Ear pain in children

When babies and toddlers fiddle and pull on their ears we often wonder if they have ear pain. As a doctor-mom I have the advantage of having access to an otoscope and can take a peek to ensure there are no problems. Babies can fiddle with their ears as part of discovering their body-parts, as a way to self-soothe, because their gums are hurting (teething pain is often referred to the ear), because their ears feel “blocked” (like in an aeroplane when the air pressure changes) or because their ears are actually sore. Let me discuss some common causes of ear pain in children:

We all know we are supposed to “wash behind our ears” and we all own special baby-earbuds to clean your baby’s ears, but is this really safe and necessary? Ear wax (also called cerumen) has a very important role in the protection of the outer ear channel. The outer layer of skin in the ear channel has a unique migration towards the outside of the ear that drives the wax and debris out. Movements like chewing and yawing also helps to move the wax outwards. If we clean the ear with ear buds we are actually pushing the wax back into the channel, thus causing a build-up of wax in the ear.

The only thing you need to clean your baby’s ears is a warm, wet, soft washcloth / cotton-round to catch the excess wax that move into the outer ear, so you only clean where you can see. If you are worried about wax build-up in older children (some children form wax plugs in their ears) , you can put some “Sweet Oil” drops in their ears once a week at night. This should keep the ear well lubricated and assist in the wax-removal process.

The outer ear channel is a unique area of the human body, forming a cul-de-sac that is warm, dark and prone to become moist. This is excellent breeding ground for bacteria. The outer ear channel is normally protected by a layer of cerumen (earwax) that prevents infections. When this natural barrier is damaged by prolonged exposure to moisture or due to trauma (when foreign objects are pushed into the ear) or due to skin conditions like eczema, the pH is changed and the ear becomes more prone to infections.  

Otitis externa (only inflammation or with bacterial or fungal infection) occurs more often in older children (5-14yrs) and is more commonly known as Swimmer’s ear.

Symptoms: ear pain is the most common symptom, can also be accompanied by itching in the outer ear channel and a puss-like discharge from the ear. The ear channel becomes red and swollen. Due to the swelling there can also be hearing loss or a feeling of increased pressure in the ear.

Examination: your doctor will need to ensure that there are no foreign objects stuck in the ear, and that the ear drum is not perforated by looking into the ear channel with a light.

Treatment: treating the pain is the most important. This can be done with a combination of oral and local analgesia such as Nurofen. Antibiotic ear drops will be effective to treat infection. (A combination of antibiotic/steroid ear drops work very well to decrease the swelling and inflammation).

Sometimes it will be necessary for a doctor to rinse out the puss and any excess wax out of the ear channel. Using “Sweet oil” or Then it is important to keep the ear dry by staying out of the swimming pool and using soft wax earplugs while showering. It has been suggested to use a hairdryer after swimming/showering to dry the ear channel, but there are no studies to validate this suggestion. 2% acetic acid drops can be used in the ear after exposure to water to help maintain an acidic environment and prevent infections.

Now that we understand the working of the outer ear, check back next time for more information on the middle ear. I will discuss middle-ear infections and the use of gromits, I know many toddlers struggle with this!

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