The pain may also be continuous or intermittent.Ear pain due to an infection is the most common in children and can occur in babies. Adults may need further evaluation if they have hearing loss, dizziness or ringing in the ear. Additional red flags include diabetes, a weakened immune system, swelling seen on the outer ear, or swelling along the jaw. Causes
Ear pain has a variety of causes, the majority of which are not life-threatening. Ear pain can originate from a part of the ear itself, known as primary ear pain, or from an anatomic structure outside the ear that is perceived as pain within the ear, known as secondary ear pain. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt. Primary ear pain is more common in children, whereas secondary (referred) pain is more common in adults.Primary ear pain is most commonly caused by infection or injury to one of the parts of the ear. External ear
Many conditions involving the external ear will be visible to the naked eye. Because the external ear is the most exposed portion of the ear, it is vulnerable to trauma or environmental exposures. Blunt trauma, such as a blow to the ear, can result in a hematoma, or collection of blood between the cartilage and perichondrium of the ear. This type of injury is particularly common in contact sports such as wrestling and boxing.
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.