Earache

EARACHE (EAR PAIN)

Symptom Definition

  • Pain or discomfort in or around the ear.
  • Child reports an earache.
  • Younger child acts like he did with previous ear infection (e.g., crying or fussy).

Causes

  • Usually due to an ear infection.
  • Ear infections peak at age 6 months to 2 years.
  • The onset of ear infections peaks on day 3 of a cold.

Return to School

  • An earache or ear infection is not contagious.  No need to miss any school or daycare.

See More Appropriate Topic (instead of this one) If

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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance:)

  • Not moving or very weak

Call your doctor now (night or day) if:

  • Your child looks or acts very sick.
  • Earache is severe and not improved 2 hours after taking ibuprofen
  • Pink or red swelling behind the ear.
  • Stiff neck (can't touch chin to chest).
  • Fever above 104 F (40 C) and not improved 2 hours after fever medicine.
  • Pointed object was inserted into the ear canal (e.g., a pencil, stick or wire).

Call your doctor within 24 hours (between 9am and 4pm) if:

  • All other earaches, but none of the symptoms described above (probably ear infection).
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HOME CARE ADVICE FOR SUSPECTED EAR INFECTION (until your child can be seen)

  1. Reassurance:
    • Your child may have an ear infection, but it doesn't sound serious. The only way to be sure is to examine the eardrum.
    • Diagnosis and treatment can safely wait until morning if the earache begins after 5 pm.
    • Ear pain can be controlled with pain medicine and eardrops.
  2. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief or for fever above 102° F (39° C).
  3. Local Cold: Apply a cold pack or a cold wet wash cloth to the outer ear for 20 minutes to reduce pain while the pain medicine takes effect. (Note: Some children prefer local heat for 20 minutes.)
  4. Avoid Earplugs: If pus or cloudy fluid is draining from the ear canal, the eardrum has ruptured from an ear infection. Wipe the pus away as it appears. Avoid plugging with cotton (Reason: Retained pus causes irritation or infection of the ear canal).
  5. Eardrops: 3 drops of prescription eardrops or olive oil drops will usually relieve pain not helped by pain medicine. If your child has ear tubes or a hole in the eardrum, don't use them.
  6. Contagiousness: Ear infections are not contagious.
  7. Call Your Doctor If:
    • Your child develops severe pain
    • Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Clinical Practice Guideline: Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1462.
  2. Canto RM. Otitis externa and otitis media: A new look at old problems. Emerg Med Clin North Am. 1995;13:445-455.
  3. Hoberman A, et al. Efficacy of Auralgan for treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med. 1997;151:675-678.
  4. Licameli GR. Diagnosis and management of otalgia in the pediatric patient. Pediatr Ann.1999;28(6):364-368.
  5. Maxson S and Yamauchi T. Acute otitis media. Pediatr Rev. 1996;17:191-195.
  6. Pirozzo S, Del Mar C. Otitis media. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 238-247.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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