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WHAT  IS  EARACHE?

 

Earache in children can be caused by a middle ear infection, a foreign body in the ear, an infection in the outer ear canal or referred pain (where the problem is based somewhere else, for instance in the teeth). Children often have earache when they have a cold. The difficulty is distinguishing between an earache that will pass of its own accord in a few days and one that needs to be treated by a G P.

 

Middle ear infection (otitis media)

 

The most common cause of earache in children is otitis media, or middle ear infection, following a cold. If the pain is severe, the doctor will probably see that the ear drum looks dull, red and bulging, and it may even pulsate. As pressure builds, the ear drum may burst, with a profuse, even blood­stained, discharge from the ear. There may be some temporary deafness.

 

Under two years old:

·        Fever

·        Vomiting

·        Diarrhoea

·        Irritability

·        Difficulty feeding

·        Not sleeping

 

Older children:

• Fever
• Ear pressure or a feeling of fullness in the ear
• Severe earache
• Deafness 

When to call the doctor

 

Earache can be so painful - and otitis media is potentially very serious-that doctors usually do all they can to see your child the same day. It is important to seek medical help if:

 

• There is fluid coming from the ear canal.
• Your child has a temperature over 38°C (100.4 OF), which does not go down with pain relief.
• Your child has severe earache that paracetamol or ibuprofen does not relieve, or if symptoms persist for more than 24 hours. 
• Your child develops pain and tenderness over the skull behind the ear about 10 days after the initial earache, as this could indicate mastoiditis.
• Your child has other worrying symptoms, e.g. severe headache or profuse vomiting. 

Your child is not drinking enough, i.e. if he has not passed urine for over eight hours or his nappies are dry all day or overnight.

 

The doctor will look into your child's ear using a special instrument called an auroscope. If your child has otitis media that requires treatment by antibiotics, the ear drum will look red and bulging and will probably pulsate.

 

What you can do at home

 

There are several things you can do at home to ease the pain of otitis media:

 

• Give your child infant paracetamol or ibuprofen both to alleviate pain and reduce fever. 
• Apply heat to soothe his ear - for instance, a hot water bottle filled with warm water. 
• Raise your child's head when sleeping as the pressure on the ear drum when lying down could increase pain.
• Do not get his ear wet in the bath. Your child should not go swimming until the infection has totally cleared up. 
• Consult your doctor before flying. 

What causes earache?

 

The middle ear is a small cavity filled with tiny bones, lying behind the ear drum. Children are more prone to earache because their ears are less developed.

 

When the thin membrane of the ear drum vibrates in response to sound waves, the bones in the middle ear transmit the sound signals to the inner ear. The eustachian tube connects the middle ear to the nose and this ventilates and equalizes pressure to the middle ear. Otitis media is an infection that produces pus in the middle ear. Children have smaller eustachian tubes than adults and are more prone to bugs tracking along the tube to the middle ear.

 

Complications of otitis media

 

It is important to monitor a child with otitis media closely as complications associated with the illness can be serious and prolonged.

 

Perforated ear drum: this will take four to six weeks to heal and your doctor will want to see the child at six weeks to confirm that the ear drum has healed.

 

Deafness: after the infection, fluid can remain in the middle ear causing temporary deafness. Short-term deafness following otitis media may last several weeks before gradually improving. Long term deafness may be caused by glue ear. Sometimes both operations are performed.

 

Glue ear (chronic secretory otitis): if fluid remains in the middle ear, it can become thick and gluey causing deafness. It can be corrected by an operation either to remove the adenoids (glands at the entrance to the eustachian tubes) or to insert grommets (tiny plastic tubes) into the middle ear to rebalance pressure. Sometimes both operations are performed.

 

Recurrent otitis media (chronic suppurative otitis media): the ear constantly discharges and there is a persistent perforation of the ear drum.

 

Mastoiditis: the mastoid bone is in the part of the skull that lies behind the ear. Before antibiotics, an infection in the mastoid was a rare, but serious, complication of otitis media, developing about 10 days after the initial ear infection.

 

Intracranial abscess: this is very rare.

 

Otitis externa

 

This is an infection of the outer ear canal, between the eardrum and the external opening of the ear. Otitis externa is not commonly seen in children. The symptoms include a discharge from the ear and itchiness and pain, especially on touching the ear canal. Any dead skin, pus and wax need to be removed and then the ear should be packed with: special dressings until the infection dies down.  Sometimes, antibiotic drops into the ear Canal are enough to cure it. Oral antibiotics can increase the risk of diarrhoea, rashes and vomiting. Your doctor will advise you about the best treatment.

 

Preventing earache

 

Unfortunately, if you suffered from frequent earache as a child, your own child is at greater risk. Most children get ear infections when they catch colds from other children, and this can't always be avoided. But there are some precautions you can take.

 

• Wrap up your child in cold, windy weather and get him to wear a hat 
• Children who are breastfed have fewer incidences of otitis media 
• Your child is more likely to have problems with glue ear and deafness if subjected to a very smoky environment. 

Although covering up ears in cold weather will not prevent infection, it might ensure the condition doesn't get worse.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.