A common cause of “ear pain” in adults is actually joint and muscle pain in front of and around the ear and upper neck. The name for this type of pain is TMJ pain, named for the temporomandibular joint (or jaw joint). The TMJ is located directly in front of the ear and allows you to open and close your jaw. To feel the joint, place your fingers right in front of your ears and open and close your mouth widely.
TMJ pain is very commonly mistaken for an ear infection. I frequently see patients who are convinced that they have chronic ear infections who actually have TMJ pain. Sometimes they have taken one or more rounds of antibiotics with no effect.
It is usually pretty straightforward to distinguish an ear infection from TMJ pain. A middle ear infection by definition means that you will have infected fluid trapped behind your eardrum. This fluid will cause a substantial amount of hearing loss, similar to plugging your ear with a finger. If you do not have obviously muffled hearing, it is very unlikely that you have an ear infection.
On the other hand, TMJ pain is generally reproducible by pressing on the joint and the muscles around the ear and upper neck. If things like opening/closing your mouth, chewing, and pressing around the ear cause the pain to worsen, you likely have TMJ pain, not an ear infection (especially if there is no hearing loss).
The pain can be localized to the actual jaw joint or it can be only in the surrounding muscles (or both).
Other associated symptoms with TMJ pain can be: ear pain, pain while opening the mouth widely, clicking in the joint during mouth opening or chewing, temple pain, neck pain, locked jaw, or frequent head/neck aches.
TMJ pain can come out of the blue, but it is commonly caused by stress on the joint and surrounding muscles. This stress can come from teeth grinding (can occur while you are asleep), previous trauma to the head or jaw, poorly aligned teeth or dentures, arthritis of the TMJ, frequent gum chewing, or general stress and anxiety. Most patients with dentures or many missing teeth will experience TMJ pain from time to time. Patients with a history of migraines or generalized muscle pain disorders such as fibromyalgia are prone to having TMJ pain as well.
The pain can be sharp and occur every time you move your jaw, chew, etc, or it can be dull and constant.
Once the diagnosis has been made, the majority of patients will improve with some simple measures. I recommend that you treat a sore TMJ the same as any other sore joint or muscle in your body and do the following: 1. Rest the joint/muscles by avoiding chewy foods and gum, 2. Massage any painful areas several times a day, 3. Apply warm moist compresses at least twice a day, and 4. Take ibuprofen or other over the counter anti-inflammatory medication 3 times a day with meals until symptoms improve.
These simple measures will usually get the pain under control in a majority of patients with TMJ. The pain may come back in the future but now you will know what to do.
If the above measures are not sufficiently helpful, the next step is to see a dentist or oral surgeon. There are a variety of options they can perform including adjusting dentures/teeth, providing oral appliances to prevent teeth grinding, and potentially surgery on the TMJ in some instances. A physical therapy evaluation can also be helpful for stretching and strengthening exercises in the joint.