Pain below the ear can be confusing because this anatomical region is densely packed with structures like glands, joints, muscles, and nerves. The discomfort can range from a dull ache to a sharp sensation, often involving the angle of the jaw and the upper neck. Understanding the potential source is crucial, as the cause can be local or referred from a distant site. This pain often signals the body’s reaction to an infection, structural strain, or an issue in a nearby system.
Pain Originating in Glands and Soft Tissue
A common reason for localized discomfort below the ear involves the lymphatic system, specifically the lymph nodes. These small, bean-shaped structures are part of the body’s immune defense, with several chains located along the jawline and neck. When the body fights an infection, such as a cold, flu, or strep throat, these nodes swell with immune cells, a process called lymphadenopathy.
This swelling presents as tender, movable lumps that indicate a localized immune response. The pain is usually a constant tenderness that gradually subsides as the underlying infection resolves. A dental abscess or an infection in the scalp can also trigger this reaction in the lymph nodes positioned below the ear.
Another cause of localized pain is an issue with the salivary glands, particularly the parotid gland. The parotid gland is one of the largest salivary glands, situated just in front of and below the ear. Inflammation of this gland, known as parotitis, leads to painful swelling in this location.
A viral infection like mumps is a common cause of parotitis, but bacterial infections or a blockage from a salivary stone (sialolithiasis) can also cause painful swelling. The discomfort often worsens when eating, as saliva production increases. If the infection is bacterial, symptoms like fever, chills, and redness over the area may be present.
Issues Related to the Jaw Joint and Muscles
Mechanical problems related to jaw movement are a frequent source of pain felt near or below the ear. The temporomandibular joint (TMJ) connects the lower jawbone to the skull and is located immediately in front of the ear canal. Dysfunction of this joint (TMD) causes pain that often radiates backward, making it feel like the ache originates below the ear.
Pain from TMD is exacerbated by movement, such as chewing, yawning, or speaking, and may include a clicking, popping, or grinding sound in the joint. Causes of TMJ strain include teeth grinding (bruxism), stress, poor alignment, or joint inflammation like arthritis. Because the jaw joint and the ear share nerve pathways, the brain can misinterpret the joint pain as an earache.
Muscular tension in the neck and jaw can also cause discomfort that travels toward the ear area. Muscles like the sternocleidomastoid (SCM) run from behind the ear down the neck and can develop trigger points from poor posture or chronic clenching. This muscle strain or spasm can manifest as a persistent, dull ache that spreads into the jaw and the area below the ear. This muscular discomfort is often relieved by massage or stretching and is tied to the tension of the soft tissues.
Pain Referred from Other Areas
Sometimes, the source of the pain is a distant issue that sends pain signals along shared nerve pathways, a phenomenon known as referred pain. The trigeminal nerve is the largest cranial nerve and transmits sensation from the face, teeth, and parts of the ear, creating a common route for pain referral.
Dental problems are a frequent cause of referred pain felt in the ear and jaw area. An infected tooth, a deep cavity, or a dental abscess, particularly in the back molars, can cause pain that travels along the nerve and is perceived below the ear. An impacted wisdom tooth that puts pressure on surrounding tissues can also result in inflammation and discomfort that radiates up the jawline.
Infections of the throat can also cause referred pain to the ear and neck area, especially during swallowing. Conditions like tonsillitis or pharyngitis may trigger pain felt in the nearby ear region due to the proximity of the nerves supplying these structures. If the pain is significantly worse when swallowing, a throat infection is a likely source.
When to Consult a Healthcare Provider
While many causes of pain below the ear are minor and resolve with home care, certain symptoms require medical evaluation. Consult a healthcare provider if the pain is severe or rapidly worsening. Also seek attention if the discomfort is accompanied by a fever, especially above 101°F.
Immediate attention is warranted if you experience difficulty swallowing, an inability to fully open your mouth, or trouble breathing. Seek professional advice if you notice a lump that is hard, fixed in place, or does not become smaller after one week. Any pain that persists for longer than seven days without improvement should also be checked.