The infection may extend to cranial nerves, or rarely to the meninges or brain. Examination of the ear canal may reveal granulation tissue in the inferior canal. It is treated with several weeks of IV and oral antibiotics, usually fluoroquinolones. Mechanical obstruction
Earwax impaction: results in 12 million medical visits annually in the United States. Cerumen impaction may cause ear pain, but it can also prevent thorough examination of the ear and identification of an alternate source of pain. Foreign body: commonly include insects or small objects like beads

Less common
Herpes zoster: varicella zoster virus can reactivate in an area that includes the ear. Reactivation can produce pain and visible vesicles within the ear canal and, when combined with facial paralysis due to facial nerve involvement, is called Ramsay Hunt syndrome. Tumors: the most common ear canal tumor is squamous cell carcinoma. Symptoms can resemble those of otitis externa, and cancer should be considered if the symptoms are not improving on appropriate treatment. Middle and inner ear
Acute otitis media
Acute otitis media is an infection of the middle ear. More than 80% of children experience at least one episode of otitis media by age 3 years. Acute otitis media is also most common in these first 3 years of life, though older children may also experience it. The most common causative bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Otitis media often occurs with or following cold symptoms.
There may be certain parts of the muscles or tendons (connective tissue connecting the muscles to bones) that are especially painful when pressed
Trigeminal neuralgia: attacks of shooting pain down the face that may be triggered by touching the face or temperature changes
Dental pain from cavities or an abscess
Oral cavity carcinomaConditions causing irritation of the facial nerve (cranial nerve VII) or glossopharyngeal nerve (cranial nerve IX):
Tonsillitis: infection/inflammation of the tonsils
Post-tonsillectomy: pain following surgical removal of the tonsils
Pharyngitis: infection/inflammation of the throat
Sinusitis
Parotitis: inflammation of the parotid gland, the salivary gland right in front of the ear
Carcinoma of the oropharynx (base of tongue, soft palate, pharyngeal wall, tonsils)Conditions causing irritation of the vagus nerve (cranial nerve X):
GERD
Myocardial ischemia (inadequate oxygen supply to the heart muscle)Conditions causing irritation of cervical nerves C2-C3:
Cervical spine trauma, arthritis (joint inflammation), or tumor
Temporal arteritis: an autoimmune disorder leading to inflammation of the temporal artery, a large artery in the head. This condition tends to occur in adults older than 50. Pathophysiology
Primary ear pain
The ear can be anatomically divided into the external ear, the external auditory canal, the middle ear, and the inner ear. These three are indistinguishable in terms of the pain experienced. Secondary ear pain
Many different nerves provide sensation to the various parts of the ear, including cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus), and the great auricular nerve (cervical nerves C2-C3). These nerves also supply other parts of the body, from the mouth to the chest and abdomen.