Earache
Middle ear infections are
the most common bacterial illness in childhood. Ironically, they are most prevalent in the
age group too young to complain of an earache! 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, however, so
failure of a runny nose to resolve in
the expected time frame is a better clue. In the older child 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.
It is important to remember
that whenever a child has an ear infection, the involved ear(s) have some degree of conductive
hearing loss until both the
infection and the fluid have resolved. 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. If an ear infection is diagnosed, we should always re-examine the child's
ears at the end of the antibiotic course to be sure the infection and the fluid have fully
resolved. Oftentimes full resolution has not occurred and more treatment is required even
though outward signs and symptoms are better - it is important for us to discover and
respond to this due to the issues of hearing loss and possible chronic ear problems
mentioned above.
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, PLUS
the side effect of drowsiness promotes sleep. Sometimes, if an ear infection is in its
earliest stages, this type of medication may even arrest its progression or "nip it
in the bud".
3. Call during office
hours (or in the morning on Sundays/holidays) to arrange for your child to be seen.
Even though the earache may be going away, what caused it is probably still there and is
likely to need a prescription to ultimately get better.
© 1989, 1997 Children's Medical Office of North
Andover, P.C. |
