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Earache in children

What causes earache in children?

The commonest cause of earache is acute infection of the middle ear (otitis media), which usually follows a nose or throat infection such as the common cold.

Another common cause, especially in older children, is infection of the outer ear (otitis externa) caused by fungi or bacteria that infect ears blocked with wax, water and sweat. This often occurs after swimming, and so is more prevalent in summer.

An important cause to consider is a foreign body in the ear (eg. an insect or the child poking something down the ear). This could even cause a ruptured eardrum.

Middle ear infection (otitis media)

What is the cause?

Viruses and bacteria can travel up the short and narrow Eustachian tube, which connects the middle ear to the back of the throat. When this tube becomes congested and blocked from a cold, the germs get trapped in the middle ear cavity and cause a painful infection, often with infected fluid (pus). The younger the child, the more likely is infection. The two commonest age groups appear to be between 6 months and 5 years (when school is commenced).

What are the symptoms?

The main symptoms are:

• earache, often intense pain
• irritability; frequent rubbing or pulling of ear
• fever or general feeling of being unwell
• usually a blocked or runny nose

There may also be:

• poor hearing
• a discharge from the ear

What should you do?

• Place the child in an upright position with pillows or by nursing in your lap.
• Give analgesics such as paracetamol or aspirin. (It is very important to relieve pain.)
• Give a decongestant to free the Eustachian tube, preferably an oral one but nose drops or spray can be used.
• Contact your doctor, who may prescribe an antibiotic after inspecting the ear.

Glue ears

It is advisable to have your child checked after a middle ear infection to see that the ear has returned to normal. Sometimes a 'glue ear' (secretory otitis media) follows acute otitis media. This is the build-up of a sticky glue-like fluid that gets trapped behind the drum when the fluid cannot drain out of the Eustachian tube.

What are the symptoms?

• deafness (usually partial only) and inattentiveness
• earache (usually mild)

What is the treatment?

Glue ears usually get better naturally but can be helped with decongestant medicine and strong nose-blowing exercises. If possible, get the child to pinch the nose and blow out hard against the back of the hand. Sometimes it is necessary to operate to drain the sticky fluid out of the ear by placing small drainage tubes through the drum.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia