Where is the pain coming from?
The area behind the ear includes the mastoid bone (the bony lump behind the lobe), lymph nodes, the base of the skull, neck muscles and nerves. Pain here may start in the ear itself, spread from nearby structures (jaw, teeth, throat) or come from the neck and head. The exact spot, whether it is tender or swollen, and any ear symptoms help to narrow down the cause. See bultos detrás de la oreja (Spanish).
Ear-related causes
- Outer ear infection (swimmer’s ear): pain, itching, discharge; ear tug hurts. See swimmer’s ear.
- Middle ear infection: deep ear pain, fever, muffled hearing.
- Mastoiditis: infection of the mastoid bone, typically after untreated middle ear infection, with swelling, redness and tenderness behind the ear and fever; needs urgent treatment.
- Eustachian tube problems and fluid with fullness. See fluid in the ear.
- Earwax impaction or foreign body.
- Cholesteatoma: abnormal skin growth behind the eardrum, with foul discharge and hearing loss; needs ENT care.
- Perichondritis after piercings or injury.
Swollen lymph nodes and skin
- Swollen glands (lymph nodes) behind the ear in response to infection of the scalp, ear, throat or skin, or a viral illness; usually tender, mobile, and shrink as the infection clears. See bultos detrás de la oreja (Spanish).
- Skin problems: infected cyst, boil, folliculitis, seborrhoeic dermatitis, insect bites, ingrown hairs or irritation from earrings and glasses.
- Shingles (herpes zoster): burning or stabbing pain followed by a blistering rash, sometimes with facial weakness.
- Rarely, tumours or enlarged parotid or salivary tissue.
Jaw, teeth and neck causes
- Temporomandibular joint (TMJ) disorders: pain near the ear, jaw clicking, pain when chewing or opening wide. See ear pain when swallowing.
- Teeth clenching or grinding (bruxism), particularly overnight.
- Dental infection or wisdom teeth referring pain.
- Neck muscle tension and cervical spine problems, often from posture and screen use.
- Occipital neuralgia: sharp, shooting pain at the base of the skull and behind the ear.
- Tension or migraine headaches that radiate behind the ear.
- Sinus infection sometimes causes pain in this area.
Home care
- A warm compress for 10–15 minutes can ease muscle and skin pain.
- Take paracetamol or ibuprofen if suitable.
- Rest the jaw: soft diet, avoid chewing gum and wide yawning.
- Stretch and relax the neck and shoulders; correct posture at screens.
- Manage stress, which increases clenching and tension.
- Keep the ear dry if there is ear pain and avoid cotton buds.
- Avoid pressing or squeezing lumps or skin lesions.
- Wash and avoid irritating earrings or glasses frames.
Medical treatment
- Ear drops or antibiotics for ear infections.
- Urgent IV antibiotics and sometimes surgery for mastoiditis.
- Antiviral medicine for shingles, started early.
- Treatment of dental problems by a dentist; bite splints for bruxism or TMJ disorders.
- Physiotherapy for neck and jaw dysfunction.
- Nerve-targeted medicines or injections for occipital neuralgia.
- ENT assessment for cholesteatoma or persistent lumps.
Red flags: when it is urgent
- Swelling, redness and tenderness behind the ear that pushes the ear outward, with fever (possible mastoiditis).
- Severe headache, neck stiffness, confusion or vomiting.
- Facial weakness or drooping.
- A painful blistering rash on the ear or scalp.
- Sudden hearing loss or dizziness.
- Pain after head injury.
- Diabetes or immune suppression with ear pain.
A lump behind the ear
A small, tender, movable lump that appears with an infection is usually a reactive lymph node and shrinks over 2–4 weeks. A lump that is hard, fixed, painless, growing or lasts more than 3–4 weeks, or is accompanied by weight loss, night sweats or fever, needs medical assessment. See also bultos detrás de la oreja (Spanish).
When to see a doctor
- Pain lasting more than a few days or getting worse.
- Ear discharge, hearing loss or fever.
- Swelling or a lump that persists.
- Pain with chewing or jaw locking.
- A rash or blisters.
- Recurrent headaches with behind-the-ear pain.
- Any red flag above.
Three common situations
Pain behind the ear with a cold and a small tender lump: likely a reactive lymph node; rest and watch for 2–4 weeks.
Pain near the ear on chewing and morning jaw soreness: consider TMJ or bruxism; see a dentist or doctor.
Child with fever, ear sticking out and swelling behind it: urgent assessment for mastoiditis.
Key points to remember
Pain behind the ear may come from the ear, glands, jaw, neck or nerves. Most causes are minor and settle with care, but swelling with fever, rash, weakness or hearing loss is urgent. Our ENT team can examine the ear and find the source.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about pain behind the ear
These answers are general information and do not replace an examination or individual medical advice.
What causes pain behind the ear?
Ear infections, swollen lymph nodes, jaw and neck problems, nerve pain, headaches or skin problems.
When is pain behind the ear serious?
With swelling, redness, fever, an ear pushed forward, facial weakness or severe headache.
What is mastoiditis?
An infection of the bone behind the ear, usually after a middle ear infection, needing urgent treatment.
Can TMJ cause pain behind the ear?
Yes, jaw joint problems commonly cause pain near and behind the ear.
Is a lump behind the ear normal?
Small tender nodes during infection are common; a persistent or hard lump needs examination.
What helps at home?
Warm compress, pain relief, relaxing the jaw and neck and avoiding irritants.
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.