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Earache

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Definition

  • Pain in or around the ear
  • The older child complains about ear pain
  • Younger child acts like he did with last ear infection or cries a lot
  • Not caused by an ear injury

Causes of Earaches

  • Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.
  • Swimmer's Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.
  • Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.
  • Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.
  • Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by cotton swabs, the ear canal can become blocked. This pain will be worse.
  • Ear Canal Foreign Object. Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.
  • Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.
  • Pierced Ear Infections. These are common. If not treated early, they can become very painful.
  • Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.

Ear Infections: Most Common Cause

  • Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common than bacterial ones.
  • Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
  • Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
  • Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
  • Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
  • Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
  • Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.
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When To Call

Call 911 Now

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Not alert when awake ("out of it")

Call Doctor or Seek Care Now

  • Severe earache and not improved 2 hours after taking ibuprofen
  • Pink or red swelling behind the ear
  • Stiff neck (can't move neck normally)
  • Walking is not steady
  • Pointed object was put into the ear canal (such as a pencil, stick, or wire)
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever higher than 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Outer ear is red, swollen and painful
  • Earache, but none of the symptoms above. Reason: could be an ear infection.
  • Pus or cloudy discharge from ear canal
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Care Advice

What You Should Know About Earaches:

  • Your child may have an ear infection. The only way to be sure is to look at the eardrum.
  • It is safe to wait until your doctor's office is open to call. It is not harmful to wait if the pain starts at night.
  • Ear pain can usually be controlled with pain medicine.
  • Many earaches are caused by a virus and don't need an antibiotic.
  • Here is some care advice that should help until you talk with your doctor.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Cold Pack for Pain:

  • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
  • Note: some children prefer heat for 20 minutes.
  • Caution: heat or cold kept on too long could cause a burn or frostbite.

Ear Infection Discharge:

  • If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.
  • The pus may be blood-tinged.
  • Most often, this heals well after the ear infection is treated.
  • Wipe the discharge away as you see it.
  • Do not plug the ear canal with cotton. Reason: retained pus can cause an infection of the lining of the ear canal.

Fever Medicine:

  • For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Note: fevers less than 102° F (39° C) are important for fighting infections.
  • For all fevers: keep your child well hydrated. Give lots of cold fluids.

Return to School:

  • Ear infections cannot be spread to others.
  • Can return to school or child care when the fever is gone.

Call Your Doctor If:

  • Pain becomes severe
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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