Ear Pain — Common Causes and do you always need antibiotics?

Ear pain (otalgia) is a prevalent reason why children visit a physician. The pain may have different causes such as teething, sore throat, an ear infection, or blocked Eustachian tubes. However, it is worth noting that not all ear pain indicates an ear infection. In case of an ear infection, children’s ear infections typically improve within two to three days, especially for kids who are two years or older. Therefore, it is essential to seek medical advice to determine the underlying cause of the ear pain and ensure appropriate treatment.

Experts recommend antibiotics for ear infections for children for the following cases:

• Age 6 months or younger
• Age 6 months to 2 years with moderate-to-severe symptoms
• Age 2 or older with severe symptoms

Parents should be vigilant for severe symptoms such as a high fever above 102.2 degrees and persistent ear pain lasting more than two days without improvement.

In cases where children with ear tubes develop ear infections, healthcare professionals may recommend antibiotic eardrops as a more effective treatment than oral antibiotics. This is because the tubes allow the medication to directly reach the middle ear, where most infections occur. Additionally, eardrops are less likely to cause the development of resistant bacteria compared to oral antibiotics.

However, if symptoms persist or are severe, it is important to consult with a healthcare professional regarding the use of oral antibiotics.

Otitis media with effusion (Fluid behind eardrum)

Otitis media with effusion is caused by a blockage in the Eustachian tube which allows fluid to collect behind the eardrum. Antibiotics are not helpful as there is no infection. Symptomatic treatment includes acetaminophen or ibuprofen for pain relief and warm compresses. Hearing loss may occur, but it generally self-resolves within three months. If the fluid persists or hearing loss is a concern, an ENT specialist may recommend tympanostomy tubes to help drain the fluid.

Summary: Antibiotics are not helpful as there is no infection

Swimmer’s ear

Swimmer’s ear, or otitis externa, is caused by an infection in the external ear canal due to skin irritation or scratches. Ear drops are commonly used to treat this condition, while pain can be managed with over-the-counter pain killer.

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

Summary: Antibiotics are not always necessary

Ear infection

Ear infections (acute otitis media) can occur when fluid accumulates in the middle ear space due to a blockage in the Eustachian tube. Viruses or bacteria can then grow in the fluid and cause pain. Ear infections are common after a viral upper respiratory infection and are more frequent in children who attend daycare during the winter. Antibiotics are not always necessary since ear infections may not always be caused by bacteria.

To prevent ear infections, please use the following:

· Make sure to keep your child’s vaccinations up to date, including pneumococcal and influenza vaccinations.

· Avoid exposing your child to passive smoking and consider breastfeeding your child exclusively for the first 6 months of life.

· Additionally, avoid bottle propping in babies.

If a child experiences recurrent ear infections, with 3 episodes in 6 months or 4 episodes in 1 year, an Ear, Nose and Throat specialist (Otolaryngologist) may evaluate them for tympanostomy tubes (ear tubes) to help with fluid drainage.

Summary: Antibiotics are not always necessary

Eustachian tube dysfunction

The Eustachian tube connects the middle ear to the nasopharynx and plays an essential role in equalizing pressure across the ear drum, preventing infection and clearing ear secretions. Eustachian tube dysfunction can cause ear pain, fullness, reduced 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 passive smoking

Summary: Antibiotics are not necessary

Other causes of ear pain

Less common etiologies of otalgia comprise physical injury to the ear or ear canal, presence of a foreign object within the ear canal, or excessive accumulation of cerumen.

Additionally, referred ear pain may stem from other medical conditions such as teething, parotitis, sinusitis, pharyngeal infections, lymphadenopathy/lymphadenitis, and cervical spine injury.

When should you seek help for ear pain?

It is advisable to contact your healthcare provider or seek medical attention if:

• The ear pain is worsening, persistent, or not relieved by supportive care measures.
• There is drainage of blood or pus from the ear canal.
• The area surrounding the ear becomes swollen or red.
• Your child develops a new or higher fever.