Ear Pain in Children: What You Should Know

Sharon Gibson, MD

Ear infections and ear fluid are the most common illnesses in childhood other than colds. If your child has ever had an ear infection, you know how painful it can be.

Most ear problems in children can be divided into two types. The first is known as acute otitis media (AOM), which means there is acutely infected fluid behind the eardrum. The second is otitis media with effusion (OME), which is when there is fluid in the middle ear that is not infected.

The facts

  • Both AOM and OME are often associated with viral upper respiratory infections and therefore typically occur in fall, winter and spring.
  • Over 80 percent of children in the United States will have at least one episode of AOM by their second birthday, and 90 percent will have had OME by age 5.
  • OME can be seen during the resolution of AOM or can occur on its own.
  • Some children have recurrent AOM and chronic OME between infections.

Causes of ear pain

When a child is experiencing ear pain, it does not necessarily mean there is an infection. There are other common causes of ear pain in children, such as teething, nasal congestion and throat inflammation. A complete physical exam is necessary to make the diagnosis.

Acute otitis media  

Symptoms

When a child has AOM, the most common symptoms include:

  • ear pain
  • fever
  • irritability
  • poor sleep
  • decrease in hearing
  • ear drainage (occasionally)

Treating AOM

AOM is typically treated with oral antibiotics. Watchful waiting is appropriate in some milder cases, with antibiotics given if symptoms or physical findings worsen at additional doctor’s exams.

Complications of AOM

There are some complications that can occur because of AOM but are relatively uncommon. Those include perforation of the eardrum, spread of infection to the surrounding skull bone (mastoiditis), spread of infection to the brain, and facial palsy. These complications were more common in the days before antibiotics. If these conditions do occur, though, they require more aggressive treatments, such as intravenous antibiotic therapy and urgent surgery.

Risk factors of AOM

Some children may have risk factors that make it more likely they will experience recurrent ear infections. Those include:

  • first ear infection before six months of age
  • family history of ear infections
  • immune deficiencies
  • going to bed with a bottle
  • tobacco smoke exposure
  • large group daycare attendance.

Reducing the risk of AOM

There are ways that you can reduce the chances of your child developing AOM. Breastfeeding during infancy may reduce the risk of AOM in some children. Pneumococcal and flu vaccines can reduce infections related to those organisms. Also, frequent washing of hands and toys may reduce chances of getting a cold which may lead to an ear infection.

Otitis media with effusion

The most common symptom of OME is hearing loss, with or without ear pain; however, it can be present with no significant symptoms. It may be diagnosed unexpectedly by a failed screening hearing test at school or at the pediatrician’s office.

OME can resolve on its own spontaneously and can be monitored without intervention in many children if not associated with ear pain or hearing loss that interferes with daily functioning. Medical treatment can be tried in children older than two years of age, and is aimed at reducing nasal congestion, therefore helping the ears to “pop” and clear fluid more easily.

Because good hearing is an important factor in speech and language development, OME is treated more aggressively in children with speech delay. Children with cleft palate or Down syndrome are at higher risk of persistent OME and speech delay and are more likely to require placement of ear tubes than the general population.

Ear Tubes

Because ear infections and ear fluid are the most common illnesses in childhood other than colds, the insertion of ear tubes (also called pressure equalizing or ventilating tubes), is the most common surgical procedure performed in the United States.

To insert ear tubes, a child is placed under general anesthesia and the ear surgeon uses a microscope for the procedure. The procedure itself typically takes less than 15 minutes. The vast majority of children are back to their usual activities by the next day.

The tubes prevent the accumulation of middle ear fluid. This helps to reduce the number of infections and improve hearing. They typically stay in place for about a year, and most come out on their own.

When are ear tubes recommended?

The recommendation for ear tube insertion may vary depending on each child’s history and physical condition. Ear tubes are recommended when a child has:

  1. recurrent AOM with OME between infections: four episodes in 6 months, or 6 episodes in 1 year, or fewer if complicated by eardrum perforation, speech delay, febrile seizures, allergies to or side effects from antibiotic treatment
  2. an ongoing episode of AOM that does not respond to treatment
  3. chronic OME with hearing loss lasting three months or more
  4. chronic OME of shorter duration if associated with speech delay, Down syndrome, cleft palate, concern for underlying nerve hearing loss, balance problems, behavioral problems, poor school performance or chronic ear pain

We know how painful these conditions can be. If your child is experiencing ear pain, please contact your child’s pediatrician as soon as possible. If your child is having pain with ear drainage, hearing loss, or recurrent infections, please contact the ear, nose and throat specialists at Hasbro Children's Hospital.