Overview

Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear). Ear infections (otitis media) most often occur when children have cold symptoms, such as a runny or stuffy nose and a cough, for a few days.

An ear infection may occur when the eustachian tube swells and closes and fluid builds up in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection can cause pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.

Middle ear infections happen more often in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.

Ear infection is the most commonly diagnosed bacterial infection in young children. Almost all children will have at least one ear infection by the time they are school age. Most ear infections occur in babies between the ages of 6 months to 2 years. As children get older, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections most often occur in children who:

• Spend time in day care settings.
• Use a pacifier.
• Aren't breastfed.
• Live in households where parents or caregivers smoke.
• Have had a previous ear infection.
• Have had certain conditions since birth. These may include cleft lip, cleft palate, or Down syndrome.
• Have allergies.

Fluid often remains in the middle ear (serous otitis, or middle ear effusion) after an ear infection. This may cause no symptoms, or it may cause a muffling of sound, decreased hearing, and mild discomfort. The body usually reabsorbs fluid behind the eardrum within 3 months, and hearing returns to normal. Some children have ear infections that keep coming back or fluid in the middle ear that doesn't go away.

Even though ear infections are a common cause of ear pain, not all ear pain means an infection. Other common causes of what seems like ear pain in young children include:

• Teething.
• A sore throat.
• A build-up of earwax.
• An object in the ear.
• Air pressure changes, such as when flying in an airplane.
• Fluid buildup without infection (serous otitis).

When checking ear pain in a child, remember that ear infections most often occur after a child has had cold symptoms for a few days. When a child has other symptoms, such as a fever, then the ear pain or drainage may be less important than the other symptoms.

Ear problems caused by an injury to the ear can occur at any age. Here are some common injuries:

• A fall or a forceful, direct blow to the side of the head can burst the eardrum or damage the tiny bones in the inner ear that send sound to the brain.
• An injury during contact sports can cause an injury, such as "cauliflower" ear from wrestling.
• Loud noises or explosions can damage the eardrum (acoustic trauma).
• Atmospheric pressure changes (barotrauma) can cause problems with the eustachian tube and trap air in or keep air out of the middle ear. Middle ear problems can be severe. For example, the eardrum can burst or the middle ear can fill with blood or pus. Or they can be mild and only be felt as changes in pressure.
• Cuts or scrapes may injure the outside of the ear or ear canal.
• Cleaning the ear canal too often, too forcefully, or with a cotton swab, bobby pin, or sharp fingernail can cause irritation or injury.
• Burns or frostbite can cause ear injuries (thermal injuries).
• Objects placed in the ear can cause injury to the ear canal or the eardrum (tympanic membrane).

Self-Care

When ear discomfort or pain is mild or it comes and goes and occurs without other symptoms, home treatment may be all that is needed. Here are some things you can do to help your child feel better.

• Encourage your child to swallow more often. The discomfort may be caused by a blocked eustachian tube that can occur with mild irritation in the ear canal. If your child is younger than age 12 months, let your child drink from a bottle or cup to try to help open the eustachian tube.
• Some babies and children who have mild ear pain are more comfortable in an upright position. Allow your child to rest in the position that is most comfortable.
• To relieve a red, swollen external ear:
  • Put ice or a cold pack on the ear for 10 to 20 minutes at a time. Put a thin cloth between the ice and your child's skin.
  • Encourage your child to rest as much as possible.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse pain.
• New or worse signs of infection, such as redness, warmth, swelling, or a fever.
• New or worse drainage from the ear.
• New symptoms develop, such as hearing loss or dizziness.
• Symptoms occur more often or are more severe.

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