Earache and Sore Throat: What Can Cause Both?

By Your Health Magazine Health Information Team

An earache and sore throat often occur together because the ears, nose, and throat are closely connected. A cold or another respiratory infection can inflame the throat and block the eustachian tubes, causing ear pressure or pain. Throat inflammation can also create “referred pain,” meaning the ear hurts even when the ear itself is healthy. Less commonly, both symptoms may result from strep throat, tonsillitis, sinusitis, a middle ear infection, or a deeper throat infection.

Why Can a Throat Problem Make the Ear Hurt?

The eustachian tubes connect the middle ears to the back of the nose and throat. They help regulate air pressure and drain fluid from the middle ear. A cold, allergy, or upper respiratory infection can make these tubes swollen or blocked, producing fullness, popping, muffled hearing, or pain.

The throat and ear also share nerve pathways. Because of this connection, the brain may interpret pain originating in the tonsils, throat, jaw, or teeth as an earache. This is called referred pain and is particularly common in adults. The American Academy of Otolaryngology–Head and Neck Surgery provides more information about earaches and their possible sources.

Common Causes of an Earache and Sore Throat

Possible cause	Clues that may occur with it
Viral respiratory infection	Runny or stuffy nose, cough, hoarseness, mild fever, fatigue, and pressure in one or both ears
Tonsillitis or strep throat	Red or swollen tonsils, painful swallowing, fever, tender neck glands, or white patches; strep often begins suddenly and usually does not cause a cough
Middle ear infection	Ear pain, fever, reduced hearing, irritability in children, or fluid draining from the ear; it may follow a cold
Sinusitis or allergies	Nasal congestion, facial pressure, postnasal drip, cough, ear fullness, and throat irritation
Infectious mononucleosis	Severe fatigue, fever, swollen neck glands, enlarged tonsils, and a persistent sore throat
Peritonsillar abscess	Severe pain—often worse on one side—along with a muffled voice, drooling, difficulty swallowing, swelling, or trouble opening the mouth

Viral infections

Viruses cause most sore throats. A cold, influenza, COVID-19, or another viral illness can inflame the throat while nasal congestion interferes with middle-ear pressure regulation. Symptoms such as cough, runny nose, hoarseness, and eye redness tend to favor a viral cause. According to the CDC’s sore throat guidance, most viral sore throats improve without antibiotics.

Strep throat and tonsillitis

Tonsillitis means that the tonsils are inflamed, usually because of a viral infection but sometimes because of bacteria such as group A Streptococcus. The resulting throat pain may travel toward one or both ears.

Strep throat may cause a rapidly developing sore throat, fever, painful swallowing, swollen lymph nodes in the front of the neck, and red or enlarged tonsils. White patches can occur, but their appearance alone cannot confirm strep. Other conditions can also cause white pimples or spots in the throat. A healthcare professional may use a rapid strep test or throat culture when appropriate. The CDC’s overview of strep throat explains the symptoms, testing, and treatment.

Sinus inflammation and postnasal drip

Sinusitis and allergies can cause mucus to drain down the back of the throat, leading to soreness, coughing, or frequent throat clearing. Nasal swelling may simultaneously block the eustachian tubes and create ear pressure. Facial pain, congestion, reduced sense of smell, and thick nasal drainage may also occur. Learn more about sinusitis symptoms and treatment from MedlinePlus.

A deeper infection around the tonsil

A peritonsillar abscess is a pocket of infection beside a tonsil. It can cause intense one-sided throat pain that radiates to the ear. Other warning signs include fever, a muffled or altered voice, drooling, difficulty opening the mouth, visible swelling, and displacement of the uvula. This condition needs prompt medical evaluation and may require drainage and prescription treatment.

How the Cause Is Diagnosed

A healthcare professional may examine the ear canal and eardrum, look at the throat and tonsils, and feel the neck for swollen lymph nodes. Depending on the symptoms, testing may include a throat swab for strep or, less commonly, blood testing for mononucleosis.

Ear pain does not automatically mean there is an ear infection. An ear examination is important because fluid, pressure, an inflamed ear canal, referred throat pain, and a middle ear infection may feel similar but require different care.

What May Help While You Recover

For mild symptoms without warning signs, supportive measures may provide relief:

Drink plenty of fluids and try warm broth, tea, or cool drinks according to preference.
Gargle with warm salt water if old enough to do so safely.
Use a clean cool-mist humidifier to reduce dryness.
Try saline nasal spray for congestion and postnasal drip.
Consider an over-the-counter pain reliever when appropriate, following the product label and advice from a clinician or pharmacist.
Use honey for cough or throat irritation only in adults and children at least 1 year old.
Avoid smoking and secondhand smoke, which can worsen throat and airway irritation.
Do not insert cotton swabs or other objects into the ear.

Antibiotics do not treat viral infections and should not be used simply because throat or ear pain is present. They may be prescribed when a healthcare professional diagnoses an appropriate bacterial infection.

When to Seek Care

Seek emergency care for difficulty breathing, inability to swallow, drooling, rapidly increasing mouth or throat swelling, severe neck stiffness, blue or gray lips, confusion, or other signs of a medical emergency.

Arrange prompt or same-day evaluation for:

Severe or rapidly worsening pain, especially on one side
A muffled voice or difficulty opening the mouth
Dehydration or inability to drink enough fluids
Fluid, pus, or blood draining from the ear
New hearing loss, significant dizziness, or swelling behind the ear
A high or persistent fever
A rash with a sore throat
Symptoms in someone with a weakened immune system
A baby younger than 3 months with a temperature of 100.4°F (38°C) or higher

Contact a primary care clinician, pediatrician, urgent care center, or ear, nose, and throat specialist if symptoms are not improving within several days, keep returning, or last longer than expected. Persistent one-sided ear and throat pain—particularly with hoarseness, painful swallowing, a neck lump, unexplained weight loss, or tobacco exposure—also deserves medical evaluation, even when there is no obvious ear infection.