Humans have 5 essential sensory systems known as auditory (hearing), vision (seeing), taste, smell and touch. Ear is a part of hearing sensory system. Normal anatomy of ear is important for hearing. Pain in ear indicates something is going wrong in our hearing apparatus. Thus, ear is an important part of our sensory system. Ear is divided in 3 segments as external, middle and inner ear. External ear is open to atmosphere and separated from middle ear by a soft circular membrane known as ear drum. Middle ear has a 3 tiny bones that conduct sound to hearing sensory nerve fibers. Middle ear is connected to pharynx or throat by a tiny tubular tube known as eustachian tube. Inner ear has cochlea that transfers hearing signal to brain and three semicircular tube that manages balance in all body position. Ear pain can occur in any of these 3 segments.
Ear Conditions That Can Cause Shooting Pain in Ear
- Ear Wax,
- Ear barotrauma,
- Outer (External) Ear Infection,
- Middle Ear Infection,
- Eardrum Rupture,
- Shooting Pain in Ear due to Foreign Body ,
- Cholesteatoma and
- Meniere’s Disease.
- Earwax – Outer ear tube (external ear) protects the ear drum and middle ear. The ear is constantly exposed to dust and tiny foreign body that passes in and out of ear. Ear secretes thin wax that traps these harmful tiny substances. Most trapped tiny dust mix with wax falls out while at sleep or when head moves. When trying to prevent entry of dust and germs in the ears, excess accumulation of wax or cerumen in the ears can occur. Sometime wax gets thick and does not fall. Wax slowly increases in size and blocks the external ear that results in hearing impairment.1 The excess wax that builds up can get dried and blocked, causing a sensation of fullness in the ears. This usually results in shooting pain in the ears.
- Ear Barotrauma – Pressure changes in the ear, commonly occurs at higher altitudes or while in flight above the sea level. The rapid pressure changes within middle ear causes sudden shooting pain in the ears. Along with general discomfort, it causes stuffiness or fullness in the ears and reduced hearing. Symptoms reduces or disappears by the act of swallowing, yawning and performing mouth exercises like opening, closing and twisting the mouth. Ear barotrauma is often seen during air traveling. Air barotrauma is preventable.2
- Outer (External) Ear Infection – Infections of the outer ear (otitis externa) is also known as swimmer’s ear.3 The infection is often seen in swimmer. The cause of infection is swimming in contaminated pool or using towel that was used by someone who had infection. The infection is caused by bacteria, viruses or fungi.3 The public pool is often contaminated by individual suffering with upper respiratory tract or gastrointestinal infection. Swimming in contaminated water or use of contaminated towel transfers the infecting bacteria, fungi or viruses into external ear. The infection is promoted by presence of moisture in the ear canal.
- Middle Ear Infection – Middle ear is connected to pharynx by eustachian tube. The extension of infection from pharynx (throat) and nose in to eustachian tube causes continuation of infection in middle ear.4 Such infection is known as otitis media. It is common in those suffering from recurrent cold and young children. Sharp shooting ear pain may worsen in the night with a pulling sensation and may also affect hearing in some cases.
- Mastoiditis – Mastoid is the prominent bone of skull that lies behind the ear. The middle ear infection often extends into mastoid and causes mastoiditis. Mastoiditis causes pain in the ear and behind the ear. Recurrent mastoiditis is observed in children.5 it is thus important to further investigate ear pain to prevent mastoid infection.
- Eardrum Rupture – The eardrum or the tympanic membrane plays an important role in the hearing process. Certain sports like scuba diving, high altitude activities or insertion of objects in the ears can cause the eardrum to rupture and result in sharp shooting ear pain. Eardrum rupture causes otitis media and infection of middle ear causes purulent discharge from external ear.6
- Shooting Pain in Ear Due to Foreign Body Impaction – Sometimes, small objects can get impacted in the ear canal, commonly when children play with small toys, nuts, marbles, etc. It causes severe shooting ear pain and can also increase the risk of infection if not detected in time.
- Cholesteatoma – Inflammation and infection of oral cavity travels through the eustachian tube in to middle ear. The inflamed mucosa at posterior section of middle ear interferes with air exchanged between middle ear and pharynx. Condition causes cystic swelling of mucosa on back side of ear drum and negative pressure in middle ear causes dryness of ear drum. Cystic swelling also causes increased pressure over the ear drum and thus causes damages of the bones within infected middle ear. Infection should be treated as soon as possible to prevent extension of infection beyond ear.7 If infection is not treated then individual may develop meningitis or abscess in the brain.
- Meniere’s Disease – Inner ear protects delicate organ called labyrinth. Labyrinth is formed by cochlea that helps to carry sound signals to brain and 3 semicircular canals. The membranous labyrinth is filled with fluid known as endolymph and the movement of endolymph helps to maintain the normal body position.8 Meniere’s disease causes increased secretion of endolymph that interferes with balance while standing and sitting.9 The symptoms are dizziness (vertigo), ringing in the ear, and hearing loss. Appropriate treatment would be decided based on the diagnosis.
Nose and Throat Conditions that Cause Shooting Pain in Ear
Eustachian tube links middle ear and nasopharynx (throat). Infection of nasopharynx expands into middle ear and causes otitis media that results in ear pain.
- Allergies – Allergic conditions like allergic rhinitis, common cold and similar nasal conditions can cause shooting pain in the ears. It is associated with other symptoms of irritation like running nose, sneezing, fever and ear pain.
- Sinusitis – Infection of the maxillary and frontal sinuses are associated with infection of nose and throat. The sinus infection causes mucosal swelling and increased mucosal secretion. The inflammation of sinus mucosa also causes increased mucosal congestion. The serous secretion may become purulent if sinus is infected. The accumulation of secretions in sinuses causes severe headache and ear pain. Pain is also felt in the cheek bone, above the eyes and usually also radiates to the ears.
- Sore Throat – Irritation or inflammation of the throat causes sneezing and coughing. Most throat inflammation (pharyngitis) is causes by allergy, and infection. The nasopharyngeal inflammation causes blockade of eustachian tube opening in nasopharynx cavity. The middle fluid amount increases since fluid cannot be drained from middle ear into nasopharynx. The increase middle ear pressure cayuses ear pain. Nasopharyngeal infection also causes swelling of lymph node, that results in neck pain. swollen glands in the neck and changes in voice.
- Tonsillitis and Other Infections – Tonsillitis is an inflammation of tonsils. The tonsil swells up and may cause difficulties in swallowing and breathing. Tonsillitis is more common in children and often associated with high fever, cough and difficulties swallowing.
Referred Shooting Pain in Ear
Most of the times shooting pain in the ear is caused by the diseases affecting external, middle or inner ear. Occasionally pain from other organs that lies adjacent to the ear also causes ear pain. Some other causes of referred pain resulting in shooting ear pain are described below-
- Jaw Pain– Temporomandibular joint disorders or injuries to the mandibular (jaw) joint can cause ear pain or pain around the ear. The ear pain become worst when jaw is moved or during yawning. Jaw pain also refers to the ear when someone is singing and yelling. The area in front of the ear and over the jaw may be tender and painful to touch.
- Teeth Grinding – A habit of grinding the teeth, called bruxism can eventually lead to pain in the jaw joint and the ears.
- Dental Causes of Shooting Pain in Ear– Dental causes like tooth decay, gum abscesses, tooth extraction, etc. too can cause pain in the ears.
- Shooting Pain in Ear Caused Due to Nerve Problems – Compression of nerves due to injuries, spinal disc problems, growth or other causes can cause severe, shooting ear pain.
- Infections/Tumors – Infections and tumors of the structures in the surrounding areas like those affecting the throat, neck, thyroid gland, etc. can cause shooting pain in the ears.
Ear pain is important symptom and should not be ignored. The symptoms of ear pain suggest possible infection, cancer or trauma to the ear and surrounding tissue. The refer pain suggests disease may be located outside ear includes brain. Hence, one should see primary care physician or specialist as soon as possible to prevent serious damage to ear or surrounding tissue.
Air travellers’ awareness of the preventability of otic barotrauma.
Outer ear infection: Overview
Created: October 29, 2013; Last Update: November 30, 2017; Next update: 2020., https://www.ncbi.nlm.nih.gov/books/NBK279353/
Middle ear infection: Overview
Created: June 29, 2009; Last Update: December 1, 2016; Next update: 2019., https://www.ncbi.nlm.nih.gov/books/NBK279381/
Management of traumatic tympanic membrane perforation: a comparative study
Cholesteatoma and Its Management
Clinical manifestations of hydropic ear disease (Menière’s).
Jan;276(1):27-40. NIH, https://www.nidcd.nih.gov/health/menieres-disease
- What are the Causes of Nerve Damage in the Ear?
- What is Inner Ear Nerve Damage, Know its Symptoms, Causes, Treatment