Earaches, medically known as otalgia, are generally not considered a primary or defining symptom of COVID-19. While the virus presents with a broad spectrum of symptoms, ear pain is typically an atypical or less common manifestation compared to classic signs like fever, cough, and fatigue. Ear pain is not what doctors look for first when diagnosing COVID-19.
How Common Are Earaches in COVID-19
Earaches are not listed among the most common symptoms by major health organizations, such as the World Health Organization (WHO). These organizations focus on general symptoms like fever, chills, and sore throat. While ear-related issues have been reported in some patients, they occur with low frequency.
Studies have shown wide-ranging reports of ear symptoms in COVID-19-positive individuals. One large survey indicated that otalgia was reported by approximately 19% of participants who experienced any ear-related symptom, placing it behind vertigo and tinnitus. Other analyses have reported otalgia incidence as low as 1.8% in some groups. This low rate confirms ear pain is not a signature symptom of the infection.
The rise of newer variants, such as Omicron, often causes more upper respiratory tract symptoms. Some research suggests that ear symptoms like ringing in the ears and dizziness might have been slightly more common with the Delta variant than with Omicron. Ultimately, ear pain is a low-frequency symptom that does not appear on official lists of the most expected signs of infection.
The Biological Link Between COVID and Ear Pain
The mechanism by which SARS-CoV-2 can potentially cause ear pain is primarily linked to inflammation in the upper airway system. The virus causes significant inflammation and congestion in the nasopharynx, the area connecting the nasal passages to the throat. This swelling directly impacts the function of the Eustachian tube, a narrow channel linking the middle ear to the nasopharynx.
When the Eustachian tube becomes inflamed or blocked, it cannot properly equalize pressure between the middle ear and the outside environment. This dysfunction, known as Eustachian Tube Dysfunction (ETD), leads to a buildup of negative pressure in the middle ear space. This is experienced as pain, fullness, or a clogged feeling. The pain is often a secondary effect of respiratory inflammation rather than a direct infection of the ear structure itself.
Rarely, the virus may directly infect structures within the ear. Cells in both the middle and inner ear possess the ACE2 receptor, the entry point for SARS-CoV-2. Direct viral infection of the inner ear’s sensory hair cells or vestibular nerve cells may be responsible for other reported symptoms like hearing loss, vertigo, and tinnitus. Direct viral infection causing otalgia is considered an uncommon event.
Other Causes of Ear Pain During Respiratory Illness
Experiencing ear pain during any respiratory illness, including COVID-19, often points to common secondary causes not unique to the coronavirus.
Referred Otalgia
The most frequent reason for ear pain is referred otalgia, which is pain originating from a different source but perceived in the ear. Severe sore throat (pharyngitis) or sinus inflammation (sinusitis) commonly causes this pain because the same nerves, such as the vagus nerve, serve both the throat and the ear.
Secondary Infections
Another common issue is the development of a secondary bacterial ear infection, known as acute otitis media. Viral infections like the flu or COVID-19 create an environment of fluid buildup and inflammation in the middle ear. This fluid accumulation behind the eardrum can become a breeding ground for bacteria, leading to a painful infection after the initial viral illness.
Fluid remaining in the middle ear after the acute infection clears, known as otitis media with effusion, can also cause a lingering feeling of blockage or pressure. Persistent severe pain, drainage from the ear, or a sudden change in hearing warrant medical evaluation. These secondary issues are common complications of many upper respiratory tract infections.