Dr. Smith: Hey guys, welcome back to our podcast. Today we’re gonna talk about a commonly asked question, which is like, what is the cause of this pain? I have some discomfort in my ear. What’s going on? This just doesn’t feel right. So patients often come in with a complaint of one side or even both sides giving them some problems. So we’ll come and talk about some of the most common causes of ear pain and maybe some like quick tips about trying to figure out maybe which one might be the cause of your ear pain? Anyone else?
Dr. Reddy: All right. So, I look, I think of ear pain as having two main causes. The first cause is ear pain that’s coming from the ear. And then the second main cause is ear pain that’s not coming from the ear. And that has many other subcategories. But first I’ll just briefly touch on ear pain that’s coming from the ear. And most commonly it’s from either trauma to the ear by getting hit to the ear, or from an ear infection. And the ear infection, there’s different kinds of ear infections. Most people think of either an outer ear infection or otitis externa or a middle ear infection, which is called otitis media. And that’s also oftentimes confused with an inner ear infection, which is a little bit different.
Dr. Smith: And outer ear infections, the kind of layman’s term would be swimmer’s ear.
Dr. Reddy: Swimmer’s ear, exactly. So the way that we figure out what’s going on with what type of infection is just a physical examination and maybe some testing. And then we treat it usually with some drops or some antibiotics.
Dr. Smith: And you may get some pointers or tips about that just on your history alone. And this is why we kind of always harp on this, taking a very thorough history and getting these questions from patients can be extremely helpful in trying to figure out. So you may have some drainage from the ear, you may have some pressure in the ear or something like muffled hearing or something else that lets us know that, okay, maybe there’s an ear issue here as opposed to one of the other kind of referred areas. Do you wanna talk about some of the other referred areas that can then trigger?
Dr. Undavia: Sure, I did wanna just say, first of all, the three of us, I would consider us experts in ear pain, even if the thing that’s causing the pain is not coming from the ear. And that’s because everybody who has ear pain comes to us first. So even if it’s coming from the tooth or something, we’re pretty great at treating those things. Having said that, the one thing that I usually tell patients, going back to the source of this being from the ear, is that if I’m unable to see them, or if it’s a telemed visit or something like that, if the symptom of ear pain is also accompanied by either pressure or hearing loss, more likely to be ear related. If it’s not accompanied by those two things, probably something that’s in the subcategory that we’re about to talk about. Having said that, probably the most common thing we see related to ear pain is from the mouth. So, from like a TMJ arthritis, so temporal mandibular joint arthritis or dysfunction, where patients are either grinding their teeth at night or maybe they have an occlusion problem or maybe they have roxism where they’re swaying their teeth. Those things cause a lot of stress on the joint here and then they tend to say it hurts here but they might not know that it’s actually coming from their mouth.
Dr. Reddy: Do you want to talk about another subcategory?
Dr. Smith: Yeah, sure. So headaches are a very common cause of ear pain or otalgia is the medical term for ear pain. A lot of referred pain in this case is coming from the brain and people can even get hearing changes with these headaches or migraines, but the pain can run the gamut of dull achy, sharp stabbing, and it can be all headache related. A lot of times we try to get a history if there’s a history of headaches or migraine disorder. It may be temporal in that it’s not constant. So it comes and goes throughout the day or throughout the week. It may be associated with other things like nausea or dizziness or sound sensitivity, light sensitivity. So they may have other symptoms that go along with a headache disorder and don’t quite fit, you know, the TMJ patient or the ear infection patient. And so, migraines would probably be another big category of ear related issues and pain discomfort that we see as well.
Dr. Reddy: One of the things that we worry about in patients that have persistent ear pain that isn’t getting any better is rare causes of what we call referred pain, where there’s something else that’s kind of referring the pain up to the ear.
Certain examples of that are things like a tonsil growth or a tonsil cancer or a base of tongue growth or a voice box or a laryngeal growth that may cause a referred pain there. And oftentimes to diagnose that, we need to take a look with a little camera, the flexible laryngoscopy camera that we have in the office that allows us to take a look at those areas and determine if that’s the potential cause.
Dr. Smith: Right, yeah, so a lot of times we don’t see before we just go chalking it up to TMJ or migraine or one of those things, you may, if you go see an ENT, end up getting a scope through the nose to look for other, as Dr. Reddy had pointed out, other refer sources to make sure those bad things aren’t laying dormant there.
Dr. Undavia: What do you find is the most pain?
Dr. Smith: The patients complain the most painful?
Dr. Undavia: Which one, I mean, first of all, we haven’t gone over all the categories, but it’s tough to go over everything, but these are the major categories that we’ve talked about. What would you say is the most painful?
Dr. Smith: That’s tricky. Outer ear infections tend to be extremely painful and they trigger a lot of swelling in the surrounding tissues as well. So outer ear infections can trigger swelling around the temporal mandibular joint, it can trigger swelling and fluid within the middle of your space. And so it can cause some fluid within the middle ear and give you that pressure and popping sensation as well. Um, it can trigger inflammation in the sinus behind the ear, which is called the mastoid sinus and that sinus, which is connected into the middle ear, sinus, um, can get inflamed and get fluid within it as well and trigger a lot of other kind of symptoms all around the ear. So, I would say most patients that come in with an outer ear infection are pretty miserable. Now, outer ear infections can be bacterial which are typically the ones that are extremely painful, but they can also be fungal related as well which tend to be less, you know, it’s you know, yeah, but still irritating and painful but not quite as painful.
Dr. Undavia: Typically our ear infections patients will say “I touch my ear like that and it hurts”.
Dr. Smith: Yeah, they don’t want to lay on it.
Dr. Undavia: Yeah, and it’s constant versus something like TMJ where they might say It really hurts just when I eat or it hurts when I wake up in the morning because they’ve been grinding all night.
Dr. Reddy: Anything else to add?
Dr. Smith: No, I think we covered it pretty well.
Dr. Reddy: What’s the most interesting foreign body you’ve taken out of someone’s ear that’s caused ear pain? Because that’s another cause is that’s the foreign body in the ear.
Dr. Smith: A googly eye. One of those little glue on crafts, like little eyes that flip around. Taken one of those out in the toddler before.
Dr. Undavia: Batteries are destructive.
Dr. Reddy: Yup. Yeah. Batteries. Yeah. How about bugs? Have you taken out bugs?
Dr. Smith: All sorts of bugs, yeah.
Dr. Undavia: I did have to take out superglue on a psychiatric patient once. Oh my God. They were hearing sounds and they just wanted to put the superglue in there to try and stop the sound.
Dr. Reddy: Wow, did it work?
Dr. Undavia: Nope. All right. Well, I think that’s- Any other zebras, there are other zebras. Like for instance, I have patients that come in and they say, you know, you do a full exam, everything is normal, but they say, it just hurts to touch here. Like even like little feather touches hurts and the only thing that I can think of is that they have like a nerve sensitivity where it’s just going to go away and so it’s kind of like this inflammatory thing.
Dr. Smith: Um, there are some autoimmune conditions that affect the cartilage around the ear that can cause pain and discomfort and swelling as well. So there are other things. Um, some people get those shingles outbreaks and occur around the ear as well, which can cause extreme pain and hearing loss. So there are other skin infections and things too, that can, that can trigger those.
Dr. Reddy: Yeah, there’s another condition that I see every once in a while where you get a little nodule on your, on your helix area right here on your ear, um, from just sleeping on it consistently. It’s called, um, chondritis nodularis helices. And so the way you treat it as you put like an anti, like a steroid topical medication, you just sleep on the other side. There’s rare nerve disorders like you were mentioning, even variants of trigeminal neuralgia that can just affect the ear, where it feels like a lightning bolt pain in your ear. There’s a cell pangitis, which is relatively rare. Where you take a look inside the nose and you can see actual inflammation and pus coming out of your eustachian tube orifice. There’s myringitis, which is usually a viral infection of the tympanic membrane where you get these bubbles on your eardrum that can cause your pain. So there’s a ton of like other causes of this.
Dr. Undavia: We actually had a patient who had ear pain from reflux. We tried everything.
Dr. Reddy: Yeah. Reflux can do it.
Dr. Smith: Causes eustachian tube dysfunction, which then can cause that as well.
Dr. Reddy: Yeah. So yeah, there’s a lot of causes, but I think that’s all we have for today. Right? You guys have anything else? No, no. Very good.
Dr. Undavia: Hope you don’t get ear pain.
Dr. Reddy: Take care.