“WHY IS MY CHILD’S EAR HURTING?” 14 startling reasons

“Why does my child’s ear hurt?” This is one of the primary queries that brings parents to emergency room, at dark hours. Though there could be a number of reasons why it happens, here we will discuss few most common causal agents of ear pain in a child. Also we will discuss how ear pain in a kid differs from that of ear pain in adult.

Symptoms of ear pain 

Older kid can complain pain or discomfort in ear. What small kids do is, they repeatedly rub or pull one ear. They become irritable, cry constantly and do not sleep properly at night. These are indirect signs of ear pain in a child. 

Basic parts of ear.

Before going in detail into causes of ear pain, one must have some preliminary idea about structure of ear. An ear has 3 parts.

    1. Outer ear – This is the part of ear that is visible towards the outer side. 
    2. Middle ear – It’s the segment of ear that lies between outer and inner ear. 
    3. Inner ear – This is the portion that lies towards the inner most side of ear. 

Eustachian tube – To explain simply, it is a tube-like structure that joins nose at one end and ear (middle ear) at another end. Its basic function is to balance out pressure inside ear with outside air pressure. This pressure balance is vital for sake of hearing. 

Causes of ear pain

1. Common cold

After covid restrictions ended and schools opened, suddenly there is a surge of cold and cough in children. Few days following common cold parents start noticing that child is having acute pain in ears. What is the reason for it?

In children eustachian tube ( tube connecting nose and ear ) is straight, which gives an easy access to germs to enter inside from nose. So eustachian tube easily gets inflamed and blocked. 

As discussed earlier function of eustachian tube is to equalise pressure. With blocked eustachian tube pressure inside ear can not be balanced as that of outside. That creates a negative pressure inside ear and intense pain. 

2. Middle ear infection

Ear infections are much more frequent in children than one can imagine. Middle ear infection is commonest out of all. Data suggests that 80% children endure middle ear infection at least once, by the time they turns 3 years old. 

Though some middle ear infections are self-limiting, some may advance into complications that are debilitating permanently, if not treated on time. Hence never ever try to self-diagnose or self-treat a middle ear infection. 

Your physician is the best person to decide gravity and type of treatment, based on clinical findings. 

3. Outer ear infection

It’s also known as “swimmers’ ear”. This name comes from the fact that following swimming when water moves into outer ear, it breeds infection and results in ear pain.

Sometimes after taking bath some water or soap might enter inside ear incurring outer ear infection. Common age group for swimmers ear is child between 7 to 14 years.

Outer ear infection can also happen when some wax builds up inside ear and then child scratches ear with nails causing trauma. It’s a common practice to put cotton wicks or oil inside ear to remove wax, which introduces bacterial or fungal infections inside.

4. Improper Feeding Position

This is commonly seen that mothers give breast feeding, while putting child in completely flat and supine position. As discussed babies have straight Eustachian tube. So in flat position when head is at same level to body while feeding, milk can easily enter into Eustachian tube. Clogging of Eustachian tube causes ear pain. 

Hence baby should always given feeding with head at least at 30 degree elevation. 

After feeding baby should be burped for a minimum of 10-15 minutes till excess air from stomach comes out. This again prevents regurgitation ( throwing up ) of milk to mouth and to eustachian tube. 

5. Tonsillitis / Pharyngitis/ Laryngitis 

The kind of ear pain we discussed earlier was primary ear pain. Primary ear pain means when there is some trouble primarily in ear and child gets ear pain. There is another category of ear pain too, called referred pain. 

When ear hurts sometimes the problem is not in ear but somewhere else. This pain is called referred pain. It is possibly an infection in tonsils or pharynx ( area behind nose and mouth )or larynx ( voice box ). 

Ear shares its nerve supply with tonsils, pharynx and larynx. So when a child suffers from pharyngitis/ tonsillitis / laryngitis and it pains here, body will falsely sense pain to be coming from ear, owing to common nerve supply.

6.  Impacted Wax

When wax keeps on accumulating inside ear, sometimes it gets impacted inside. This causes extreme pain and discomfort. 

7. Adenoiditis

When a child sleeps at night with open mouth or snores while sleeping or frequently wakes up owing to obstructed nose, parents discard it as a normal phenomenon. Rather it could be a sign of enlarged and infected adenoid gland (adenoiditis). 

Adenoiditis blocks opening of Eustachian tube causing ear ache. Consult a paediatrician or ENT specialist for the same.

8. Sinusitis 

When a child gets repeated cough cold and headache this could be symptom of sinusitis. Sinusitis leads to congestion and clogging of Eustachian tube. This effects ear pain and hearing of muffled voices. 

9. Teeth pain

Toothache gets referred to ear. When a person gets dental caries, gingivitis, abscess or impacted molar tooth, pain arises out of it. Due to sharing of common nerve root between tooth and ear, this pain feels like coming from ear. 

Besides, when a kid starts teething (eruption of tooth), s/he will frequently pull and rub ears. This is due to referred pain from tooth or gum. 

10. Herpes zoster 

Herpes zoster infects ear pinna and outer ear bringing about multiple small vesicles over it. Typically it will cause severe pain in ears. If herpes is not treated properly, risk of face muscle paralysis (facial nerve paralysis) is there. 

11. Foreign Body

Foreign bodies, if enter inside ear, for instance an insect crawling inside ear canal, or child putting some object inside ear, will lead to ear pain. Child may start crying inconsolably. In these situations don’t put oil or any other thing inside. Do not panic. Bring child to an ENT specialist, who can help removing the object. 

12. Trauma

If there is some impact on ear causing injuries / bleeding inside ear, then this will provoke ear pain too. 

13. Barotrauma or Barotitis

‘Baro’ means pressure. Best example of barotrauma is while travelling by flight. When flight takes off, the pressure of outside air drops at certain height. This causes a significant pressure difference between inside ear and outside air. This begets pressure injuries inside ear or barotrauma. Barotrauma is more common when a child is having running nose cough and cold. 

For adults like us, it’s advisable to chew gums, swallow own saliva intermittently or take juices / water in slow sips while flight is taking off. For babies it’s suggested to carry out breast feeding, as sucking keeps Eustachian tube open. 

14. Jaw Joint Pain 

Any pain in jaw joint will cause excruciating ear pain. This is because of referred pain as discussed earlier.

How adult ear pain differs from child

Ear pain in child is chiefly because of common cold ( URTI – Upper respiratory tract infection ) , ear infection, impacted wax etc.

But in adults underlying reason of ear pain are usually tonsillitis, tooth pain, jaw joint pain etc. 

Infection of ear is a far more common cause of ear pain in children than adults. 

What to do when a child gets ear discharge?

Ear discharge ( watery fluid coming out of ear ) can be a sign of middle ear infection, that needs careful attention and medical consultation. 

Conclusion:

As I mentioned prior, don’t panic if your child gets ear pain. You can give mild analgesic as prescribed by paediatrician for pain relief in proper doses, for temporary relief. But then visit to nearest doctor, either a paediatrician or an ENT specialist. 

You can put saline nose drops as advised by your doctor to relieve nose block or nose congestion. However, do not self medicate with ear drops before seeing a doctor. Because in case of ear drum perforation, ear drops worsen the situation.

Caution

All the informations provided here are for educational and awareness purpose only. Kindly do not use these as alternative to medical consultation.

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