My Child’s Ear Hurts – Is it an ear infection?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

All parents have experienced the middle of the night cry from their child, “my ear hurts!”  Ear pain is one of the most common reasons a parent calls their child’s doctor or provider.  But how do you know if it is an ear infection? When do you need to bring your child to the office?

There are many causes of ear pain.  Sometimes the pain has nothing to do with the ear itself.  Children can have “referred” ear pain that is actually coming from the tonsils or the teeth.  You may see ear pain or ear pulling in a baby that is teething, especially when the molars are coming in.  Children with swollen tonsils or strep throat will often come into the office complaining of ear pain.  This referred pain occurs because the tonsils and throat are actually quite close to the inner ear.  Another example of referred ear  pain is seen in an older child or teenager that has temporal mandibular joint pain (or TMJ syndrome) – the hinge of the jaw is right in front of the ear, so a child with teeth grinding or TMJ pain can also feel ear pain.

Of course many children with ear pain do have a problem with their ear.  This could be swelling of the ear canal as in “swimmer’s ear”, which is common in the summer.  But in most cases ear problems are behind the ear drum, which is sometimes referred to as the “inner ear”. The inner ear has a tube connecting it to the nose. This is called the Eustachian tube. If your child has a stuffy nose from a cold or from allergies, fluid can push back through this tube and cause ear pain. This kind of fluid and pressure will go away with time and also improves as the nose is decongested. Ask your provider if an over the counter medicine, such as a decongestant or an antihistamine, would be appropriate for your child.

In some cases, the fluid behind the ear drum develops bacteria in it.  The bacteria create pus and more fluid and pressure behind the ear drum.  This is an inner ear infection, or “otitis media”. A child with and ear infection and ear pain will usually need antibiotics.

When you call your medical provider about your child’s ear pain, they will ask questions to try to figure out the cause of the pain. In most cases, they will recommend your child be seen if the pain persists or is severe. Sometimes they may recommend over the counter medicines if it is safe and appropriate for your child. But the only way to know if it is an ear infection is for your provider to look in the ear. Antibiotics will not help your child if it is not an ear infection and antibiotics should only be used when needed.  This is why your doctor will usually not want to prescribe an antibiotic over the phone.