Earache is one of the leading complaints that causes a parent to take their child to their health care provider’s office or to the emergency department. Usually, the child will have one of three very common reasons that aren’t usually serious; ear canal infection (otitis externa), inner ear infection (acute otitis media), or inner ear fluid (otitis media with effusion). Here is a bit more info about these common causes:
Outer ear canal:
- Otitis externa (Swimmer’s ear): Infection usually caused by bacteria after water has gotten into the outer ear canal when swimming. Pain is usually at the outer opening of the ear. Children may complain of pain when moving their jaw, feeling of ‘water in my ear’, or itchiness inside. Children usually do not have a fever, but the opening to the ear canal may look swollen and red, or may have discharge from the canal itself. Sometimes infection can be caused by fungus, be very itchy, and white, flaky debris may be seen inside the ear canal.
- Foreign body: Kids can put the craziest things in the craziest places (my brother once put paper in his ears)! Usually pain starts after its been there awhile or children can complain about not being able to hear. Usually ear wax (cerumen) builds up around it so it’s difficult to see what it is until it is removed by your health care provider.
- Cerumen impaction (Ear wax build-up): This is fairly common, though not usually very painful. Usually kids complain of ‘fullness’ in their ear or not being able to hear.
For treatment, the health care provider usually flushes the outer ear with a water/ hydrogen peroxide solution, and will manually remove foreign bodies or wax build-up with special tools or flushing equipment. Ear drops with antibiotic and anti- inflammatory medicine may be prescribed, usually for 7-10 days. Avoid getting ears wet (put a little cotton ball with vaseline in the ear during a shower), no swimming for 7-10 days, and avoid wearing in-ear headphones until it has cleared up.
Middle or inner ear:
- Acute Otitis Media (Inner ear infection): The most common illness diagnosed by paediatric health care providers! Pain can be quite severe and is felt deep inside the ear. It can be worse when lying down. Usually the child will have a stuffy nose and cough for a few days before the ear pain starts. Some children will have a fever (temperature higher than 38C/100.4F) Younger children may be very fussy, have trouble sleeping, and not want to eat. The provider will be able to diagnose by looking directly at the ear drum (tympanic membrane) with a special flashlight (otoscope); it is usually very red & swollen, with fluid or pus seen behind the membrane. Usually the ear canal looks completely normal. Sometimes the membrane will rupture (much like a pimple bursting); sounds gross, but it provides almost immediate pain relief. Usually you will see the fluid drain out of the ear canal if this happens.
- Otitis Media with Effusion (Inner ear fluid): Effusion is fluid that has build up in the middle ear, behind the tympanic membrane, usually because of nasal congestion or allergy. Usually there is no pain, but kids may complain of ‘fullness’ or trouble hearing. The provider will diagnose this by looking at the membrane with an otoscope as well. At times, little air bubbles can be seen in the fluid as well.
Treatment for inner ear infection can depend on the child’s age and if they have a fever. A child younger than two years of age, if they have a high fever, or infection in both ears, will be give antibiotics to be taken by mouth. If they are older than two years and have mild symptoms, the health care provider may ask you to ‘watch and wait’ to see if they improve on their own in one to two days. Antibiotics can cause diarrhea or rashes, and if used too frequently, can make it more difficult to treat bacteria (due to developed antibiotic resistance). Usually providers will arrange follow-up in one to two days; if the child is the same or worse, antibiotics will be prescribed. Usually inner ear fluid build up does not need treatment.
Ensure to treat PAIN! Use either Ibuprofen (Advil/Motrin) or Acetaminophen (Tylenol) ONLY when the child is complaining of pain or is feeling sick due to a fever (make sure to double check appropriate doses for the child’s weight every time!).
Don’t give COLD MEDICATIONS; they will not help with the cause of the pain and can have serious side effects for children.
Ways to AVOID ear infections:
- Don’t put anything smaller than your elbow in your ear! It is self-cleaning; don’t put fingers, towels, q-tips, or anything else inside the ear to clean it. Ear wax’s job is to protect the inner ear from water, bacteria, or injury.
- Swimming regularly can remove some wax. Use of ear plugs made for swimming may help to avoid this. After swimming, gently blow dry ears on a low setting, holding the dryer 12 inches away at a low setting or use ear drops (available over the
counter at the pharmacy).
- Minimize use of headphones or ear plugs that block the ear canal. They can cause irritation, increasing the risk of an infection.
- Breastfeeding is protective!
- Avoid any exposure to direct or secondhand cigarette smoke.
- Never put baby to bed with a bottle! Lying flat and the sucking motion can draw fluid into the eustachian tubes and into the inner ear!
- Transition from bottle to cup by one year of age.
- Minimize the use of pacifiers (soothers).
- Ensure your child’s vaccinations are up to date and they (and the whole family) gets the flu shot yearly.
- Hand washing to minimize the spread of viruses that cause colds!
If you have any questions, or are thinking this sounds like your child right now, please feel free to contact me! I’m happy to answer questions and can provide both in home or clinic visits to evaluate your child.
Lynette Wohlgemuth, RN, NP
Reflections Nurse Specialist Services
Call: (587) 393-5959 or email: firstname.lastname@example.org
Ear Infections, Jan 2016, Canadian Paediatric Society, Link: https://
O Klen, J & Pelton, S. Patient Education: Ear infections (otitis media) in children
(Beyond the Basics), UpToDate, Topic 1204 version 21.0. Link: https://www.uptodate.com/contents/ear-infections-otitis-media-in-children-beyond-the-basics?source=see_link