EAR PROBLEMS

Ear Ache:

In children, ear aches are often caused by middle ear infections (otitis media), although other conditions can also be responsible. Middle ear infections are painful because they cause the normally air-filled space in the middle ear to fill with blood and pus, putting pressure on the eardrum. In severe cases, this pressure can cause the eardrum to rupture, releasing blood and pus into the ear canal. For guidance on managing this condition, see the section on “Draining Ear” below.

It’s important for earaches, especially those associated with fever, to be evaluated by a doctor in an office visit, preferably during regular office hours. Medications are not prescribed for earaches over the phone because diagnosing the issue accurately requires an in-person examination. Prescribing antibiotics without a proper diagnosis is unsafe for your child, as explained in the antibiotics section of this handbook.

Other conditions that can cause earaches include Swimmer’s Ear (Otitis externa), viral sore throat, strep throat, and difficulties equalizing ear pressure after coughing, sneezing, or crying. If the earache is due to pressure imbalance, swallowing a liquid followed by a few minutes of rest can often provide relief. In cases where the Eustachian tube remains blocked, an antihistamine may help alleviate the discomfort.

Sore throats can feel like an earache because of how pain signals are sent in the body. The glossopharyngeal nerve (Cranial Nerve IX) carries signals from both the throat and areas in and around the ear. When your throat is sore or infected, like with strep throat, the nerve can send pain signals that make your brain think that the pain is coming from your ear. This is called referred pain because the issue is in your throat, but it feels like it's in your ear. As you can see, a simple earache is not so simple.

To provide relief for your child at home prior to an office visit for evaluation of an ear ache, the following measures may be tried:

1. Use acetaminophen for pain (Tylenol - see Dosing Guide).
2. If acetaminophen is not effective, give ibuprofen (see Dosing Guide) to control pain.
3. Ear infections can be painful because pus accumulates behind the eardrum, creating pressure on the eardrum. The Eustachian tube, which connects the middle ear space to the back of the throat, usually helps equalize ear pressure and drain fluids. However, when it becomes blocked, pressure can build up in the middle ear, leading to pain. If your child experiences ear pain, have them drink a glass of water. Swallowing can help open the Eustachian tube and equalize the pressure, which may relieve the pain after a few minutes.
4. Children who develop an ear ache should be seen in the office within 24 hours of the onset of their illness. An antibiotic may be necessary.
5. Old prescriptions should not be given to a child with a new onset of ear ache. Starting your child on an antibiotic at night will not significantly hasten his recovery, but may only needlessly expose him to a potentially harmful medicine.
   

Chronic Middle Ear Infections: 

Many children develop chronic, long-standing and recurrent infections in their middle ear spaces. These infections may require repeated courses of antibiotics and several office vis- its to manage them. They are quite frustrating for parents. Thank goodness that most children will outgrow middle ear infections eventually.

Ear recheck appointments are important after a course of antibiotics, especially for kids under two years of age to ensure that the ear infection resolves. To try to minimize hearing damage and repeated exposure to antibiotics, the American Academy of Pediatrics recommends that after 3 middle ear infections within six months or 4 middle ear infections within twelve months, the placement of pressure equalizing tubes at surgery in both ear drums. If your child meets this criteria, we will need to discuss this procedure during an ear recheck appointment.

An otolaryngologist (ENT physician) places pressure equalizing tubes in children. We can help you with this referral should it become necessary.

There are times in which a child who has had several middle ear infections, may develop a middle ear space that is filled with thick viscous mucous. We call this a “glue ear”. This condition has the medical name of serous otitis media. This condition is really not an ear infection, but a fluid filled middle ear. We treat this with watchful waiting for a few months. After three months to six months depending on how your child is hearing, the placement of a pressure equalizing ventilating tube may be necessary to prevent hearing loss by draining the affected ear. The placement of these tubes drains the fluid and helps the ear to heal.

Draining Ear: 

If your child’s ear is draining pus, then the child should come in for an examination. It is possible that she may have a perforated ear drum. Be calm, this is usually not a serious condition and the ear drum should heal with proper treatment. An office visit is necessary.

Kids who have pressure equalizing tubes (PET) in their ear drums can have a draining ear associated with a bacterial middle ear infection. The pus drainage coming out of the ear is a sign of a middle ear infection that is being drained by the pressure equalizing tubes. An antibiotic placed in the ears can treat this infection. Most ENT doctors will prescribe this anti- biotic drop when PE tubes are placed. Ofloxacin optic drops are commonly used for this purpose.

Alternatively, a draining ear may be the sign of a swimmer’s ear, which is an infection of the external auditory (ear) canal which may happen when children get water in their ears, such as when swimming. The child should come in for an office visit during regular office hours to check for this condition. A cotton wick made from a cotton ball may be placed into the ear to absorb the drainage.

To prevent swimmer’s ear you may make a solution of one-half part rubbing alcohol and one half part white vinegar. A few drops of this solution placed into the ears after swimming can prevent swimmer’s ear. If your child has pressure equalizing tubes or an ear perforation don’t use the drops in the ear because of ear pain that your child will experience if you use them.

Hearing Problems: 

All hearing problems should be evaluated in the office during regular office hours.

Object in the Ear:

Rocks, seeds, beans and other small objects that are placed in the ear by a child should be removed during regular office hours unless the child is having pain or bleeding with this. If either significant pain or bleeding occurs, the physician should be called.