Pain usually increases with neck movements and is in the form of pressure radiating behind the ear.
4. Neuralgias (Trigeminal, Glossopharyngeal, Vagus Nerve)
It is the creation of sudden and severe pain attacks by some nerves in the head and neck.
Since the ear is in close proximity to the branches of these nerves, referred pain is common.
Trigeminal Neuralgia
Creates short attacks like electric shocks in the face. Chewing, speaking, or touching the face triggers pain.
Glossopharyngeal Neuralgia
Pain is usually in the form of a sharp line between the throat, pharynx, and ear.
It is triggered by swallowing and coughing.
Vagus Nerve Pains
Can create a deeper, dull, and difficult-to-explain ear pain. It is especially seen in irritations of the lower part of the throat.
5. Tonsil Inflammations (Tonsillitis, Peritonsillar Abscess)
Tonsils receive stimulation from areas close to the ear through the glossopharyngeal nerve.
Therefore, an infection in the throat often manifests with unilateral ear pain.
Accompanying symptoms:
- Severe pain when swallowing
- Difficulty opening the mouth
- Fever
- Bad breath
- Lymph node swelling in the neck
If a peritonsillar abscess develops, the pain becomes much more severe and often radiates to the ear.
6. Tongue Base, Pharynx, or Larynx Tumors
It should definitely be kept in mind in people over 40 years of age with a history of smoking and alcohol.
These tumors may not show symptoms in the early period, but unilateral, persistent, and unexplained ear pain is one of the most important warning signs.
Other warning signs:
- Hoarseness
- Difficulty swallowing
- Neck mass
- Weight loss
- Bloody sputum or bleeding from the mouth
- Persistent sore throat
Therefore, if there is otalgia and the ear appears normal, the upper respiratory tract and neck must definitely undergo detailed endoscopic examination.
7. Eagle Syndrome (Elongated Styloid Process)
It occurs when the styloid process, which is normally small, becomes elongated or the stylohyoid ligament becomes calcified.
It can create pressing, deep pain that sometimes radiates to the jaw-pharynx-ear.
Symptoms:
- Ear and facial pain increasing with swallowing
- Discomfort triggered by neck movements
- Feeling of fullness in the ear
- Tenderness in the tonsillar region on intraoral examination
Diagnosis is made with CT, and treatment is quite successful in properly selected patients.
When Should You See a Doctor?
In the following situations, ear pain should definitely be evaluated by an ENT specialist:
- If no problem is found in the ear on examination
- If pain lasts longer than 3–5 days
- If it is unilateral and persistent
- If it increases with swallowing, speaking, or chewing
- If accompanied by sore throat, weight loss, or neck mass
- If there is a history of smoking and alcohol
Evaluation with Prof. Dr. Gediz Murat Serin
Referred ear pain, when not correctly diagnosed, can continue for a long time and reduce quality of life. Even if the ear appears completely normal, the source of the problems can be in a very wide spectrum. Therefore, endoscopic examination, neck evaluation, dental/jaw joint analysis, and imaging if necessary are critically important in diagnosis.
