Otalgia or an earache is ear pain. Primary otalgia is ear pain that originates inside the ear. Referred otalgia is ear pain that originates from outside the ear.
Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx.
Although ear pain can be troublesome and cause a difficult, sleepless night for both parents and child, it is rarely a reason to rush into emergency or to urgently start antibiotics.
Causes
Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.
External ear pain may be:
- Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
- Infective (otitis externa): Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral Myringitis.
Middle ear pain may be:
- Mechanical: barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media.
- Inflammatory / infective: acute otitis media, mastoiditis .
It’s not unusual for an ear infection to develop in early childhood. Although they’re not contagious, ear infections can occur as side effects of contagious illnesses—colds, coughs, or eye ailments.
Clinical History
Pain is the number one symptom indicating an ear infection. A child may tell that his ear hurts. Or, if he can’t talk yet but seems cranky or is tugging at his ear, an ear infection is a definite possibility. A recent cold or sinus infection is another clue. He may or may not have a fever.
Associated Symptoms
- Reduced appetite. An ear infection makes it painful for your child to swallow and chew.
- Difficulty sleeping. Lying down can make an ear infection more painful.
- Diarrhea or vomiting.
- A yellow or whitish fluid draining from the ear. This doesn’t happen to most children, but it’s a sure sign of infection.
- Trouble hearing quiet sounds. Fluid buildup in the middle ear can block sound.
- Difficulty with balance. The ear helps with equilibrium, so it may be noticed that the child seems a bit more unsteady than usual.
Epidemiology
- Ear infections peak at age 6 months to 2 years
- The onset of ear infections peaks on day 3 of a cold
Return to School
- An earache or ear infection is not contagious. No need to miss any school or child care.
Diagnosis
It is normally possible to establish the cause of ear pain based on the history. Usually the reason is an ear infection.
Treatment
The American academy of Pediatrics recommends an antibiotic if the child has severe symptoms indicating acute otitis media. If the symptoms are not severe and the child is 2 yrs or older keep the child under observation fro next 48 to 72 hrs and antibiotics are not started.
Identification of a causative etiology is often necessary to successfully treat referred otalgia.
Keeping in mind that the antibiotic will not relieve the child’s pain in the first 24 hours – in fact, it will only minimally affect it after that. What’s more likely to help is the correct dose of an analgesic like acetaminophen or ibuprofen.
The child may also be comforted by warm compresses held to his ear.
