Middle ear infections are the most common bacterial illness in childhood. Babies often pull and poke at their ears for a variety of reasons, so this is not a very good indicator of possible infection. Middle ear infection is usually a complication of a cold or an allergy. Thus, failure of a runny nose to resolve in the expected time frame is a better clue for infants. In older children an earache may also represent an external ear infection, which is an irritation of the skin in the ear canal and is treated with drops rather than oral antibiotics.
Some children are prone to repeated ear troubles. Sometimes these are recurrent (they get better in between episodes), and sometimes they are chronic (their middle ears rarely if ever return to normal). The approaches to recurrent vs. chronic middle ear dysfunction are different. If your child develops either of these problems, please ask for our more detailed information handout,THE PROBLEM OF “PROBLEM” EARS.
Although examination will be required before specific treatment can be begun, AN EARACHE IS NOT AN EMERGENCY and does not need to be seen right away. Earaches are worst soon after they first begin, and by 12-18 hours the pain begins to subside regardless of whether therapy has begun or not. Indeed, whatever antibiotic or eardrop the doctor prescribes takes 2-3 days to even begin to work! The pain eases not because of the medicine, but because of the body’s own compensatory mechanisms. Unfortunately, there is nothing we can do beyond what you can do yourself to speed up that process. A prescription may be necessary, but whether it is begun now or tomorrow is of no consequence.
A number of measures will effectively help with the acute pain of an earache:
1. Acetaminophen or Ibuprofen, in the same dose listed above for fever control, is the single most important thing. Even if there is no fever, these medicines are effective pain relievers.
2. Decongestant/antihistamine preparations help in 2 ways – they reduce the swelling in the middle ear which leads to the pain and pressure.
3. Call during office hours to arrange for your child to be seen.