Earache in children: Common causes and treatments

Did you know that earaches are one of the most common reasons behind paediatrician visits, with five out of six children experiencing an ear infection before their third birthday?

Ear pain (medically known as otalgia) can be excruciating for babies, toddlers, and young children and can impact sleeping patterns, appetite and mood. Because childhood earaches can have many causes, it’s tricky for parents to determine which treatment is the right option. Here’s how to make the job of treating earaches a little easier.

What causes an earache?

Teething, a sore throat, an ear infection, a blocked eustachian tube, or fluid behind the eardrum (medial otitis with effusion) are all possible reasons for ear pain.

What is medial otitis with effusion?

When the Eustachian tube, which connects the middle ear to the back of the nose, becomes clogged, it causes otitis media with effusion. This causes fluid to accumulate behind the eardrum.

Antibiotics are not necessary because there is no infection. Instead, the treatment is symptomatic. Parents often turn to acetaminophen or ibuprofen for children as needed for pain alleviation. Warm compresses can also be used as needed.

While otitis media with effusion usually cures on its own within three months, it can cause temporary mild hearing loss. If the fluid remains for more than three months or there is a worry about hearing loss, your child may be referred to an ENT (Ear, Nose, and Throat specialist) for additional assessment. The ENT may recommend tympanostomy tubes (ear tubes), which aid in fluid drainage from the ear.

Infection of the ears

When the Eustachian tube becomes clogged and fluid accumulates in the middle ear space, viruses or bacteria can grow in the fluid and produce pain.

Ear infections are most commonly caused by a viral upper respiratory illness, are more prevalent in the winter, and often affect children who attend daycare. 

Antibiotics are not usually required since ear infections are not always caused by bacteria.

Ear infection prevention strategies include:

• Maintain your child’s vaccines, including pneumococcal and influenza shots.
• Limit your exposure to secondhand smoking.
• Breastfeed your baby entirely during the first six months of their existence.
• Avoid bottle propping in infants.

If your child has three or more bouts of ear infections in six months or four in a year, it’s best to take them to see an ENT.

Swimmer’s ear

Swimmer’s ear (otitis externa) is caused by an infection in the external ear canal. This can happen if the skin in the ear canal becomes inflamed or scratched, resulting in an infection.

Swimmer’s ear is treated with topical antibiotic drops. To relieve discomfort, ibuprofen or acetaminophen can be taken.

Preventative measures for children with recurring swimmer’s ear include:

• Using earplugs when swimming
• After swimming, dry the ear with a hair drier on low heat and at least 12 inches away from the ear.
• After swimming, use acetic acid or alcohol ear drops.

Dysfunction of the Eustachian tube

Sometimes ear pain can be caused by the eustachian tube’s dysfunction, which connects the middle ear to the nasopharynx (back of nose and top of throat). This tube aids in the equalisation of pressure across the tympanic membrane (ear drum), the protection of the middle ear against infection, and the clearance of middle ear secretions.

Ear pain, ear fullness, impaired hearing, tinnitus, or popping/cracking in the ear are all symptoms of Eustachian tube dysfunction.

The treatment entails addressing the underlying cause of Eustachian tube dysfunction:

• Treat any underlying allergic rhinitis, rhinosinusitis, laryngopharyngeal reflux, or gastroesophageal reflux disease (GERD).
• Reduce your child’s exposure to secondhand smoking.

Disorders of the temporomandibular joint

Referred ear discomfort can be caused by problems with the temporomandibular joint, which connects the jaw to the skull. Other signs of temporomandibular joint disease include jaw or facial pain, headache, and pain when chewing or opening the mouth.

Children over age ten are more likely to suffer from temporomandibular joint issues.

Patient education, avoidance of triggers, jaw exercises, use of an occlusion splint if teeth grinding is an issue, and anti-inflammatory pain drugs are all part of treatment.

Other reasons for ear pain

Other less common causes of ear pain include ear trauma, foreign bodies in the ear canal, wax build-up, teething, parotitis, sinusitis, pharyngeal infections, lymphadenopathy/lymphadenitis, and cervical spine injuries.

Signs of ear ache in children

Watch out for possible signs that your child has an earache including:

• Rubbing or pulling on the ear
• A temperature of 38C or above
• Restlessness
• Loss of appetite
• Loss of balance

When should you seek medical attention for your child’s ear pain?

If your child has any of the following symptoms, contact their doctor or seek medical attention:

• Ear pain that is increasing, chronic, or is not managed by supportive care measures
• Blood or pus is draining from the ear canal.
• The skin around the ear begins to swell or turn red.
• Your child develops a new or elevated fever

At-home ear pain treatment

• Because ear pain can be worse when lying down, encourage your child to sit or sleep with their head up.
• Warm compresses may help relieve ear pain. However, be careful not to burn your skin.
• To relieve pain, take acetaminophen or ibuprofen as directed on the package or by your doctor.
• Do not administer aspirin to anyone under the age of 18. It has been connected to the development of Reye syndrome, a disease that causes brain and liver enlargement.
• Nothing should be inserted into the ear (including Q-tips). It is safe to use a warm washcloth to clean the exterior of the ear.