Is ear pain a sign of throat cancer?

Ear pain can be a symptom of many different things when it comes to our health – a cold, sinus infection or allergies can cause inner ear pain, as well as compacted ear wax, or simply a change in air pressure. It can be hard to differentiate whether ear pain is caused by a temporary condition or something more serious such as throat cancer. Learning about throat cancer symptoms and risk factors, and knowing your own body, can help lead to a quicker diagnosis if you experience persistent ear pain.

Where is throat cancer located?

Not to be confused with cancers of the thyroid and esophagus, throat cancer refers to cancers of the larynx (voice box) or pharynx, which connects the mouth and nose to the esophagus. “The pharynx is separated into three sections: the upper portion called the nasopharynx, which is the back of the nose, the oropharynx, which is the back of the mouth, and the hypopharynx. This is the portion below your tongue that directs food toward the esophagus," explains Ryan McSpadden, MD, Assistant Professor of Oncology in the Head & Neck/Plastic Surgery Department at Roswell Park Comprehensive Cancer Center. 

Ear pain and throat cancer

Although ear pain is not the most common symptom of throat cancer, it is something to look out for. “Even though the pain is coming from the throat, you’re feeling it in your ear because of how the nerves are crisscrossed in the head and neck,” explains Dr. McSpadden. This pain is called referred pain.

“Specifically, that nerve is called Arnold’s nerve – a branch of the vagus nerve, which gives sensation to the back of the throat,” says Dr. McSpadden. “Arnold’s nerve gives sensation to the ear itself, so when you have something causing pain in your throat, the referred pain is felt in your ear.” This connection of nerves is also the reason some people may begin to cough if they are having their ears cleaned out – referred to as an ear-cough-reflex.

Since ear pain is not a symptom that is commonly presented in throat cancer, it’s important to pay attention to any other changes in your health. “The most common symptoms we see are pain or trouble when swallowing or a neck mass,” says Dr. McSpadden. Other symptoms could include trouble breathing, a change in voice or the feeling of something stuck in your throat, referred to as globus.

Dr. McSpadden stresses the importance of having these symptoms checked if they persist for several weeks, specifically if ear pain is not subsiding after multiple rounds of antibiotics. “Colds, ear infections and sinus infections are all things that can cause similar symptoms,” Dr. McSpadden says about addressing ear pain. “But if you’ve been treated by your doctor for two or three weeks and the symptoms aren’t getting better, you should seek a higher level of care.”

Next steps for throat cancer diagnosis

If these symptoms are not subsiding, even after the illness has passed or after allergy or antibiotic treatment, the next step is to determine whether they could point to cancer. “We would start by asking about your symptoms and see if you have any risk factors for throat cancer,” says Dr. McSpadden. Tobacco use and heavy alcohol use are the two largest risks for developing this kind of cancer. The two actions individually will create a risk, but the combination of frequent tobacco and alcohol use increases it.

“We’ll look in the ear to see if we see any signs of ear infection,” Dr. McSpadden continues. “Then we would normally look into the nose and back of the throat with a camera to see if there are any abnormalities.”

This procedure is done in clinic. “We will numb the nose with a bit of topical numbing medicine and use a flexible camera that goes in through the nose,” Dr. McSpadden explains. “We’ll record this process and show the patient, going through everything we see.” If there is a mass or abnormality of the surface of the throat – called the mucosa – the next steps involve imaging and biopsies.

Like the diagnosis of any cancer, it’s important to know your body and your health. “Not infrequently, patients will come in after being treated with multiple rounds of antibiotics for these vague symptoms without it getting better and it just delays the diagnosis,” Dr. McSpadden expresses. “These are patients we could have diagnosed earlier.”