Diagnosis and management of pain in the head and neck is very challenging even to experienced physicians. The reason behind this is the overlapping diseases presenting with similar symptoms and odd presentation of diseases expected to be seen in their classic description. All in all, accurate diagnosis of a sharp pain behind the ear is in need of close clinical examination and most probably some form of medical imaging.
This type of pain can fall under the category of neuralgia, which means severe pain in the path of a nerve due to damage or irritation of the nerve. More specifically, glossopharyngeal neuralgia can cause similar symptoms. It is classically characterized by severe pain in the ear, beneath the jaw and base of the tongue. Other cranial nerve neuralgias could also create similar symptoms. Glossopharyngeal neuralgia is occasionally accompanying a much frequent neuralgia known as trigeminal neuralgia. The accompanying signs and symptoms help to tell them apart.
Another important structure that can be the source of this pain is the ear. The domain of ear diseases capable of producing this type of pain is vast but each is presented with a number of other symptoms enabling a physician to distinguish them. Once again, it should be noted that the clinical examination and imaging studies are inevitable.
Infectious diseases of the ear form a large group that might be presented with pain behind the ear. The underlying bone behind the ear has cavities, which can harbor an infection.
The ear and other structures around it are in close proximity to throat and at some points they are directly connected. Therefore, diseases of the throat e.g. infection or inflammation can cause similar symptoms.
The bone structure behind the ear is the place of insertion of some muscle tendons. Diseases of the muscle ranging from a simple spasm to more complicated muscle-nerve diseases can account for a sharp pain behind the ear.
The moving part of the jaw forms a joint with the skull deep in front of the ear. This joint is known as temporomandibular joint. It can undergo degeneration, which might also cause pain that is felt behind the ear.
Some dental diseases can also create a pain that is felt behind the ear because of the shared path of the irritated nerve.
A number of other less frequent diseases could potentially account for this symptom but there is no way to get to the actual diagnosis other than close examination and observation by an experienced physician.
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