An earache, medically termed otalgia, is a common symptom arising from many different conditions. Since the emergence of SARS-CoV-2, which causes COVID-19, patients and healthcare providers have sought to understand the full scope of its effects. The question of whether an earache might signal a COVID-19 infection is relevant given the virus’s wide array of reported manifestations. Understanding the relationship between ear pain and the virus requires distinguishing between primary and secondary symptoms.
Earaches and the COVID-19 Symptom Profile
Otalgia is generally classified as a less common or secondary manifestation of COVID-19, unlike primary symptoms such as fever, persistent cough, and fatigue. Early in the pandemic, earaches were rarely highlighted in public health guidance. Its presentation is often mild and occurs alongside more typical signs of a viral upper respiratory infection.
The frequency of earaches has varied with the evolution of the virus, particularly with the emergence of variants like Omicron. These newer variants often affect the upper respiratory tract, leading to increased inflammation in the nasal and throat passages. This shift may account for the more frequent reporting of ear discomfort in recent case studies. Otalgia should be distinguished from other ear-related issues like tinnitus (ringing in the ears) or sudden hearing loss, which are distinct neurological symptoms sometimes observed in COVID-19 patients.
Biological Mechanisms Linking COVID-19 to Ear Pain
The connection between a SARS-CoV-2 infection and ear pain is often indirect, stemming from the body’s reaction to the virus in neighboring structures. The most common pathway involves Eustachian tube dysfunction, a frequent complication of any severe upper respiratory infection. Viral inflammation and swelling of the mucosal lining in the nose and throat can obstruct the Eustachian tube, the passage connecting the middle ear to the nasopharynx.
This blockage prevents proper ventilation and equalization of pressure in the middle ear, resulting in a feeling of fullness, muffled hearing, and subsequent pain. Another mechanism is referred pain, where discomfort originates from an irritated nerve pathway outside the ear but is perceived in the ear itself. Because the ear, throat, and jaw share common sensory nerves, severe pharyngitis or tonsillitis caused by the virus can translate to pain felt in the ear.
There is scientific evidence suggesting a more direct viral effect on the auditory system. Studies have identified ACE-2 receptors, which SARS-CoV-2 uses to enter cells, on certain cells within the inner ear. This suggests the virus could potentially invade and damage inner ear structures like the hair cells or the cochlea. This damage may contribute to inflammation and related symptoms like pain, though this direct attack is thought to be less common than inflammatory processes.
Common Causes of Earaches Unrelated to Viral Infection
While COVID-19 can cause ear pain, most earaches are entirely unrelated to the virus. One frequent cause of ear pain, particularly in adults, is referred pain originating from the temporomandibular joint (TMJ). Disorders affecting this joint, which connects the jawbone to the skull, can cause discomfort that radiates directly into the ear canal due to its close proximity. TMJ pain is often worsened by chewing or jaw movement.
Infections are another major category. These include otitis media, a middle ear infection characterized by fluid buildup behind the eardrum. Otitis externa, or Swimmer’s Ear, is an infection of the outer ear canal that causes pain when the outer ear is pulled or pressed. Congestion from non-viral sources like allergies or a simple head cold can also lead to sinus pressure that pushes on the Eustachian tubes, resulting in ear discomfort.
Dental issues, such as an abscessed tooth or impacted wisdom teeth, can also cause pain referred to the ear. Simple blockages, like earwax accumulation or pressure changes from flying or diving (barotrauma), are common, non-infectious sources of temporary otalgia. A thorough examination by a medical professional is necessary to differentiate these causes from a viral infection.
When to Seek Medical Attention
An isolated, mild earache that resolves within one to two days often does not require immediate medical intervention. However, an earache that persists for more than 48 to 72 hours, or one accompanied by other concerning symptoms, warrants a professional medical evaluation. Prompt attention is needed if the earache is accompanied by a high fever, especially one exceeding 103 degrees Fahrenheit.
Other warning signs include:
- Discharge from the ear, such as pus or bloody fluid.
- Sudden or significant hearing loss.
- Intense dizziness and vertigo.
- Facial weakness or paralysis developing alongside ear pain.
If the earache occurs concurrently with typical COVID-19 symptoms, such as a sore throat, cough, or loss of taste or smell, seek testing and medical advice to determine the cause of the illness.