Earaches happen when something irritates or inflames the structures in or around your ear. The cause can be an infection, a pressure imbalance, a buildup of earwax, or even a problem that originates somewhere else entirely, like your jaw or teeth. Understanding where the pain is coming from helps you figure out whether it will resolve on its own or needs attention.
Middle Ear Infections
The most common cause of earaches, especially in children, is a middle ear infection (otitis media). This happens when bacteria or viruses get trapped behind the eardrum, usually following a cold or upper respiratory illness. The two bacteria most often responsible are Streptococcus pneumoniae and Haemophilus influenzae. Cold viruses can also trigger middle ear infections on their own.
The infection causes fluid to build up in the small space behind the eardrum, creating pressure and pain. You may also notice muffled hearing, a feeling of fullness, or a low fever. In some cases the pressure becomes intense enough to rupture the eardrum, which actually relieves the pain but produces visible drainage from the ear canal.
Not every middle ear infection needs antibiotics right away. For mild cases in older children and adults, doctors often recommend a 48 to 72 hour observation window, managing pain in the meantime, to see if the infection clears on its own. If symptoms are severe, including a fever above 102°F, moderate to severe pain, or symptoms lasting more than 48 hours, antibiotics are typically started immediately. When antibiotics are prescribed, the course length varies by age: 10 days for children under 2, 7 days for ages 2 to 5, and 5 days for those 6 and older.
Outer Ear Infections
An infection of the ear canal itself, often called swimmer’s ear, is another frequent culprit. Water that stays trapped in the ear canal after swimming or bathing creates a warm, moist environment where bacteria thrive. The pain from an outer ear infection tends to worsen when you tug on your earlobe or press on the small flap of cartilage at the front of your ear. You might also notice itching, redness, or clear drainage before the pain sets in.
Using cotton swabs, earbuds, or anything else that scratches the delicate skin of the ear canal increases your risk. Even small breaks in the skin give bacteria an entry point.
Eustachian Tube Problems
Your eustachian tubes are narrow passages that connect each middle ear to the back of your throat. They serve two jobs: equalizing air pressure and draining fluid. When these tubes swell shut or get clogged with mucus from a cold, allergies, or sinus congestion, fluid backs up behind the eardrum. That trapped fluid creates a persistent ache and a plugged feeling that can last days or weeks.
This type of earache is especially common during or after a cold, even without a full-blown infection. Swallowing, yawning, or chewing gum can sometimes help the tubes open temporarily, but if the underlying congestion doesn’t clear, the discomfort tends to come back.
Pressure Changes From Flying or Diving
Barotrauma is the most commonly reported medical problem among air travelers. It happens when a rapid change in external pressure, like during an airplane’s descent or a scuba dive, creates a vacuum in the middle ear. That vacuum pulls the eardrum inward, causing sharp pain, a feeling of stuffiness, and sometimes temporary hearing loss.
The eustachian tubes normally adjust to pressure changes, but if they’re even partially blocked from congestion or swelling, they can’t keep up. Flying with a head cold is one of the most reliable ways to end up with significant ear pain. Swallowing frequently during descent, or gently blowing against pinched nostrils (the Valsalva maneuver), can help force the tubes open before the pressure difference becomes painful.
Earwax Buildup
Earwax is normal and protective, but when it accumulates enough to block part of the ear canal, it can cause pain, a feeling of fullness, muffled hearing, ringing, or itching. Complete blockage isn’t required for symptoms to develop. Any accumulation large enough to press against the canal walls or eardrum can be uncomfortable.
The irony is that the most common cause of problematic earwax buildup is trying to clean your ears. Cotton swabs, pen caps, and paper clips don’t remove wax so much as pack it deeper into the canal. If you suspect impacted earwax, over-the-counter softening drops often help. Persistent blockages can be removed safely by a healthcare provider using irrigation or suction.
Why Children Get More Earaches
Children are far more prone to ear infections than adults, and anatomy is the main reason. A child’s eustachian tubes are shorter, narrower, and more horizontal than an adult’s, which makes it harder for fluid to drain out of the middle ear even under normal conditions. Add a cold or respiratory illness, and the tubes clog easily.
A child’s immune system is also still developing, so it’s less efficient at clearing infections early. The adenoids, small patches of immune tissue near where the eustachian tubes meet the throat, can compound the problem. Bacteria sometimes get trapped in the adenoids and spread into the eustachian tubes, seeding repeated infections. As children grow, their eustachian tubes lengthen and angle downward, which is why most kids eventually outgrow frequent ear infections.
Pain That Comes From Somewhere Else
Not every earache starts in the ear. Referred pain, where you feel discomfort in one spot but the source is somewhere else, is surprisingly common with earaches. The ear shares nerve pathways with the jaw, throat, and teeth, so problems in any of those areas can register as ear pain.
TMJ disorders are one of the most frequent non-ear causes. The temporomandibular joint sits just in front of each ear canal, and when it’s irritated by teeth clenching, grinding (bruxism), excessive gum chewing, or stress, the result is an aching pain in and around the ear that can easily be mistaken for an infection. A dental abscess or impacted wisdom tooth can produce similar referred pain. Severe sore throats, including tonsillitis, can also radiate to the ears.
If your earache comes with jaw clicking, worsens when you chew, or follows dental work, the source is likely your jaw or teeth rather than your ear itself.
Warning Signs That Need Attention
Most earaches from colds or minor irritation resolve within a few days. If your ear pain persists beyond three days, or you develop any of the following, it’s worth getting evaluated:
- Drainage from the ear, which can signal a ruptured eardrum or outer ear infection
- High fever of 103°F (39.4°C) or above
- Hearing loss that doesn’t improve as the pain fades
- Swelling or skin discoloration around the ear
- Nausea and vomiting alongside ear pain
- Recurring earaches, which may point to a structural issue or chronic eustachian tube dysfunction
In young children who can’t describe their symptoms, watch for ear tugging, unusual fussiness, difficulty sleeping, or trouble hearing sounds they’d normally respond to.