Q: I have been having an earache that develops overnight while I am sleeping. It usually goes away during the day. My family physician did not find any infection and ear wax was removed. I do not have TMJ. I have been having this problem for about a month. Do you have any suggestions?

A: There are a number of reasons for otalgia (ear pain) to exist. In order to determine where the pain originates, it will help to understand that primary otalgia is pain that originates from within the ear, while referred otalgia is pain from outside the ear. When the pain occurs in a child, the first thing we generally consider an infection, yet this is generally not the case when adults are concerned.

Pain and diminished hearing may occur when air and fluids build up behind the eardrum, a condition referred to as serous otitis media; a situation that can occur if congestion blocks the Eustachian tube (the tube that naturally drains the middle ear), tumors of the head/neck/chest are present, the patient has nasal allergies, or bacterial middle ear infections. Left untreated, a blocked Eustachian tube may take weeks or months to clear. Meniere’s disease is an inner ear disorder that causes ringing in the ears, a feeling of fullness, pressure, and disturbances in both hearing and balance. Middle ear infections (acute otitis media) are one of the most common causes of ear pain, particularly during the winter season. It might be preceded by the common cold which, by itself, is sufficient to cause ear pain.

Other less common possibilities include mastoiditis (inflammation of the mastoid bone, myringitis (eardrum inflammation), chondritis (inflammation of the cartilage of the external ear), and cellulitis (inflammation of the cartilage in the external ear. Something that should not be overlooked is a dental issue. Often, ear pain involves a person’s molars.

Treatment should be dictated by the underlying cause of the symptoms presented. When the cause of the pain lies within the ear itself, it is easier to identify and treat; however, in those instances where the cause isn’t evident, a more in depth evaluation may be warranted. Over the counter oral pain relievers, ear drops, decongestants and even antihistamines may diminish or dissipate the symptoms that can take weeks or months to otherwise clear on their own. When OTCs fail to produce results, an ear-nose-and-throat specialist (an otolaryngologist) might choose to prescribe a nasal spray which should reduce the swelling present in the nose and Eustachian tube and allow the ear to drain.

If your primary care physician is unable to zero in on a diagnosis for your complaint, it’s time to request a referral to an ear specialist. If your teeth are in need of repair, it may be a good time to have them checked out, as well. Make those appointments now so you can get back to enjoying life to the fullest without the annoyance of ear pain.