Ear Pain – Everything You Need to Know

Ear Pain

Hello, everyone! Dr. Binns here, back again to review one of the most common reasons parents schedule sick visits with us – the dreaded earache.

What causes an earache?

The most common reason parents bring their children in for an earache is to see if they have an ear infection (AKA otitis media/middle ear infection), but there are other reasons why their ears may be hurting. Some examples include:

  • Swimmer’s ear (AKA otitis externa)
  • Fluid buildup behind the eardrum
  • Earwax buildup
  • Rash/skin infection around the ears
  • Pain originating elsewhere that can be felt in the ears, such as pain in the mouth or throat (this is very common in teething infants and toddlers)

Ear infections often occur after viral illnesses or colds. Sinus pressure and mucus build-up from your child’s illness can cause inflammation and blockages in their nose and sinuses. Specifically, there is a small tube that connects the middle ear space to the nose called the eustachian tube (this is what enables us to pop our ears when we fly in an airplane). Anything that blocks this tube can set a child up for an earache, as obstruction can lead to accumulation of mucus behind the eardrum. The bacteria and viruses that normally live in your sinuses can then grow in that fluid without anywhere to drain out naturally. This causes the eardrum to bulge and swell, leading to the characteristic ear pain we associate with ear infections.

Ear infections are more common in kids for a few reasons. A child’s immune system is not as fully developed as an adult’s, making them more vulnerable to getting sick in general. Younger children, especially those who attend daycare, are also frequently exposed to all sorts of germs, leading to lots of colds. In addition, children have shorter, narrower eustachian tubes than adults, making it easier for these tubes to get blocked and for fluid to accumulate behind the eardrum.

How can my doctor help?

Your doctor will ask questions about how your child has been doing and what other symptoms they have such as fever, cough, or if they have had any drainage from their ears. If your child is found to have an ear infection, your doctor may prescribe an antibiotic to help treat the infection, though bear in mind that many ear infections are caused by viruses and not bacteria. Ear infections caused by viruses tend to be associated with milder symptoms than those caused by bacteria and will generally resolve without antibiotics. In some cases, your pediatrician may opt to observe your child’s symptoms for 24-48 hours with a plan to treat with antibiotics if their symptoms do not improve by then, or if their symptoms worsen.

If your child is getting frequent ear infections, your doctor may refer you to see an Ear, Nose, and Throat doctor (ENT/Otolaryngologist) for evaluation and to discuss whether your child may benefit from ear tube placement.

It’s 7pm and I can’t get in to see my pediatrician until tomorrow morning. Is there anything I can do at home to make my child feel better?

Absolutely! You can give your child ibuprofen (if they are more than 6 months old) or Tylenol as needed to help soothe their pain. You can also apply heat or ice to the ear. As long as your child’s symptoms are manageable with these supportive measures, it is ok to wait until the morning to see your doctor. Your child should be seen in the ER if they have severe pain that is not responsive to ibuprofen or Tylenol, if they have a fever higher than 105F, or if they develop other severe symptoms.

Is there any way to reduce my child’s risk of getting ear infections?

Make sure your child has received their recommended routine immunizations, including their pneumococcal vaccines (PCV) and yearly influenza vaccines. These will also help to decrease the risk of ear infections.

While ear infections are not contagious, the often-preceding viral illnesses are. Encourage your child to wash their hands frequently, especially after playing with other children. Minimize exposure to people with colds and secondhand smoke, as both are associated with an increased risk of ear infections. In addition, a child’s early nutrition has been associated with reduced risk of ear infection. Specifically, studies have shown that breastfeeding during infancy has been associated with a reduced risk of developing ear infections.

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