Ear Ache in Children

How do ear aches occur?

  • Ear aches (also known as otalgia) in children can occur following a cold where the cold (infection) enters the middle ear via the eustachian tube. This is known as a middle ear infection (also known as otitis media).
  • Ear aches can also occur because of a buildup of wax. Another cause is if a person instruments the child’s ear. This may push the wax onto the ear drum causing pain.
  • An infection of the external ear caused by scratching or insertion of an object can result in otalgia.

What should you do?

If the ear is being instrumented that should stop immediately. Consult your ENT doctor immediately. Medicine to relieve pain can be given. Medicine such as paracetamol relieves pain effectively. Nasal decongestants can also be given.

How is Otitis media treated?

Otitis media is usually caused by a cold entering the middle ear via the Eustachian tube. The child will simultaneously present with a respiratory infection. The ENT doctor will carefully examine the ears, nose and throat of the child.

The commonest bacteria (germs) that cause respiratory tract infections and otitis media are streptococcal bacteria. Staphylococcal bacteria and others may also be found. Often two or more bacteria can be present causing both the upper respiratory tract infection and otitis media.

If the infection is mild and has just manifested itself, oral antibiotics will be given. The kind of antibiotic will be based on (a) Type of bacteria suspected to have caused the infection. (b) Dosage of the antibiotic will depend on the child’s body weight and severity of infection. (c) The duration for which the antibiotic will be given will depend on how quickly the infection responds to the medication.
Symptomatic treatment can also be given simultaneously. This medication is given to bring down fever, pain (otalgia) and congestion of the nasal cavity.

Parents, doctors and caregivers need to observe the child’s response to determine if the child is responding adequately to the medication.

Look for antibiotic reactions like a rash, diarrhea, vomiting. Check the child’s temperature. If the child is still listless, still complaining of pain and running a temperature then this means that the child is not responding well to the medication. If this is so then the child will likely need hospitalization.

Can Otitis media cause serious complications?

Yes it can.

It can result in septicemia. This is a condition where the body is not able to contain and resist the infection despite adequate medications and antibiotics being given.

The child will need to be admitted to hospital. Intravenous antibiotics will need to be given. The choice of antibiotic will depend on the bacteria causing the infection. This will be based on a swab taken to identify the bacteria. The swab will be taken from the nose and / or throat.

If the ear drum is red and swollen the doctor might decide on performing a myringotomy. This is a surgical procedure where the surgeon takes a cut (an incision) on the ear drum. This reduces the pressure buildup of pus in the middle ear. The surgeon can aspirate this pus and send it for examination to identify the bacteria causing the infection. The myringotomy goes a long way to reducing pain and pressure in the ear. The myringotomy is performed in the operating room under anesthesia and the surgeon will use an operating microscope to perform the procedure.

On occasion the ear drum ruptures spontaneously and the pus will discharge out in the external ear. Very often the perforation is tiny and heals spontaneously.

On occasion it can be a large perforation which may require surgery at a later date when the infection has been treated. Aggressive treatment with the appropriate antibiotic needs to be given along with other medications to reduce other symptoms like pain.

Ear drops need not be given as the problem lies in the middle ear and not in the external ear.

Can Otitis media cause deafness?

Yes it can.

It can cause temporary deafness or permanent irreversible, profound, sensorineural hearing loss. Therefore each attack of otitis media needs to be treated appropriately and thoroughly.

What are the symptoms of Otitis media?

  • Otalgia (ear pain).
  • Fullness in the ear which results in the child tugging at the ear.
  • Diminished hearing.
  • Fever.
  • Feeling of pressure in the ear.

Should a hearing test be done?

Yes it should be done. This will include a test for hearing as well as to measure the pressure in the middle ear. The hearing tests should be done before and after treatment. However if the child is very ill it may not be possible to perform a hearing test immediately and can be deferred until the child is better.

What are the complications of Otitis media?
The complications can be quite serious.

  • Intracranial complications like
    1. Meningitis.
    2. Sigmoid sinus and venous sinus thrombosis.
    3. Brain abscess.
  • Intratemporal bone complications like
    1. deafness.
    2. facial nerve paralysis.
    3. Perforations of the ear drum.

Other causes of ear ache

  • Furuncle (commonly know as a ‘boil’). This is caused by insertion of objects or fingers in the external ear canal. The ear canal will be swollen and painful.
    Treatment consists of giving appropriate antibiotics, pain relievers and ear drops. On occasion the surgeon may need to incise and drain the furuncle.
  • Fungal infections are caused by the insertion of objects in the ear.
    These fungal are superficial and are usually not invasive. Thus they respond to the administration of antifungal ear drops. Suctioning of the debris in the ear and removal of the fungus helps in getting rid of the fungus.
  • Impacted wax: This needs to be removed gently without traumatizing the ear. A wax softener may need to be given first. After suitably applying the drops the wax can then be removed at a later date.
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