TOP FOUR CAUSES of EAR PAIN:

    1. Ear infection
    2. Swimmer's ear
    3. Common cold without ear infection – sometimes a simple cold can cause congestion or pressure inside the ear, which can be painful
   4. Referred pain from another source –sore throat or tooth pain can be perceived as ear pain

Controlling the pain until the patient can be seen is the primary problem. The most severe pain occurs when an infection comes on rapidly, because of rapid stretching of the eardrum.   When ear pain started after office hours or night time etc, give appropriate dosages of acetaminophen or ibuprofen for pain until you can bring the child to office the next day.  But do not wait longer, because eardrum could perforate which will stop the pain, but will complicate course and treatment.

You may want to ask for a prescription at the office visit to have on hand if your child is prone to frequent ear infections. If you have prescription ear drops in the house for pain, these may be used as long as there is no discharge from the ear (an indication of a perforated eardrum).

A warm compress over the ear may be helpful.  Slightly warmed up cooking oil, garlic  may also be helpful.  Another useful home treatment is to place about  5 ml rubbing alcohol into freezer for few minutes, then drop into the painful ear which  reduces  the pain until you can get to your doctor.

Call for appointment right away if

• Severe ear pain that has not responded to any home treatments
• History of any penetrating ear trauma
• Stiff neck
• Redness, swelling and tenderness over the bone behind the ear (signs of mastoiditis)
• Earache especially when accompanied by: fever, loss of sleep, fussiness, ear discharge, poor appetite, pulling off the bottle or breast
• Child on antibiotics for an ear infection that is still having significant pain symptoms after 48 hours
  
  
  

Ear Infections

There are two types of ear infections can cause ear pain, middle ear infection or ear canal infection commonly known as swimmer’s ear.

Swimmer’s Ear

Swimmer’s ear (otitis externa) is an infection of the skin of the ear canal. There is usually a history of swimming and pain with movement of the earlobe or when the ear is touched.

Patient should be treated for pain with Tylenol or motrin and schedule to be see right away.

Middle Ear Infection

The middle ear is a small space located behind the eardrum. An acute otitis media (middle ear infection) may be caused by a bacterial infection behind the eardrum. It usually comes as a complication of a cold. Some ear infections are caused by viruses. It is not possible to tell which ear infections are bacterial or viral simply by looking at the eardrum. The reason ear infections are common in children is because the eustachian tube, which is the tube between the middle ear and the back of the nasal passage, is short and straight compared to adults. This tube becomes blocked and does not function well when congestion is present. Fluid then builds up in the middle ear and may become infected. 

Middle ear infection is most common in children from 6 months until 2 or 3 years old, but can occur at any age, even newborns.

     Signs of an acute ear infection may include:

• Fussy babies who don't eat well or pull off the bottle or breast
• Not sleeping well
• Usually with a cold but occasionally without signs of a cold
• May or may not have a fever
• Pulling on the ear  (pulling  ear in a happy, non-sick child may be a sign of teething)
• Not hearing well, talking loudly, ignoring normal voice tones, television volume increased
• Older child complaining of pain

    Situations that will increase risk of ear infection include:

• Daycare
• Smoking environment
• Taking a bottle or nursing with the baby lying flat
• Family history of lots of ear infections or allergies (from foods, animals, dust, mold or pollens)
• Allergies in the child with chronic congestion (more than 3 weeks)
• Flying (especially with a cold)
• Swimming underwater and diving into the water
• Enlarged adenoids (see adenoids in the treatment section below).

5 to 10% of children may rupture the eardrum with an acute ear infection and yellow, thin possibly bloody fluid may be noted coming from the ear. These will usually heal within a couple weeks.

When seen in the office, some children may have serous otitis, fluid in the middle ear that is not infected with bacteria and usually without symptoms of pain. This may accompany a cold or may be present after an acute infection has already been treated with antibiotics. Your doctor may elect not to treat this with antibiotics depending on the situation.

Antibiotics. Your physician will probably prescribe antibiotics when your child is diagnosed with an acute ear infection. However, some ear infections may not need antibiotics depending on the situation.  Make sure you keep the medicine refrigerated if instructed by the pharmacy. Some antibiotics are taken with food and others must be taken on a empty stomach and some can be taken either way. Antibiotics that may be taken with food, may be mixed in with food, like applesauce or pudding or drinks. However, you must make sure the child will take the full dosage, so mix it with a small amount of the food or drink. Symptoms of the earache should improve within 48 hours of starting the antibiotic. The congestion and cough do not necessarily improve with antibiotics. Antibiotics do have an expiration date, so be sure to discard after that date. Complete the entire course of antibiotics as directed, usually ten days, but some newer antibiotics only need to be taken for five days.

Serious complications of a middle ear infection can include meningitis (an infection of the fluid surrounding the brain and spinal cord) and mastoiditis (an infection of the mastoid bone that is around the middle ear).  Signs of a mastoiditis include an ear that protrudes out more from the head and tenderness and redness on the bone behind the ear.

Another concern about ear infections involves hearing loss and language development. Fluid that stays in the middle air space for a long period of time may eventually cause hearing loss and may affect language development and behavior.

Ear wax.

Ear wax production is normal and healthy, with some people producing more wax than others. Color can vary from whitish to dark brown. It acts as protection for the ear canal. It naturally becomes pushed out, but occasionally some people produce so much that it may become impacted in the ear canal. If you see wax around the edge, you may remove it with a washcloth or cotton swab. However, never insert cotton swabs into an ear canal to clean the wax. This only packs the wax in deeper.

Impacted wax may be painful. If your physician does note excess ear wax production, they may ask you to use an over-the-counter wax-softening agent and then some gentle irrigation with warm water.  To remove impacted ear wax prior to swimming season might prevent swimmer’s ear.  Since dirty water trapped behind ear wax will cause  infection of  the skin of the ear canal in most cases.

• Many young children (4 months to 18 months) may pull on their ears with teething. These children usually do not have a cold and sleep fine.
• Myths about ear infections: Getting water splashed in the ear, wind or being cold do not cause a middle ear infection.
• Ear infections are not contagious, but the viruses that cause a cold which leads to an ear infection are contagious.
• Home otoscopes to see the eardrum for parents to diagnose ear infections are not very useful. The lights on these are not strong and it takes a lot of training to see the eardrum and understand what it all means.
• At times a child is brought to the office with a cold for a day or two and the physician does not find an ear infection. If the cold continues, an ear infection may still develop and the child may return in 2 or 3 days with an obvious ear infection. Be alert to worsening of symptoms or if the cold does not seem to run its course in a week or so.
• Flying with an ear infection
  It is generally not recommended to fly with a sick child with an acute painful ear. There is a small chance of triggering a perforation, although perforation of the eardrum may occur without flying. Many parents have inadvertently flown with children with an ear infection without any apparent problems and if the ear infection is mild or under treatment with antibiotics, the child may be able to fly. Discuss with your physician if you have any travel plans at the office visit. The decision may need to be based on the appearance of the eardrum and how sick the child is acting.