Sore Throat and Ear Pain: Causes and Care
Medical review pending
This educational article does not replace care from a licensed clinician. Automated publication checks and human medical review are separate states; the review label above reflects the recorded state for this exact content.
Introduction
Sore throat and ear pain often occur together, but discomfort may not start in both places. Pain from the throat can be felt in the ear because nearby areas share nerve pathways 5.
In other cases, illness or inflammation affects the ear itself. Viruses cause most sore throats, and most cases improve within one week 1.
This guide explains sore throat and ear pain symptoms, causes, treatment, and when to seek care.
Overview of Sore Throat and Ear Pain
Ear pain may be primary or secondary. Primary ear pain starts within the ear, while secondary ear pain starts elsewhere 5.
Secondary ear pain is also called referred ear pain. It occurs because the ear and nearby body parts share nerve pathways to the brain 5.
A sore throat, tonsillitis, cold, toothache, or jaw disorder can therefore cause an earache 5. The ear itself may remain healthy when throat inflammation causes the pain 5,6.
Sore throat and ear pain can also come from separate problems. Middle ear infections, swimmer’s ear, earwax, and pressure changes can cause primary ear pain 3,5.
Finding the cause helps guide testing and treatment. Antibiotics do not help when a virus causes the sore throat 1,2.
Symptoms of Sore Throat and Ear Pain
Why throat pain can be felt in the ear
Throat and ear pain often reflects one problem rather than two separate infections 6. Referred ear pain means that the source of pain lies outside the ear 5.
Sore throat and tonsillitis are recognized causes of secondary ear pain 5. Reflux, allergies, sinusitis, toothaches, and jaw disorders can also produce this pattern 5.
The pain may affect both areas at once. It may also feel stronger in one ear or on one side of the throat 6.
Common symptoms and patterns
Symptoms vary with the underlying cause. Common sore throat symptoms include painful swallowing and a dry or scratchy feeling 1.
Other symptoms that may occur include:
Fever can occur with group A strep and several other infections 2,5.
Enlarged glands at the front of the neck may occur with group A strep 2.
Cough and a runny nose often suggest a viral illness rather than strep throat 1,2.
Ear drainage, hearing loss, or swelling around the ear needs medical attention 5.
Sinus infections may include cold-like symptoms and thick yellow or green mucus 6.
Tonsillitis may involve fever, swallowing trouble, or red and swollen tonsils 6.
Ear discomfort may feel dull, sharp, mild, severe, constant, or intermittent 5. Some people also describe their ears as feeling blocked or filled with cotton 6.
Pressure changes and eustachian tube dysfunction are recognized causes of ear pain 5. The eustachian tube connects the middle ear with the back of the throat.
Clues suggesting a viral illness or strep throat
Cough, runny nose, and conjunctivitis often suggest a viral cause 1. Conjunctivitis is inflammation of the eye’s outer surface, commonly called pink eye.
Group A strep often causes sudden sore throat, fever, and pain with swallowing 2. Enlarged front-neck glands and tonsil exudate may also occur 2. Exudate is a white or pus-like coating.
These patterns provide clues, but symptoms are not always enough. Without clear viral signs, examination alone cannot separate viral pharyngitis from group A strep 2. Pharyngitis means inflammation of the throat.
Causes of Throat and Ear Pain
Viral and bacterial throat infections
Viruses that cause colds or influenza are the most common sore throat causes 1. These illnesses can also cause secondary ear pain 5.
Most viral sore throats improve on their own within one week 1. Antibiotics cannot treat a viral sore throat 1,2.
For more information about cold symptoms, read our [common cold guide](/conditions/common-cold-symptoms-causes-treatment-care-e89666).
Group A strep bacteria can cause strep throat, also called streptococcal pharyngitis 1,2. This infection commonly causes fever, sudden sore throat, and painful swallowing 2.
Tonsillitis is another possible cause of throat and ear pain 5,6. Tonsillitis means inflammation or infection of the tonsils.
A peritonsillar abscess is an infected pocket near a tonsil. It may cause fever, face or neck swelling, headache, and voice changes 6. This condition requires evaluation by a healthcare professional 6.
Ear infections and pressure problems
Otitis media is an infection or inflammation involving the middle ear behind the eardrum 3. Otitis externa, commonly called swimmer’s ear, affects the outer ear and ear canal 3.
Fluid may also collect behind the eardrum without an active infection 3. This condition is called otitis media with effusion 3.
Other primary ear pain causes include:
Eustachian tube dysfunction can cause ear pain 5.
Earwax buildup can cause discomfort within the ear 5.
Air or water pressure changes can cause barotrauma and ear pain 5.
A ruptured eardrum can cause primary ear pain 5.
A foreign object in the ear can cause pain or hearing problems 5.
Treatment depends on the cause rather than pain alone 5. Some cases need medicine, while others improve with supportive care 5.
Allergies, reflux, dental problems, and other causes
Allergies can cause sore throat and secondary ear pain 1,5. Smoking and secondhand smoke exposure can also irritate the throat 1.
Gastroesophageal reflux disease can cause throat and ear pain 5,6. It is often shortened to GERD.
Sinusitis, toothaches, and temporomandibular joint disorders are other causes of referred ear pain 5. Temporomandibular joint disorders affect the jaw joints and nearby muscles.
An abscessed tooth may cause jaw swelling, a loose tooth, or drainage from the gums 6. A dental abscess needs prompt evaluation because the infection can spread beyond the tooth 6.
Persistent throat and ear pain may need specialist assessment. Pain lasting longer than four weeks should be evaluated by an ear, nose, and throat specialist 6.
How a Clinician Finds the Cause
Health history and physical examination
A healthcare professional usually begins by asking about symptoms and performing a physical examination 1. Clear details can help focus the evaluation.
Useful information to report includes:
Describe when the sore throat and ear pain began and whether onset was sudden 2.
Report fever, painful swallowing, cough, runny nose, or eye redness 1,2.
Mention close contact with someone who had strep throat 2.
Report ear drainage, hearing loss, or repeated earaches 5.
Mention reflux, dental pain, sinus symptoms, or jaw discomfort 5.
Tell the clinician about recurrent sore throats or worsening symptoms 1.
The clinician may examine the throat, tonsils, and glands at the front of the neck 2. The ear canal and area behind the eardrum can also be affected by ear inflammation 3.
An ear examination can help locate the problem. History, physical examination, and assessment of eardrum movement remain important for evaluating ear pain 4.
Strep tests and throat cultures
People with clear viral symptoms generally do not need group A strep testing 2. Viral clues include cough, runny nose, and conjunctivitis 1,2.
When clear viral symptoms are absent, symptoms and examination cannot reliably separate viral illness from strep 2. Clinicians may use a rapid antigen test or throat culture to confirm group A strep 2.
A rapid antigen detection test checks a throat swab for group A strep 2. A throat culture is the standard confirmation test 2.
A positive rapid test or culture confirms group A strep pharyngitis 2. Symptomatic children aged three or older need a backup culture after a negative rapid test 2.
Routine backup cultures are not required for other age groups after a negative rapid test 2. The clinician will consider age, symptoms, exposure, and examination findings.
Ear examination and other assessment
The clinician examines the ear for signs involving the outer canal, middle ear, or eardrum 3,4. This helps distinguish swimmer’s ear, middle ear infection, fluid, and other ear problems 3.
A normal-looking ear may shift attention toward referred pain. Possible sources include the throat, tonsils, teeth, jaw, sinuses, allergies, or reflux 5.
Additional assessment depends on the symptoms and examination. Imaging is not recommended for the routine diagnosis of uncomplicated sinusitis 4.
Treatment and Home Care
Comfort measures for mild symptoms
Uncomplicated sore throat and ear pain often improve with simple comfort measures. Most sore throats resolve within one week 1.
The following measures may ease mild symptoms:
Drink plenty of fluids and consider warm beverages for throat comfort 1.
Gargle with salt water when the person can gargle without swallowing it 1.
Use a clean cool-mist humidifier or vaporizer 1.
Suck on ice chips, frozen treats, or suitable throat lozenges 1.
Rest while symptoms are improving 5.
Consider warm or cold packs for ear pain relief 5.
Raise the head to help ease pressure inside the ear 5.
Honey may relieve a cough in adults and children aged at least one year 1. Do not give honey to an infant younger than one year 1.
Medicines and age-related precautions
Acetaminophen or ibuprofen may relieve sore throat or ear pain 1,5. Follow the product label and ask a clinician about the correct amount for children 1.
Important age precautions include:
Children younger than six months should receive acetaminophen rather than ibuprofen 1.
Children aged six months or older may receive acetaminophen or ibuprofen when appropriate 1.
Avoid giving aspirin to children without specific clinician direction because it can cause Reye’s syndrome 1.
Give lozenges only to children aged four years or older 1.
Avoid cough and cold medicines under age four unless a clinician recommends them 1.
Discuss cough and cold medicines with a clinician before giving them to older children 1.
Caregivers should report all prescription and nonprescription medicines the child takes 1. They should also ask about an amount suited to the child’s age and size 1.
Do not place objects inside the ear canal. Repeated attempts to remove a foreign object can increase the risk of ear injury 5.
Ask a healthcare professional before using ear drops. Do not use them when a ruptured eardrum is possible 5.
When prescription treatment may help
Antibiotics do not treat viral sore throats 1,2. Unneeded antibiotics may cause side effects and contribute to antibiotic-resistant infections 1.
People with a positive rapid strep test or throat culture need antibiotics 2. Antibiotic treatment can shorten symptoms, reduce spread, and lower complication risks from confirmed strep 2.
Ear pain treatment depends on its cause 5. A clinician may prescribe antibiotics, antifungals, corticosteroids, ear drops, or oral medicine when appropriate 5.
Not every ear problem represents an infection. Fluid can exist behind the eardrum without an active ear infection 3.
Use only the medicine prescribed or recommended for the identified condition. Complete any prescribed treatment according to the clinician’s instructions.
When to See a Doctor
Breathing, swallowing, and other serious concerns
The CDC lists difficulty breathing or swallowing as reasons to see a healthcare provider 1. Excessive drooling in young children also requires medical assessment 1.
Contact a healthcare professional for dehydration or blood in saliva or phlegm 1. A rash, joint swelling, or joint pain also warrants medical attention 1.
Face or neck swelling can occur with a peritonsillar abscess 6. Contact a healthcare professional for assessment when this swelling accompanies throat and ear pain 6.
Any severe or concerning symptom deserves medical evaluation 1.
Reasons to contact a clinician soon
Several changes may suggest that the problem needs direct examination. Contact a clinician if any of these occur:
Ear drainage, new hearing loss, or frequent earaches need medical attention 5.
Swelling or skin discoloration around the ear needs medical attention 5.
Chills, nausea, vomiting, or severe sore throat should be reported 5.
Worsening throat symptoms or symptoms unimproved after several days need evaluation 1.
Recurrent sore throats should be discussed with a healthcare professional 1.
A suspected dental abscess requires prompt dental or medical evaluation 6.
Do not make repeated attempts to remove an object lodged in a child’s ear 5. Arrange a pediatric visit if one removal attempt does not work 5.
Children and persistent symptoms
Contact a healthcare professional right away for an infant younger than three months with fever. The threshold is 100.4°F, or 38°C, or higher 1.
Most sore throats improve within one week 1. Arrange evaluation when symptoms do not improve within several days or become worse 1.
Call a healthcare professional if ear pain lasts longer than three days 5. Frequent or returning ear pain also deserves evaluation 5.
Persistent throat and ear pain lasting longer than four weeks needs an ear, nose, and throat assessment 6. This advice also applies when ongoing pain affects one ear and one side of the throat 6.
Conclusion
Most sore throats come from viruses and improve within about one week 1. Referred ear pain may occur even when the ear is not the original source 5,6.
Testing can confirm group A strep when appropriate 2. Treatment depends on whether pain comes from infection, pressure, irritation, reflux, dental disease, or another cause 3,5,6.
Seek medical care for breathing or swallowing difficulty, dehydration, ear drainage, hearing loss, swelling, or persistent symptoms 1,5,6. Timely evaluation can identify the cause and guide the right treatment.
Keep the evidence
Take Sore Throat and Ear Pain: Causes and Care questions with you.
- Every answer cited to a checkable source
- Sources graded by evidence tier
- Your questions and their evidence, kept
Scan to open the download page