Earaches can be caused by a variety of problems; fortunately, not all of them require the use of oral antibiotics to get better. An earache can be a symptom of excess wax, teething, strep throat, or an actual ear infection. The following lists a few of the several kinds of ear infections that a child may have:
1. AOM (acute otitis media) is an acute infection of the middle ear which typically presents with sudden ear pain, which can be severe, and often leads to sleep disturbance and may be accompanied by fever. Generally these symptoms emerge a few days after the onset of a cold. Infants may swat at their ears, refuse to lie down, or simply become atypically whiny & clingy compared to their usual happy nature. Pain management can be achieved by using acetaminophen in infants under 6 months of age; or either acetaminophen or ibuprofen for those over 6 months of age. Topical anesthetic ear drops can be especially helpful for middle-of-the-night pain awakenings. Antibiotics and an ear re-check after 2 weeks is usually warranted for children less than 2 years of age. For the child who is 2 years or older and is asymptomatic, a “watchful wait” may be the best course of action, with an ear re-check in 2 weeks.
To help prevent AOM, minimize exposure to others who are sick, wash hands frequently, and never smoke around a baby or in the car. Breastfeed as much as possible; your baby is “getting a passive dose of natural antibodies” with every meal. Avoid, or delay daycare, if possible; more sick-baby-exposure means more sickness for your baby, too. No bottle “propping”, no putting baby to bed with a bottle or allowing baby to “co-sleep / comfort nurse” throughout the night, as these can also contribute to middle ear infections.
2. OME (otitis media with effusion) is essentially a “stuffy ear” which is not acutely infected and will generally resolve without treatment. Pain tends to be more intermittent, and less severe than in AOM, and often sleep is not adversely affected. Addressing underlying nasal congestion with the use of saline nasal mist & bulb suction is suggested. Pain that persists beyond 48 hours warrants an ear check. Topical anesthetic ear drops can be prescribed to help with discomfort. Unfortunately, oral decongestants such as Sudafed, homeopathic “candling” and chiropractic adjustments are ineffective, and therefore, not recommended. An effusion which persists and adversely affects hearing and/or speech development warrants further evaluation.
3. OE (otitis externa) is most commonly known as “swimmer’s ear” and typically follows a lot of recent swimming or an injury to the ear canal, by a Q-tip, for example. Pain is usually quite severe, and simply touching the ear can elicit tears. Generally, antibiotic ear drops are prescribed with avoidance of swimming through the duration of treatment. For prevention of swimmer’s ear, instill & “shake out” a 50/50 blend of rubbing alcohol and white vinegar at the end of the swim day, provided there is no current infection, and the eardrums are intact (i.e. no ear tubes or perforations).
4. FB (foreign body) can be “internal” such as excess hard earwax or “external” in origin such as a hair bead or popcorn kernel inserted by a curious toddler. The foreign body can become lodged and uncomfortable. Q-tip use is discouraged in all children, as it simply pushes the foreign body back down into the ear canal. Curettage at the pediatrician’s office is suggested, as some items can actually swell and become further lodged by attempting to “wash out” at home.
The providers at East Cobb Pediatrics are adept at treating all sorts of ear infections and earaches. If your child has an earache, please call us and we can start helping.
By Deanna Fetsch, CPNP
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