Ear pain (otalgia) can be a common reason children visit a physician. There are several causes of ear pain, including teething, sore throat, ear infection, or blocked Eustachian tubes.
Otitis media with effusion (Fluid behind eardrum)
Otitis media with effusion occurs when the Eustachian tube that connects the middle ear to the back of the nose becomes blocked. This allows fluid to collect behind the eardrum.
Since there is no infection, antibiotics are not beneficial. Treatment is aimed at symptomatic control: acetaminophen or ibuprofen as needed for pain relief. You can also use warm compresses as needed.
Otitis media with effusion generally self-resolves within 3 months.
Temporary mild hearing loss can be associated with otitis media with effusion. Strategies to help with hearing loss, if present, include:
- Speak directly to your child in a louder voice than normal; make good eye contact and use gestures.
- Reduce background noise when talking to affected individual (lower volume of TV and radio)
If fluid persists longer than 3 months or hearing loss is a concern, your child may be referred to ENT (Ear, Nose and Throat specialist/Otolaryngologist) for further evaluation. The ENT may discuss tympanostomy tubes (ear tubes), which help drain the fluid in the ear.
When the Eustachian tube that connects the middle ear to the back of the nose becomes blocked, and fluid collects in the middle ear space, viruses or bacteria can sometimes grow in the fluid and cause pain (acute otitis media).
Commonly, these ear infections may occur after or during a viral upper respiratory infection. Otitis media is more common in the winter, and occurs more frequently in children who attend daycare (related to the increased number of viral URIs experienced by these children). Otitis media does not occur after getting water in the ear.
Antibiotics are used for some patients with an ear infection. Since ear infections are not always caused by bacteria, antibiotics are not always needed.
Strategies to prevent ear infections include:
- Keep your child’s vaccinations up to date, especially pneumococcal and influenza vaccinations
- Avoid exposure to second-hand smoke
- Breastfeed your child exclusively for the first 6 months of life
- Avoid bottle propping in babies
If a child has repeated episodes of acute otitis media (3 episodes in 6 months or 4 episodes in 1 year), the child may be referred to ENT (Ear, Nose and Throat specialist/Otolaryngologist) for evaluation for tympanostomy tubes (ear tubes) to help the fluid drain.
Swimmer's ear (otitis externa) occurs when there is an infection present in the external ear canal. This can occur if the skin in the ear canal becomes irritated or scratched and then develops an infection.
Topical antibiotic drops are used in the treatment of swimmer’s ear. Ibuprofen or acetaminophen can be used to control pain.
For patients with recurrent swimmer’s ear, preventative measures include:
- Wearing ear plugs when swimming
- Drying the ear after swimming with hair dryer on low setting and at least 12 inches from the ear
- Use of ear drops containing acetic acid or alcohol after swimming
Eustachian tube dysfunction
The Eustachian tube is a tube that runs from the middle ear to the nasopharynx (back of nose and top of throat). This tube helps to equalize pressure across the tympanic membrane (ear drum), protect the middle ear from infection and help clear middle ear secretions.
Symptoms of Eustachian tube dysfunction include ear pain, ear fullness, decreased hearing, tinnitus or popping/cracking in the ear.
Treatment involves treating the underlying cause of the Eustachian tube dysfunction:
- Treat any underlying allergic rhinitis, rhinosinusitis, laryngopharyngeal reflux, GERD
- Eliminate exposure to second-hand smoke
Temporomandibular joint disorders
Problems with the hinge that connects your jaw to your skull, the temporomandibular joint, can cause referred ear pain. Additional symptoms of temporomandibular joint disorder can include jaw or facial pain, headache, pain with chewing or opening mouth.
Temporomandibular joint disorders are more common in children over age 10 years.
Treatment includes patient education, avoiding triggers, jaw exercises, use of an occlusion splint if grinding teeth is an issue and use of anti-inflammatory pain medications.
Other causes of ear pain
Other less common causes of ear pain include trauma to the ear or ear canal, foreign body in the ear canal, or wax build-up.
Other illnesses that can cause referred ear pain include teething, parotitis, sinusitis, pharyngeal infections, lymphadenopathy / lymphadenitis and cervical spine injury.
When should you seek help for ear pain?
Call your physician or seek medical care if:
- Ear pain is worsening, persistent or not controlled with supportive care measures
- There is blood or pus draining from the ear canal
- The area around the ear starts to swell or become red
- Your child gets a new or higher fever
Caring for Ear Pain
Ear pain may be worse when lying down; so try to have child sit or sleep with head elevated.
Warm compresses may help ease ear discomfort. (However, take care not to burn the skin).
Acetaminophen or ibuprofen can be used to help discomfort; following instructions on label or given by physician.
Do NOT give aspirin to any person under age 18 years. It has been linked to developing Reye syndrome, an illness that causes swelling in the brain and liver.
Do not insert anything into the ear (including Q-tips). It is ok to clean the outside of the ear with a warm washcloth.
Written/reviewed by Lauren Reed, MD
Updated February 2020