Your ear comprises outer (external), middle and inner portions. Your external ear consists of the visible outer ear (called the pinna or auricle), and the ear canal leading to your eardrum. These structures collect sound waves and direct them toward your middle and inner ear. Several conditions can trigger pain in your outer ear, most of which involve the skin of one or more of the external ear structures.
Acute External Otitis
Acute external otitis is a leading cause of outer ear pain in children and adults. Also known as AEO or swimmer's ear, this condition arises due to infection of the ear canal and posssibly the pinna. Bacteria cause most cases of external otitis, although fungi are sometimes responsible.
AEO develops quickly (less than 48 hours) and causes moderate to severe outer ear pain that worsens when you press or pull on the pinna. Chewing also frequently aggravates the pain. Other common symptoms include ear itchiness, a sense of fullness, muffled sound perception and pus-like discharge from the affected ear. The ear canal characteristically appears swollen and red on physical examination.
Risk factors for AEO include:
- Water in your ear canal (the origin of the moniker swimmer's ear)
- Hearing aid use
- Earwax buildup
- Wearing tight ear-covering garments, such as head scarves
- Scratching the ear canal with your fingernails, cotton swabs, hairpins, etc.
- Chronic skin conditions, such as atopic dermatitis and seborrheic dermatitis
- Weakened immune system
Ear Canal Boils
The outer one-third of your ear canals contain tiny hairs that help prevent dirt and other debris from getting deeper into your ears. Bacteria can invade the follicles that give rise to these hairs and lead to the development of one or more small boils, or furuncles in medical lingo. These pus-filled pimples are the same as boils that develop in other body locations.
Ear canal boils generally cause symptoms virtually indistinguishable from those that occur with AEO except boils don't typically cause ongoing drainage from the ear. Your doctor can differentiate these two conditions when looking into your ear canal. The distinction is important because it influences treatment.
It probably seems obvious but it's important to consider ear injuries if you experience sudden outer ear pain. A forceful blow to your external ear can cause substantial pain, bruising and swelling. Cuts or bites to your outer ear constitute other common types of painful outer ear trauma.
Ear trauma requires medical evaluation because of the possibility of infection, accompanying facial bone fractures or eardrum rupture, or other serious complications.
Ear Canal Blockage
Your ear canals are exquisitely sensitive, particularly the inner two-thirds because the lining skin is very thin. Pressure against the ear canal skin due to a blockage commonly causes outer ear pain as well as other symptoms, including itchiness, ear fullness and possibly hearing loss, dizziness, and/or ringing in or drainage from the ear.
Earwax buildup — known medically as a cerumen impaction — commonly blocks the ear canal, particularly among older adults. Risk factors for this condition include:
- Cleaning the ear canals with cotton swabs
- Hearing aid use
- Frequent use of earplugs
- Heavy growth of ear hair
- Ear canal deformities
Among young children, ear canal blockage often results from a foreign object — like a bead or bean — the child put in the ear. Rarely (thank goodness), it's also possible for a bug, like a cockroach, to block and/or irritate the ear canal and cause pain.
The ailments already discussed account for most cases of outer ear pain but there are other possible causes. Some of these uncommon culprits include:
Next Steps, Warnings and Precautions
Contact your doctor if you experience pain in your outer ear. This is important because determining the underlying cause typically requires examination of the ear with an instrument called an otoscope.
Seek immediate medical care if you (or your child) have a weakened immune system or diabetes, experience ear trauma, have tubes in the eardrums, or experience any warning signs or symptoms that might indicate a potentially serious condition, including:
- Severe or worsening ear pain
- Spreading redness involving the external ear and/or surrounding skin
- Fever, with or without chills
- Rash, burning or tingling near the ear
- Facial drooping
- Difficulty opening your mouth
- Sudden hearing loss
- Foul-smelling or bloody drainage from the ear
- Merck Manual Professional Version: External Ear Trauma
- Merck Manual Professional Version: External Ear Obstructions (Ear Foreign Body)
- Paediatrics and Child Health: Acute Otitis Externa
- American Family Physician: Acute Otitis Externa: An Update
- Family Medicine and Medical Science Research: External Ear Canal Folliculitis: A Frequently Under-Diagnosed Infectious Disease
- American Family Physician: Cerumen Impaction: Diagnosis and Management
- American Family Physician: Ear Pain: Diagnosing Common and Uncommon Causes
- Journal of the American Academy of Audiology: Disorders of the External Auditory Canal