[3] The conditions that cause secondary (referred) ear pain are broad and range from temporomandibular joint syndrome to inflammation of the throat.

[3] In general, the reason for ear pain can be discovered by taking a thorough history of all symptoms and performing a physical examination, without need for imaging tools like a CT scan.

If there is a bacterial infection, antibiotics are sometimes recommended and over the counter pain medications can help control discomfort.

In North America, 98% of cases are caused by bacteria, and the most common causative organisms are Pseudomonas and Staph aureus.

[18] Risk factors include exposure to excessive moisture (e.g. from swimming or a warm climate) and disruption of the protective cerumen barrier, which can result from aggressive ear cleaning or placing objects in the ear.

[20] The pain tends to be more severe than in uncomplicated otitis externa, and laboratory studies often reveal elevated inflammatory markers (ESR and/or CRP).

[23] Acute otitis media is also most common in these first 3 years of life, though older children may also experience it.

[19] The most common causative bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

[5] Complications of otitis media include hearing loss, facial nerve paralysis, or extension of infection to surrounding anatomic structures, including:[24] A variety of conditions can cause irritation of one of the nerves that provides sensation to the ear.

[3] While some disorders may require specific imaging or testing, most etiologies of ear pain are diagnosed clinically.

Etiologies leading to chronic pain may be broken down by the presence or absence of worrisome clinical features, also known as red flags.

One red flag is the presence of one or multiple risk factors including smoking, heavy alcohol use (greater than 3.5 drinks per day), diabetes, coronary artery disease, and older age (greater than 50).

[3] These factors increase the risk of having a serious cause of ear pain, like cancer or a serious infection.

[34] If red flags are present it may be necessary to do additional workup such as a CT scan or biopsy to rule out a more dangerous diagnosis.

Such diagnoses include malignant (or necrotizing) otitis externa, mastoiditis, temporal arteritis, and cancer.

While the presence of a red flag does raise suspicion for one of these four disease, it does not guarantee a diagnosis as any one symptom can be seen in a variety of situations.

Many bacterial ear infections are treated with cleaning of the area, topical or systemic antibiotics, and oral analgesics for comfort.

[7][35][9] Some types of bacterial ear infections can benefit from warm compresses included in the treatment.

[7] Some of the causes of ear pain that are typically treated with either a topical or systemic antibiotic include: Some bacterial infections may require a more advanced treatment with evaluation by otorhinolaryngology, IV antibiotics, and hospital admission.

Some causes of ear pain require procedural management alone, by a health professional, or in addition to antibiotic therapy.

One review paper wrote that 83% of children had at least one episode of acute otitis media by 3 years of age.