An earache can be described as anything that causes pain within or surrounding the ear and is one of the most common childhood complaints in a pediatric office.  

When your child has an earache, he or she may:

  • Pull at the ear
  • Cry or be irritable
  • Have ear drainage
  • Have some loss of hearing
  • Possibly have a fever.

What causes an earache?

Common causes of earache include different types of infection, injury, or pressure.  Middle ear infections are especially common in children 2 years of age and younger and are often seen during or after a cold.  This is the result of infection developing behind the eardrum where fluid may have accumulated during the cold.  Outer ear infections (swimmer's ear), though painful, are quite different in that it is the skin lining the ear canal that becomes infected and painful.  This typically happens during the summer with older kids who have been swimming, thus the term "swimmer's ear." 

Pain from injury to the ear canal or eardrum can occur in a number of ways depending on age and circumstance.  It's not unusual to see an injury from a cotton swab or from a small toy along with an assortment of other foreign objects a toddler might find irresistible.  Pressure from impacted wax or changes in air pressure can also produce pain.  

Sometimes children will say their ear hurts when in fact, the pain is actually radiating from another location.  We call this referred pain.  This can be caused by sore throats; tooth, gum or teething pain; pain of the scalp, neck or sinuses.  

How is it treated?

Suspected middle ear infections should be evaluated by your doctor.  Ear pain itself can be treated with an appropriate dose of acetaminophen or ibuprofen.  Antibiotics are usually reserved for kids under 6 months of age when symptoms won't improve or when accompanied by high fever or other significant signs of illness.   

Outer ear infections are usually treated with antibiotic drops and modified swimming activities. There are various drying techniques that can be used to help prevent these types of ear infections as well. 

Impacted wax or foreign body removal is generally best handled by your physician.

How can I help my child?

For middle ear infections, follow your doctor's instructions for care and follow up.  To help relieve pain, you may:

  • Give your child acetaminophen or ibuprofen
  • Put a cold pack or wet cloth on the ear for 15 - 20 minutes
  • Put a warm moist cloth over the ear.

To keep wax from impacting, remember to never put things like cotton swabs into the ear canal. 

To help with pressure such as that which may occur with air travel, have the older child attempt to blow out while pinching the nose and keeping the mouth closed.  You can help prevent this problem with a baby by nursing or bottle feeding while the plane is climbing or descending.  Swallowing helps equalize air pressure.

Q&A with Dr. Jennifer Lum

What is your role at Pediatrics East and how long have you been in it?

I am a general pediatrician and have been at Peds East for 5 years, but have been practicing pediatrics for almost 9 years. 

How often would you say you see children with earaches come through the office?

I would say that besides cold symptoms and fevers, ear pain is one of the most common complaints that we see in the office.

Why are earaches so common?

There are lots of different reasons that a child can complain of earache, which I think is part of what makes it such a common complaint. Sometimes it is actually due to the ear being infected, however sometimes ear pain can be due to another part of the body hurting and the patient is having referred pain to their ear. Some examples of different reasons ears can hurt include: 

  1. Middle ear infection–This happens when fluid behind the eardrum                  becomes infected. Sometimes this can be caused by viruses, but other times it can be caused by bacteria, which needs antibiotic treatment. 
  2. Outer ear infection (or more commonly known as swimmer’s ear)-This happens when the ear canal becomes infected. This type of infection usually needs antibiotic ear drops for treatment. 
  3. Middle ear effusion–Sometimes fluid can be behind the eardrum, but not be infected fluid. This can cause feelings of “fullness” or “pressure” at times for some kids, which can be uncomfortable. 
  4. Teething/tooth pain-Sometimes when babies or toddlers are cutting new teeth, they will pull at their ears due to referred pain coming from their mouth.  Children can also have referred ear pain at times, but it can be due to a tooth issue.
  5. Sore throat–Sometimes some children will complain of ear pain, but it can actually be due to referred pain coming from their throat–which could have an infection, or be irritated for other reasons like post-nasal drainage. 

How do earaches or ear infections develop?

Ear aches can develop for a number of reasons, but I think the most common thing we typically see are what we call acute otitis media, also known as a middle ear infection. This develops when fluid behind the eardrum becomes infected. It can cause the eardrum to become inflamed and can be very painful. Fluid can build up behind the ear drum for a number of different reasons, but the most common one we see is because of upper respiratory respiratory infections or colds. 

What are the signs and symptoms of ear aches?

When children have earaches the most common thing they will complain about is their ears hurting. Sometimes parents will notice their child tugging on an ear or touching it repeatedly if they are in pain as well. Babies will sometimes cry when being laid down, or not sleep as well as they normally do because the fluid behind the eardrum is hurting them more when being laid down. It is more common for fever to be a presenting sign of a true ear infection when kids complain of ear pain, but there doesn’t always have to be fever for an ear to be infected. 

How many earaches is too many, and at what point should I be concerned about my child?

Since ears can hurt for a number of different reasons, it is important to have your child evaluated by a pediatrician if the pain is persistent so we can help them figure out the cause. Typically if children are having 3 or more middle ear infections over a 6 month period, that may mean they need to see a special doctor called an ENT to help manage their ear infections.

Can anything be done to prevent earaches?

Given the various causes of ear infections, there usually is not one thing that can help prevent them from developing. The best thing to do is to try to keep your child as healthy as possible, and when symptoms arise have them checked out by your pediatrician to evaluate the cause.

 At what point should I call a pediatrician for an earache? 

If your child has a fever with ear pain, I usually tell parents to bring them in sooner rather than later with those symptoms, usually if it persists for a day or more. If your child has had cold symptoms, and then starts complaining of ear pain but doesn’t have a fever, sometimes you can wait and see if the ear pain resolves, but if it persists after 2-3 days then I would recommend having them seen by their doctor. 

What do earache treatments look like, both for mild and severe earaches?

For symptom control for pain, I recommend either tylenol (aka acetaminophen) or motrin (aka ibuprofen for children ages 6 months and up) as a starting point. Depending on the cause of the ear infection, some kids need antibiotics by mouth or sometimes they need antibiotic eardrops. Once they have been seen by their doctor, they can decide on the best treatment plan to help them get to feeling better. 

Can my child go to school with an earache?

If your child has a fever or cold symptoms plus an earache I would recommend them being seen by their doctor to evaluate for the cause. Ear infections in general are not contagious to other people, but if they have a viral cold or fever, that could be something that could be spread to other children. 

I’ve heard about ear tubes, when are those needed and what does that procedure look like?

Ear tubes (also known as pressure equalization tubes) are tiny cylinders that are inserted into the eardrum by a specialized doctor called an ENT.  This ear tube helps balance the pressure in the middle ear and allows fluid to drain, so it doesn’t build up behind the eardrum. 

In terms of what that procedure looks like, I will leave that to the experts, the pediatric ENT specialists, to describe to parents in case they ever need that done. 

Is there anything else you can tell us about earaches that we didn’t hit on?

I think that about covers everything I would like families to know about earaches. My main point to all of this is, ear pain can be caused by a number of different reasons that can have different treatments, and our job as pediatricians is to help decide what the best treatment would be for the specific cause. So if parents are ever in doubt, please bring their kids in for us to check them out and help get them to feel better as soon as possible. 

Schedule an Appointment