Referred otalgia from throat pathology: This is often the most common cause of ear pain that worsens with swallowing. The most frequent culprit is a sore throat, but other conditions like tonsillitis or pharyngitis can also refer pain to the ear due to shared nerve pathways.

Acute otitis media: An infection of the middle ear can cause pain that may seem to worsen with swallowing due to the movement and pressure changes in the Eustachian tube, which connects the middle ear to the back of the throat.
Eustachian tube dysfunction: Problems with the Eustachian tube, such as blockage or poor function, can lead to middle ear pressure changes that cause pain, especially noticeable during swallowing or yawning.
Temporomandibular joint (TMJ) disorder: While primarily associated with jaw pain, TMJ disorders can also cause referred pain to the ear, potentially worsening with actions like swallowing due to the proximity and shared nerve supply of the TMJ to the ear.

Lymphoma or other malignancies of the throat: Although less common, cancers in the throat area can cause ear pain that worsens with swallowing due to the involvement of nerves or direct pressure on the Eustachian tube.
Peritonsillar abscess: A serious complication of tonsillitis, this condition involves a collection of pus behind the tonsils and can cause severe throat pain that may radiate to the ear, worsening with swallowing.
Epidural abscess or other central nervous system infections: Infections that spread to the central nervous system can cause a variety of symptoms, including pain that might seem related to swallowing, though this would typically be accompanied by other severe symptoms like fever, confusion, or neurological deficits.

Glossopharyngeal neuralgia: A rare condition characterized by recurrent episodes of severe pain in the tongue, throat, ear, and area of the jaw, triggered by swallowing or other actions.
Otoscopic evidence of a foreign body in the ear: Though more common in children, an object lodged in the ear canal can cause pain, potentially worsening with swallowing if the foreign body irritates the Eustachian tube or surrounding structures.
Relapsing polychondritis: A rare autoimmune disorder that can cause inflammation and pain in the cartilaginous structures of the body, including the ears, potentially leading to ear pain that could be exacerbated by actions like swallowing.