Earaches are one of the most common complaints that bring kids to my office. 

Symptoms of ear infections—which actually are an infection of the middle ear—can be very vague or specific to the ear. Symptoms vary based on the age of a child. Younger infants can present with a fever, increased irritability and tugging at their ears, whereas older kids usually present with intense pain and clogged sensation or difficulty hearing along with or without fever. Ear infections are usually preceded by cough and cold/URI symptoms.

I stress to parents that not all ear pain means an ear infection. Here’s how I diagnose ear infections and how I treat them.

How I Diagnose Ear Infections

First, like in any medical condition, in order to diagnose ear infection, there has to be a history suggestive of an ear infection, including fever and coryza (inflammation of the mucous membrane of the nasal cavities). 

Next, I’ll use an otoscope to look at the tympanic membrane (the membrane separating the middle ear from the outer ear) for signs of inflammation. The tympanic membrane is usually a translucent membrane, and when we shine light using an otoscope, we can see a reflection of the light. In the case of an ear infection, the tympanic membrane is: 

• Very red
• Angry-looking
• Bulging 
• Dull (because of fluid in the middle ear)
  
  

Lastly, an important feature of an ear infection is decreased mobility of the tympanic membrane. A normal tympanic membrane moves when air is pushed into it, but in the case of an ear infection, the tympanic membrane is immobile.

Other Sources of Ear Pain 

Not every ear pain or tugging of the ear is because of an ear infection. Since the ear is very close to the mouth and oral cavity, and shares a nerve supply, issues with the throat and oral cavity can present with symptoms similar to ear infections.

Some common causes of symptoms related to the ear:

• Normal exploration of ears (infants around 9 months of age know that the body has ears and start to explore the ears and tug at them) 
• Teething 
• Impacted ear wax
• Swimmer's ear
• Foreign body in ear canal
• Allergies and simple colds
• Issues with the jaw
• Skin infection (since the outer part of the ear canal is lined with skin, any type of skin infection can cause ear pain)

How I Treat Ear Infections

Treatment is based on the history of ear infections in the family, history of recurrent infections etc. 

It may include pain management with either acetaminophen or ibuprofen. Most of the time, pain resolves in three days after the onset of symptoms.

Certain patients should be immediately treated with antibiotics including: 

• Children at increased risk of severe infection or complications
• Children with recurrent infections
• Children less than six months old
• Children who are immunocompromised
• Toxic-appearing patients 
• Patients with cleft palate and other craniofacial abnormalities
  
  

In older patients who are not at risk for severe infections or complications, we can wait for starting antibiotics and can control symptoms with acetaminophen or ibuprofen.

When I Recommend Ear Tube Surgery

Ear tube surgery—or tympanostomies—is a common procedure for children. This surgical procedure places ear tubes in the ears to enable drainage of the middle ear and prevent fluid buildup. 

I won’t recommend ear tube surgery for all children who come in with an ear infection—it’s a case-by-case recommendation based on a few factors:

• If the patient has three or more documented ear infections within six months, or
• If the patient has four or more ear infections within 12 months if fluid in the middle ear is present
  
  

The bottom line I stress to parents is that not all ear pain is from an ear infection, and it’s important to understand what’s causing it.

Next Steps & Resources:

• Meet our source: Anil Pawa, M.D.
• To make an appointment with a pediatrician near you, call 800-822-8905 or visit our website.
  
  

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.