How the ear and throat are connected
The Eustachian tube runs from the middle ear to the back of the nose and throat. It equalises pressure and drains fluid from the middle ear. When the nose and throat are inflamed during a cold or infection, the tube swells and blocks, fluid builds up behind the eardrum and bacteria or viruses can multiply there.
The throat and ear also share sensory nerves, including the glossopharyngeal and vagus nerves, which explains why pain from the throat is often felt in the ear.
Which comes first?
- Throat first, then ear: the most common pattern; a cold or sore throat is followed a few days later by ear pain and blocked hearing.
- Ear pain from the throat: tonsillitis or a throat ulcer causes pain felt in the ear while the ear is normal.
- Ear infection spreading: an ear infection itself rarely causes a sore throat, but drainage of fluid and the original infection can keep the throat irritated.
Common causes of both together
- Colds and flu.
- Tonsillitis and strep throat; see tonsillitis vs strep.
- Sinus infections with postnasal drip; see post-nasal drip sore throat.
- Glandular fever (mononucleosis).
- Allergies causing Eustachian tube swelling.
- Acid reflux irritating the throat and causing referred ear pain.
Referred ear pain
Many adults with ear pain have a normal ear on examination. The pain comes from somewhere else: the throat, tonsils, teeth, jaw joint or neck. Pain in the ear when swallowing is a classic sign of a throat source. See ear pain when swallowing and jaw and ear pain.
Persistent one-sided ear pain with a sore throat in an adult, especially a smoker, without an obvious infection should be checked by an ENT specialist.
Symptoms to look for
- Ear pain, fullness and muffled hearing.
- Sore throat and pain when swallowing.
- Fever and feeling unwell.
- Swollen glands in the neck.
- Runny or blocked nose and cough.
- In babies and young children: pulling at the ear, irritability, poor feeding and disturbed sleep.
What helps at home
- Rest and drink plenty of fluids.
- Take paracetamol or ibuprofen for pain and fever, if suitable.
- Gargle with warm salt water and suck lozenges (adults and older children).
- Use a warm or cool compress over the ear.
- Saline nose sprays to help the Eustachian tube drain.
- Avoid smoking and smoky environments.
See sore throat remedies.
Medical treatment
Most ear infections and sore throats are viral and get better within 3 to 7 days without antibiotics. Doctors may prescribe antibiotics for bacterial tonsillitis or strep throat, for ear infections that are severe or not improving after 2 to 3 days, in babies, and when there is discharge from the ear.
Recurrent ear infections or tonsillitis may lead to referral to an ENT specialist. See antibiotics for sore throat.
How long it lasts
A sore throat usually improves within a week. Ear pain from an ear infection usually settles in 3 days, though muffled hearing from fluid behind the eardrum can last several weeks. If hearing does not return to normal within 3 months, a hearing test is advisable. See fluid in ear.
Children are more prone
Children’s Eustachian tubes are shorter and more horizontal, and their adenoids are larger, so ear infections after colds and sore throats are much more common than in adults. Frequent ear infections with enlarged adenoids or tonsils may need assessment. See tonsils and adenoids in children.
When to see a doctor urgently
- High fever, severe pain or a very unwell child.
- Difficulty swallowing, drooling or difficulty opening the mouth.
- Swelling, redness or tenderness behind the ear.
- Discharge from the ear, sudden hearing loss or dizziness.
- Stiff neck, confusion or a rash.
- Symptoms lasting more than a week or getting worse.
Key points to remember
- The ear and throat are connected by the Eustachian tube and share nerves.
- Usually a sore throat or cold comes first and leads to an ear infection.
- Throat problems can cause pain felt in a healthy ear.
- Most cases are viral and improve within a week.
Questions about ear infections and sore throats
These answers are general information and do not replace an examination or individual medical advice.
Can an ear infection spread to the throat?
Infections usually spread from the throat to the ear rather than the other way.
Why does my ear hurt when I have a sore throat?
The throat and ear share nerves, so throat pain can be felt in the ear.
Is an ear infection with a sore throat contagious?
The ear infection itself is not, but the cold or throat infection behind it usually is.
Do I need antibiotics for an ear infection and sore throat?
Often not. Most are viral. A doctor decides based on severity and findings.
Can strep throat cause an ear infection?
Yes, it can lead to a middle ear infection.
How do I know if it is tonsillitis or an ear infection?
Tonsillitis causes red, swollen tonsils and pain swallowing; an ear infection causes ear pain, fullness and muffled hearing.
Can allergies cause ear and throat pain?
Allergies can cause throat irritation and blocked ears, but rarely severe pain.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.