Ear Pain When Swallowing: Causes, Relief and Red Flags

01Why

Why swallowing makes your ear hurt

The ear, throat, tonsils, tongue base, jaw and teeth share sensory nerves (mainly the glossopharyngeal, vagus and trigeminal nerves). When a problem irritates one of these areas, the brain can misread the signal as coming from the ear: this is referred otalgia. Swallowing moves and presses the inflamed or sensitive tissue and triggers the pain. The ear itself may be completely normal. See pain behind ear.

02Throat

Throat and tonsil causes

• Tonsillitis and pharyngitis: sore throat, fever, swollen glands. See tonsillitis treatment and pharyngitis.
• Strep throat. See strep throat.
• Peritonsillar abscess (quinsy): severe one-sided throat pain, fever, trouble opening the mouth, muffled voice; urgent.
• Tonsil stones. See tonsil stones.
• Throat ulcers or mouth ulcers.
• Acid reflux and LPR. See laryngopharyngeal reflux.
• Throat or tongue-base tumours (uncommon), with persistent one-sided pain and ear pain on swallowing.

03Ear

Ear and Eustachian tube causes

• Middle ear infection (otitis media) or fluid in the ear. See fluid in the ear.
• Eustachian tube dysfunction, where swallowing opens the tube and causes pain or clicking when it is inflamed. See Eustachian tube dysfunction.
• Outer ear infection (pain on chewing and swallowing). See swimmer’s ear.
• Earwax or a foreign body.
• Mastoiditis (rare).
• Barotrauma after flights or diving.

04Jaw

Jaw, teeth and nerve causes

• Temporomandibular joint (TMJ) disorders: jaw clicking or pain, pain with chewing and yawning, often with headaches.
• Teeth clenching or grinding (bruxism).
• Dental problems: abscess, impacted wisdom tooth, gum infection.
• Sinus infection with pressure. See sinus infection symptoms.
• Neck problems and muscle tension.
• Glossopharyngeal neuralgia: brief, stabbing pain in the throat and ear on swallowing, talking or coughing; treated with nerve medicines.
• Eagle syndrome: an elongated styloid bone causing throat and ear pain on turning the head or swallowing.
• Shingles affecting nerves near the ear.

05Home

Home care

• Take paracetamol or ibuprofen as directed.
• Gargle with warm salt water and suck lozenges.
• Drink plenty of fluids; warm drinks with honey soothe.
• Eat a soft diet while the throat is sore.
• Use a warm compress over the jaw or ear for joint or muscle pain.
• Rest the jaw: avoid hard or chewy foods, gum and wide yawning.
• Treat allergies, nasal congestion and reflux.
• Do not insert cotton buds or drops into the ear without a diagnosis.

06Dx

How a doctor finds the cause

The doctor asks about the side, triggers, fever, sore throat, jaw symptoms, tooth problems, smoking and alcohol, and examines the ear, mouth, throat, neck, jaw joint and teeth. If the ear looks normal, attention shifts to referred sources. An ENT specialist may use a small camera through the nose to inspect the throat, tongue base and voice box. Imaging, a dental review or tests for infection may follow.

09Cases

Three common situations

Ear pain on swallowing with a sore throat and fever: likely tonsillitis or pharyngitis; see a doctor if severe or not improving.

Dull ear pain with jaw clicking and teeth grinding: consider a TMJ disorder; see a dentist or doctor.

A smoker with one-sided ear pain on swallowing for a month and a normal ear: needs an urgent ENT examination.

10Kids

Ear pain on swallowing in children

Children often cannot say where it hurts, so a child who pulls at an ear, cries when swallowing or refuses to eat may have tonsillitis, an ear infection or both. Fever, irritability and poor sleep are typical. Paracetamol or ibuprofen at the correct paediatric dose helps comfort; a doctor should examine children with high fever, drooling, a muffled voice, neck stiffness, a swollen face or neck, or pain lasting more than 2–3 days. Babies under 3 months with fever need urgent assessment.

11Tests

Tests you may be offered

• A throat swab or rapid test for strep when tonsillitis is likely.
• A hearing test and tympanometry if the ear or Eustachian tube is suspected.
• Flexible nasendoscopy to look at the nose, throat and voice box in persistent or one-sided pain.
• Dental X-rays or a jaw joint assessment for TMJ and dental causes.
• Blood tests for inflammation or infection when indicated.
• Imaging (CT or MRI) and sometimes a biopsy when a suspicious area is found.
• A trial of reflux treatment or nerve medicines if neuralgia or reflux is suspected.

12Summary

Key points to remember

Ear pain on swallowing usually comes from the throat, tonsils, jaw or teeth, and most cases settle with treatment of the cause. Seek urgent help for severe pain with fever or trouble opening the mouth, and prompt assessment for one-sided pain lasting more than 3 weeks. Our ENT team can examine your ears and throat.

This guide is for general information and does not replace an examination by your own doctor or ENT specialist.