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January 08, 2017

Why Does the Ear Hurt with Cold Air or Cold Wind Exposure?

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Not uncommonly, some people complain about ear pain (or otalgia) that lasts about 15-60+ minutes after the ear gets exposed to cold air or wind. The pain always resolves after the ears warm up, even if nothing is done. The pain is typically described as sharp or an ache deep within the ear canal. However, the pain may radiate around the ear and even below the ear into the throat.

Wearing ear plugs or ear muffs when in cold air prevents this pain from occurring.

Such discomfort also occurs when the ear is exposed to cold water (cold water swimming or SCUBA).

Why does this happen?

First of all, this cold air otalgia should be differentiated from ear pressure pain from barometric pressure changes induced by dramatic temperature differentials. If the ear pain is described more as "pressure," than you may be suffering from eustachian tube dysfunction. More info and treatment for eustachian tube dysfunction can be found here.

However, if the ear pain does not have any pressure discomfort associated with it, the otalgia is almost certainly due to sensory nerve over-stimulation... analogous to "brain freeze" that may occur when eating cold ice cream.

The skin of the ear canal is VERY thin without any fatty layer to insulate nerve endings from cold temperature stimulation.

Also, there are numerous different nerve endings that innervate the ear and the ear canal, almost like that found in the solar plexus.

C2-4 Spinal Nerves (via Great Auricular and Lesser Occipital Nerves): Pain mainly over the mastoid
Cranial Nerve 7 (via Posterior Auricular Nerve): Pain mainly behind the ear.
Cranial Nerve 5 (via Auriculotemporal Nerve): Pain main in front of the ear.
Cranial Nerve 9 (via Jacobson's Nerve): Pain deep in the ear.
Cranial Nerve 10 (via Arnold's Nerve): Pain deep in the ear, but more in the ear canal.

Over-stimulation of these nerve endings found in or around the ear from cold air exposure can cause pain.

Once the cold air stimulation has stopped, the pain from the nerve over-stimulation will subside.

Unfortunately, there is no cure for this condition. The best thing to do is prevent the ear from being exposed to cold air via use of ear plugs or ear muffs. Some individuals will be more prone to this than others, just like brain freeze from eating cold things.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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