Ear Ache: Many times in children, an ear ache is due to a middle ear infection, although there are other possibilities. Middle ear infections hurt because the infection causes the middle ear space which is normally filled with air to fill with blood and pus, putting pressure on the eardrum. If the infection is bad enough, sometimes this pressure can cause the eardrum to rupture releasing the blood and pus into the ear canal (see the section on Draining Ear that follows on how to manage this).  Ear aches, especially when they are associated with fever, should be evaluated by the doctor. We usually recommend that this be done in the office during regular office hours. Medications are not prescribed for an earache by telephone because it is impossible to determine the problem by telephone and prescribing antibiotics without a proper diagnosis is dangerous to your child (please see the section on antibiotics). Other problems which can cause an ear ache are Swimmer’s Ear (Otitis externa, see below for a description of this condition), strep throat and an inability to equalize pressure in the ear such as following a cough, sneeze, or crying episode, etc. If the pain is due to the inability to equalize pressure, many times this will be relieved by swallowing a liquid followed by a few minutes of rest. An antihistamine decongestant preparation might help with this if the Eustachian tube is blocked.  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:

  • Use acetaminophen for pain (Tylenol – see Dosing Guide for dose).
  • If acetaminophen is not effective, give ibuprofen (see Dosing Guide) to control pain.
  • Ear infections are painful due to the accumulation of pus behind the eardrum that creates a lot of pressure.  If your child’s ear is painful, give her something to drink.  After a few minutes the pain will hopefully begin to ease after drinking a glass of water.

Children who develop ear ache and fever should be seen in the office within 24 hours of the onset of their illness. An antibiotic may be necessary. Old prescriptions should not be given to a child with a new onset of ear ache. Antibiotics usually take two to three days to have an effect on the infection. 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 visits 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 otitis media with effusion. 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 (PE) tubes in their ear drums can have a draining ear associated with a 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 PE tubes. An antibiotic placed in the ears can treat this infection. Most ENT doctors will prescribe this antibiotic drop when PE tubes are placed.

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.

Reviewed 3/16/17 by Dr. Byrum