Ear Pain and Infections in Children

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Lucile Salter Packard Children's Health Services
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The outer ear, or the part of the ear you see, picks up the vibrations from sound and sends them through the ear drum to the middle ear. Three small bones in the middle ear (the malleus, incus and stapes) pass the sound into the inner ear, or cochlea, making hearing possible. The middle ear is connected to the nose and throat by the Eustachian tube. This allows fluid to drain from, and air to get into the middle ear. If the fluid cannot drain because the secretions are too thick or because of inflammation and swelling in the tube, the fluid builds up in the middle ear causing increased pressure, pain and sometimes infection. In very young children the Eustachian tube is small, and sometimes not angled to allow easy drainage of the fluid.

Ear Pain

An earache is a miserable experience at any age. Older children may complain of ear pain, younger children may become very fussy and wake up during the night crying. If they are pulling at their ears and especially if they have a fever and have had cold symptoms, they may have an earache. However, many children who are pulling at their ears but have no other symptoms may just have an itchy ear canal from getting soap or shampoo in it. They may also have just discovered their ears and are playing with them; this may be a comforting habit, or a way of exploring a new part of their body. Temporary ear pain can occur when a child first comes inside from playing in cold weather. This should last only one half hour or less.

Ear pain is not an emergency. There are a number of ways to keep your child comfortable until you can see the doctor.

• Acetaminophen (Tylenol or Tempra) in the appropriate dose for your child. This dose can be repeated every four hours.

• A warm pack (such as a towel warm from the dryer) on the sore ear, or on both ears. Some children may prefer an ice pack. Try this for 20 minutes every hour.

• Have your child rest with the head elevated, either by sitting in a chair or by using pillows; infants can be held or placed in an infant seat.

• If the Acetaminophen does not work, or if it is bedtime, you can try a dose of Ibuprofen (Advil or Motrin) which is now available without a prescription. This medicine usually works very well, and it lasts longer so it can be good at bedtime. The dose can be repeated every six hours.

• If all these measures fail, your doctor may call in a prescription for either ear drops or for a medicine containing codeine for pain.

• Do not use any ear drops unless your doctor recommends them. Do not plug the ear with cotton, or put anything else in the ear.

Perforated Ear Drum

If there is pus or yellow or cloudy fluid draining from the ear, wipe it away as it appears. Do not plug the ear with cotton. This usually comes from a small tear or perforation in the ear drum caused by the infection. There is usually less, if any, pain after this happens. This is also not an emergency, but be sure you call your doctor within 24 hours.

Ear Infections

An infection in the middle ear is called otitis media. Otitis means inflammation or infection of the ear and media means it is the middle ear or space behind the eardrum. This can cause earaches. Most children will have at least one ear infection during childhood, and some children will have many such infections. They are a common complication of a cold. Ear infections are most common between the ages of 6 months and 2 years, but often occur in children up to 8 to 10 years of age.

Often ear pain and infection will clear naturally, without antibiotics. The cold which precipitated the earache is caused by a virus. Time cures viruses; antibiotics do not. Ear infections may clear up as the cold clears up, so if the earache is gone in 12 to 24 hours antibiotics are not needed. Your doctor will want to examine your child before deciding whether to prescribe antibiotics.

• If antibiotics are ordered be sure you understand how much to give, how often to give it, and that you must complete the entire prescription, even if the symptoms are gone.

• Ear pain may continue for one to two days after the antibiotics are started and you may need to continue with the comfort measures.

• Your child can go outside, and the ears do not need to be covered.

• Colds are contagious but ear infections are not. Day care is okay once your child is feeling better and has a normal temperature. Don't worry about solid food, but be sure your child drinks plenty of liquids.

• Swimming is okay as long as there is no tear in the ear drum or drainage from the ear. Ask your doctor about diving.

• Airplane travel or high altitudes may cause discomfort: chewing gum, sucking a pacifier or swallowing fluids can help.

• A follow up exam is especially important if the eardrum is perforated.

Chronic Ear Fluid and Surgery

The eardrum normally vibrates with sound because the space behind it (the middle ear) is filled with air. If the middle ear is filled with fluid the hearing is muffled. Some children will still have fluid in the middle ear for a month or more after an ear infection. The muffled hearing, if it continues, may affect a child's speech development. Chronic ear fluid and recurrent ear infections are usually caused by a blocked Eustachian tube. However other factors can also contribute:

• exposure to smoke

• drinking from a bottle while lying down

• frequent pacifier use

• allergies which cause nasal congestion

A surgical approach to this problem is to place a tiny plastic tube through the eardrum. This is done by an ear, nose, and throat surgeon, also called an otolaryngologist. These tubes allow secretions to drain out of the middle ear space and allow air to reenter. Because anesthesia is needed in young children this is done in the operating room. Physicians recommend these tubes only for children who definitely need them. Normally the tubes fall out on their own after about a year

Swimmer's Ear

An external ear infection can occur after frequent swimming, and so is called swimmer's ear. The ears feel itchy and painful and it hurts when the earlobe is moved up and down or when the tab on the ear lobe is pushed inward. This can be prevented by keeping the ear as dry as possible: after swimming turn the head to either side and pull the earlobe in different directions. Don't try to wipe out the ear canal with cotton swabs. Antibiotic ear drops may be needed for swimmer's ear. Call your doctor if your child has severe pain or if this is a common problem.

Call Your Doctor if

• Pulling at the ear continues for more than three days and is accompanied by other symptoms

• Your child complains of severe ear pain

• There is discharge from the ear

• Your child has a fever of over 100 degrees F or 37.8 degrees C with ear pain

• The above symptoms continue after 72 hours on antibiotics

• Your child is acting very sick with chills, dizziness, severe headaches, lethargy

• You have other concerns or questions

Adapted from Barton Schmidt MD, author of Your Child's Health, Bantam Books

Other Reading

Grundfast, Kenneth & Cynthia Carney. Ear Infections in Your Child. Compact Books,1987. Information about what to do when a child gets an ear infection, causes of ear infections, and how to make decisions regarding medication or surgery.

Lanski, Vicki. Koko Bear's Big Earache. Bantam Books, 1988. Preparing your child for ear tube surgery. Describes Koko's discomfort and temporary hearing loss; explains how these are helped by a simple operation. Includes suggestions for parents.

Schmidt, Michael. Childhood Ear Infections. North Atlantic Books, 1990. Discusses nutritional strategies, allergy management, and alternative medicine approaches to help prevent and heal recurrent ear infections.

Zand, Janet, Rachel Walton & Bob Rountree. Smart Medicine for a Healthier Child. A Parent's Guide to Safe and Effective Relief of Common Childhood Disorders Using Nutritional Supplements, Herbs, Homeopathy, Acupressure, Diet and Conventional Medicine.

Credits

Preparation of this handout supported by a donation from the Stanford University School of Nursing Alumnae

Lucile Salter Packard Children's Health Services
Parent Information and Referral Center:
1-650-498-KIDS or 1-800-690-2282