Ear Pain in Children - How & Why


Study of otitis media and treatments

Otitis Media:

Middle ear inflammation caused by infection is called Otitis Media. It commonly occurs as a sequelae to a viral respiratory infection. It occurs in one or both ears. It is the most frequent diagnosis recorded for children who visit physicians for illness. It is the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is it serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. If it is treated promptly and effectively, hearing can almost always be restored to normal.

It is also serious because the infection can spread to nearby structures in the head, especially the mastoid air cell (mastoiditis). It is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from the doctor.

How does the ear work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that are transmited to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as the outside ear, allowing free vibration. Air enters the middle ear through the narrow Eustachian tube that connects the back of the nose to the ear. During yawning and swallowing, the Eustachian tube has just sent a tiny air bubble to middle ear to equalize the air pressure and sometimes this is heard as a ‘pop’ in the ears.

middle ear

Secretory ottitis. The middle ear is filled with fluid leading to blockage and if infected causes severe pain.

Causes of otitis media:

  • Blockage of the Eustachian tube during a cold, allergy, or viral upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media.
  • The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, the child may have hearing problems.
  • Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed Eustachian tube.
  • Treatment may include myringotomy to aspirate fluid and tympanotomy tubes placed in the eardrum to allow ventilation of the middle ear.
  • Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This is called middle ear effusion or serous otitis media.This condition makes the subject prove to frequent recurrences of the acute infection and may cause difficulty in hearing.

Symptoms of Otitis Media:

In infants and toddlers look for:Pulling or scratching at the ear.

  1. Hearing problems
  2. Crying, irritability
  3. Fever
  4. Vomiting
  5. Ear drainage

In young children, adolescents, and adults look for:

  • earache
  • feeling of fullness or pressure
  • hearing problems
  • dizziness, loss of balance
  • nausea, vomiting
  • ear drainage
  • fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

What will happen at the doctor’s office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move and/or is red, an ear infection is probably present.

Two other tests may be performed for more information.An audiogram tests if hearing loss has occurred by presenting tones at various pitches.

A tympanogram measures the air pressure in the middle ear to see how well the Eustachian tube is working and how well the eardrum can move.

The Importance of Medication:

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache disappear rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full course the doctor has indicated. Other medications that the doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call a doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

What other treatment may be necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, the physician may recommend further treatment. An operation, called a myringotomy (surgical puncture of the membrane with release of pus) may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid disappears. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the Eustachian tube to return to normal. This may require several weeks or months. During this time, one must keep water out of the ears because it could start an infection, Otherwise, the tube causes no trouble, and one will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, the doctor may recommend removal of one or both. This can be done at the same time as the ventilation tubes are inserted.Allergies may also require treatment.

Points to Remember:

Otitis media is generally not serious if it is promptly and properly treated. With the help of a physician, the child can feel and hear better very soon.

Be sure to follow the treatment plan, and see a physician until he/she tells that the condition is fully cured.