Pediatric Otalgia: What Parents Should Know About Ear Aches in Children
My Ear Hurts!
What is Otalgia?
Otalgia is more commonly known as ear pain, and parents of young children are often confronted with a fussy infant pulling on his ears, or a child who complains of an earache.
Otalgia can be caused by a variety of factors, including:
- External Otitis (outer ear infection)
- Acute Otits Media (acute middle ear infection)
- Mastoiditis (infection of the mastoid bone, behind the ear)
- Tympanic membrane perforation (ruptured eardrum)
- Chronic Otitis Media (chronic middle ear infection
Sometimes, otalgia is caused by a problem elsewhere in the body. This is known as referred otalgia. Referred otalgia can be caused by:
- TMJ (Temporal Mandibular Joint problems)
- Dental problems
- Trigeminal neuralgia
- Musculoskeletal pain
- Sinus infections
- Throat infections
What Are the Symptoms of Ear Pain in Children?
The December 2010 Journal of Pain recently reported that parents' assessment of ear pain in pre-verbal children is unreliable. In other words, parents have difficulty determining their child has ear pain, especially if the child is too young to speak. The journal noted that more children would be correctly identified as having ear pain if physicians asked about the child's behavior, rather than simply asking if the child was experiencing an earache.
The 6 indicators of ear pain in pre-verbal children are:
- Ear tugging
- Eating less
- Difficulty sleeping
- Reduced play
How is the Diagnosis of Otalgia Made?
A thorough medical history will be taken for the child, and a basic physical examination undertaken. The child's temperature will be assessed, and a complete examination of the outer and middle ear will occur. If no ear pathology is found, the throat and teeth should be examined, as unidentified dental problems, tonsilitis, and pharyngitis are the leading cause of referred ear pain in children.
Once the source of the pain has been identified, treatment will begin based on the nature of the problem.
What Can Be Done to Relieve the Pain?
Analgesics may be ordered to relieve the ear pain in children. Most frequently, this will involve ibuprofen or acetaminophen. Follow the doctor's recommended dosage and timing requirements. These agents will also reduce any fevers associated with infection. Aspirin should never be given to children, as it can cause the deadly Reye's Syndrome.
Antibiotics may be ordered to eliminate the source of an infection (in the case of acute otitis media, sinusitis, or strep throat). A recent study in the New England Journal of Medicine demonstrates children less than 24 months of age recover from acute ear infections faster when antibiotics are prescribed: a reversal of earlier studies indicating a "watchful waiting" approach.
A warm pack against the affected ear may help soothe pain, as it helps dilate the blood vessels in the ear, which reduces the sensation of pain. This does not treat the underlying cause, but a warm pack may help with the symptoms while other treatments have yet to take effect.
Analgesic ear drops are also available to relieve ear pain, but should never be used without a doctor's direction or prescription.
A Cheery Outlook
The good news is that Otalgia is generally caused by easily treatable conditions, and resolves completely once the underlying cause of the pain is found. While the short term pain may cause a lot of worry and stress, the solution is often quickly in hand after a trip to the pediatrician's office.
A Pediatric Ear Exam
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