Ear Pain, Ear Infections, and Swimmer's Ear

Ear pain is a very common complaint in childhood. Often, ear pain does signify an ear infection. Ear pain can also result from pressure and congestion during a cold, air travel, or swimming deep under water.

Middle ear infections (otitis media)

Middle ear infections are usually preceded by a "head cold." Due to the cold and congestion, the middle ear space is unable to ventilate properly, allowing bacteria to fill the middle ear space with pus. The middle ear space is connected to the sinuses on the inside. There is no connection to the outside, as the eardrum separates the middle ear space from the outside. Therefore, swimming or bathing has nothing to do with middle ear infections and getting water in your child's ear will not contribute to them. Middle ear infections are diagnosed by a doctor looking in your child's ear and seeing redness and pus behind the transparent eardrum.

Symptoms of a middle ear infection

• Pain or discomfort in or around the ear. The pain is steady and sometimes severe. The onset of ear pain is classically 2-3 days into a cold.
• Crying without an obvious reason.
• Difficulty falling asleep or unusual night waking
• Irritability when laying down, such as during diaper changes
• Decreased feeding or discomfort during feedings.
• Complaint of ear pain by an older child.
• A new fever in a child who has an existing cold. Usually, with a viral infection, the fever comes at the beginning of the virus. A new fever in a child who already has a cold may be a sign of a secondary infection like an ear infection.

Treatment of middle ear infections

• Antibiotics: If a physician confirms a middle ear infection, she will likely prescribe an antibiotic. The first antibiotic we prescribe, if there is no allergy to it, is amoxicillin. Due to widespread use of antibiotics, some ear infections will not respond to amoxicillin and will require a stronger antibiotic. This is more likely in younger children, children who have had past ear infections, and children who attend day care. The reason to try amoxicillin first is that, if it does work, you are "saving" the stronger antibiotics for later, if you need them. The more you use any antibiotic, the more likely it won't work the next time. If it has been at least two months since your child's last antibiotic treatment, it is reasonable to try amoxicillin again. Just because it hasn't worked in the past doesn't mean it won't work this time!
• Pain and fever control: Treat pain and fever with ibuprofen (Motrin) or acetaminophen (Tylenol). If the fever or pain lasts longer than 72 hours after starting the antibiotic, call the office.
• Numbing ear drops: There are numbing ear drops available by prescription that often help with the pain. The drops may sting initially, but will hopefully provide relief within minutes. Use 1-2 drops in the affected ear every 1-2 hours as needed. These drops can be safely used with antibiotics and Motrin or Tylenol. If you see blood or pus draining from your child's ear, do not use the drops.
• Warm or cool washcloths may provide some relief.
• Upright positioning: Keeping your child in a more upright position may help alleviate pressure and make him more comfortable.
• Observation without antibiotic treatment: Many ear infections are viral or will resolve on their own without antibiotics. Therefore, it is reasonable in certain cases to treat the pain of the infection and monitor the patient without administering antibiotics. An ear infection is more likely to clear on its own if the patient is older and has not had frequent ear infections. If the pain or symptoms last longer than three days, it is less likely that the infection will clear on it's own.

Your child should be feeling better within 72 hours of treatment. If she is not, call the office. In some situations, your doctor may have you schedule an ear recheck. This is usually done 2-3 weeks after the completion of the entire course of antibiotics. This is especially important if your child has had repeated ear infections.

An earache is not an emergency and can wait until morning, if the office is closed, without added risk of complications. It is not uncommon for a child to complain of ear pain and not have an infection. Therefore, it is not good medicine to provide antibiotics over the phone for ear pain.

Ruptured ear infections and draining ears

The ear drum is a thin membrane and if the infection causes enough pressure, the membrane may rupture, leading to drainage of pus or blood from the ear. If you notice blood, pus, or cloudy fluid coming from your child's ear canal, you should wipe it away as it appears. If this happens, don't panic. The eardrum tearing actually relieves the pressure and pain, and helps drain the infection. Call the office during office hours if this happens to schedule an appointment. We will likely prescribe antibiotic ear drops. After the infection clears, the membrane will heal. Never put anything (i.e. Q-tips) in an ear canal. An abrasion of the canal wall can happen easily in a young child. You should clean the outside of the canal with a washcloth only.

Swimmer's ear (outer ear infection)

This is an infection of the outer ear canal. Most commonly, this occurs secondary to excessive moisture and water in the ear canal, such as from swimming. It can also occur secondary to damage to the canal from scratching or cleaning. The damaged and moist ear canal becomes a fertile ground for bacteria to grow, leading to infection.

Symptoms of swimmer's ear

• Ear pain
• Pain elicited by pulling on the ear. This is different from a middle ear infection, which is NOT made more painful by pulling on the ear.
• Pus, bloody drainage, redness, or swelling visible in the ear canal.
• Swimmer's ear is diagnosed by examination by a doctor.

Treatment of swimmer's ear

• Antibiotic ear drops
• Cleaning the drainage that you can see on the outside of the ear.
• Avoidance of swimming until ear pain has improved.

Preventing swimmer's ear

Swimmer's ear drops are available over the counter. Putting the drops in the ear after swimming helps to dry the ear canal. Alternatively, a mixture of half water, half white vinegar can be used as drops.

Dry the ear with a hairdryer set to low. Keep the dryer at least a foot away from the ear, and be careful not to burn the ear!