Temporomandibular Joint (TMJ) Disorder: This condition is a common cause of ear pain, especially in the absence of any physical findings or symptoms related to the ear itself. The TMJ is located close to the ear, and dysfunction or inflammation of this joint can radiate pain to the ear area.

Earwax Impaction: Although the physical exam is normal, it's possible that the earwax is causing intermittent sharp pain, especially if the wax is impacting on the ear canal walls or the tympanic membrane.
Middle Ear Myoclonus: This is a rare condition but can cause sharp, stabbing ear pain due to spasms of the middle ear muscles. It might not have any associated vertigo, tinnitus, or abnormal physical findings.
Referred Pain from Cervical Spine: Cervical spine issues, such as a herniated disc or osteoarthritis, can refer pain to the ear area. This is more likely if there are associated neck symptoms or if the pain changes with neck movement.

Acute Angle-Closure Glaucoma: Although this condition typically presents with eye symptoms, it can occasionally cause referred pain to the ear on the same side. It's a medical emergency requiring immediate treatment.
Malignancy (e.g., Nasopharyngeal Carcinoma): Certain cancers can cause ear pain as an initial symptom, even in the absence of other findings. This is less common but critical to consider due to the potential for serious consequences if missed.
Giant Cell Arteritis: This condition can cause sudden onset of severe headache and facial or ear pain, especially in older adults. It's essential to consider this diagnosis due to the risk of vision loss if not promptly treated.

Eagle Syndrome (Styloid Process Syndrome): This condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause sharp pain in the ear, face, or throat. It's relatively rare and might not have specific findings on a routine physical exam.
Occipital Neuralgia: This involves inflammation of the occipital nerves and can cause sharp, stabbing pain in the head, which might occasionally be perceived as ear pain. It's less common and typically associated with other headache symptoms.