Ear pain in children will be either teething, tonsillitis or ear infections. The latter can be outer ear infection (otitis externa,) or otitis media behind the eardrum. Mastoiditis is rare now.
Teething infants can have ear pain, fever, diarrhea and a runny nose. Pain from teeth can be felt in ("referred to") the ear.
A little personal aside here. When I floss between two particular teeth, my nose runs. There is obviously a reflex involved here.
The stress of teething may make your child more prone to a respiratory infection, so teething and ear infection can both be present.
It's not easy to tell if it is one or the other, or both. If your infant is badly distressed, off their feeds or has a high fever, ear infection is more likely.
If you have a family of small children, it might almost pay to buy an otoscope!
How to treat an earache depends on which of the causes of earaches, is present. Earache cures depend on treating particular earache causes. Someone needs to look in the ear.
Middle ear infection (Otitis media) has a red bulging eardrum.
Outer ear infection, of the canal leading down to the eardrum (Otitis externa) has swelling and weeping obscuring the eardrum from view.
If your child is old enough to check their hearing in both ears separately, diminished hearing on the painful side is in keeping with ear infections.
The whisper test for hearing may point to a cause in their ear. Stand a yard behind them, breath right out and then whisper as quietly as you can, something like "do you want an ice cream?" They block each ear in turn, with their finger. Is the hearing the same in both ears?
OUTER EAR INFECTION (SWIMMERS EAR)
Ear pain after swimming may be due to outer ear infection (otitis externa.) Here it is likely to cause tenderness pressing around the ear canal or on wiggling the eardrum.
I suspect chlorine contributes by damaging the skin of the ear canal. Even showering at levels added to drinking water causes dry skin.
Pseudomonas is a common germ causing this, so 50% white vinegar should be useful.
Otitis externa not responding to treatment may be due to fungal infection, when thorough cleaning under vision and packing with Lamisil cream, may be needed.
MIDDLE EAR INFECTION
After a head cold, otitis media should be suspected. If your child is sicker that you've ever seen them before, serious conditions such as mastoiditis or meningitis are possible. An urgent visit to an emergency room is needed.
Children under 2 years old with both ears infected, and children with a burst eardrum (running ear) are more likely to need antibiotics.
At the other end of the scale of severity, doctors are being taught to wait 48-72 hours before giving antibiotics for otitis media, as the ear pain will resolve without treatment in most children.
2010 update on this¹ - A survey of the medical literature showed immediate use of ampicillin or amoxicillin (vs placebo) produced only 12% more "short-term clinical success."
The "number needed to treat" was 9. This means the benefit of early antibiotic was seen in 1 per 9 children treated.
Rash or diarrhea increased by 4% as well.
The homeopathic complex Dr. Reckeweg R1 can be useful².
Children can have otitis media from a cold which was too mild to cause obvious symptoms.
Early age of onset and frequent attacks usually mean milk allergy.
INNER EAR INFECTION
This is not a cause of earache in children, but of sudden severe vertigo (spinning around sensation) and one sided deafness in adults.
It can follow a head cold and is mostly due to virus infection.
This is less common in infancy, more so when approaching school age.
Sore throat is common at the start of virus upper respiratory infections, for the first two or three days. Here there will be no white spots on their tonsils, and they may already have a cough and be hoarse.
If your child has tonsillitis, they are likely to have sore throat, bad breath, fever and may be nauseous. Their lymph glands at the angle of the jaw are likely to be tender, and the ear pain comes from both these and tonsils.
When is an earache not an ear ache – quite often, when you're an adult.
You can apply the same tests as described above for reduced hearing and tenderness, regarding ear causes.
Your jaws' temporomandibular joint is however more likely to be involved in persistent problems with earache .
With your palm facing forwards, place the tip of your index finger in your ear canal and press forwards. Open and close your mouth, and you will feel the head of your lower jaw bone (mandible) move up and down (or more precisely, down and up.)
Is this tender? Compare your two sides.
Sometimes tenderness of one side is more obvious inside your mouth.
Push your index finger right back, between your cheek and your teeth, with your jaw nearly closed, upper and lower teeth nearly touching.
The pterygoid jaw muscles here, are usually tender, so marked difference between your two sides is the clue.
Now check your neck, which is another common source of ear pain.
Press firmly on your neck an inch below and behind your ear. Move your fingers forwards and backwards and feel the hard bones of your neck. These are the lateral masses of your cervical vertebrae. Are there tender spots on this side, compared to the opposite side.
Finally feel around your voice-box just above your breast bone, for tenderness over your thyroid gland. Pain from virus thyroiditis following a recent upper respiratory tract infection (URTI) , can be felt in the ear.
Doctor, dentist, chiropractor, internist physician - this self testing may help you know where to go for earache relief.
The traditional home remedy for an earache was to warm some edible oil on a teaspoon, and pour it into the offending ear. Mullein flower oil is also a traditional remedy used this way.
You will find self help methods for tmj and neck causes on the appropriate pages of this site...
Here's one for scrabble...chondrodermatitis nodularis helicis.
This is a very tender little lump on the edge of your ear, up near the top. It wakes you up if you roll onto it at night.
The pain is actually reassuring, as skin cancer and gouty tophi here are non painful lumps.
CDNH for short, responds well to intralesional injection of triamcinolone (cortisone injected right into it.)
If you're shy of injections, make a doughnut shaped cushion to lay your ear on.
Or you could opt for surgical removal.
Intertrigo is a rash in the creases of the ear or behind the ear, rather than on the most prominent spot.
It is more likely to be due to infection than any specific skin disease. Bacteria and fungi grow where there is food and moisture, and skin creases provide both.
There usually isn't much to see, just a slight reddening of the skin in the crease.
If it is mild, just carefully cleaning with a face washer under the shower, should settle it and prevent recurrence.
Chillblains are on the edge of your ear from cold exposure. The skin is discolored. You probably need more reasonably vigorous exercise, like walking (with ear muffs.)
Dr.Schuessler's biochemic cell salt, calc phos, may be a useful preventative.
"Red ear syndrome" occurs also in adults, but I've only seen children with these sudden episodes of bright red ear(s) which can be painful or tender at the same time.
If your outer ear feels as though something is pressing on it or squeezing it, the cause is usually in your neck.
This feeling may be in the canal leading down to your eardrum, when wax could also be the cause.
If you suspect wax, cotton wool applicators are not a good option, as one can easily push wax up against the eardrum. Glycerine is a good wax softener.
1. JAMA. 2010 November 17 ;304:2161-2169
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Tophi are lumps of urate, which accumulate here in gout.