Ear Pain (Pediatric)

Why so many ear infections in kids? The short answer is bad plumbing. The middle ear drains to the throat through the eustachian tube, and in kids these pipes are smaller and more horizontal. When fluid backs up, the eardrum bulges sometimes causing maddeningly severe pain. Decongestion and drainage, even more than antibiotics, are the solution. Tympanocentesis (aspirating pus through the eardrum) used to be a common solution as well, though that’s far less common nowadays.

Red Flags:

• Fever not controlled
• Lethargy
• Failure to improve with antibiotics
• Underlying immunocompromised
• Tender, red, swollen, soft, bone behind the affected ear (super rare)
• Unvaccinated

Happy Words

• Better after sitting up
• Better with children’s ibuprofen/acetaminophen
• Still playful
• Eating and urinating normally
• Pressure equalizer (PE) tubes already in place
• “I just finished surfing and feeling sore and plugged.”

For ear pain in kids… and adults follow these steps:

  1. Sit up and point the plugged pipe down (affected ear up). Sleep inclined on a Lazyboy on your side if needed.
  2. Open the pipes with steam, Vicks, Sudafed, tea or grandma’s favorite home remedy.
  3. Pain control with acetaminophen or ibuprofen (15mg/kg and 10mg/kg respectively)

If all else fails, pack for a rough night in the ER, or call Pre-R and we’ll try to help. But don’t count on antibiotics. Perspectives on their utility vary widely. Often I either write the prescription and strongly recommend waiting to see if things improve, or I’ll ask patients or parents to call me back after waiting a day.

Patients with ear pain pretty much never receive X-rays or blood tests. Only rarely do we order CTs to chase abscesses for patients who aren’t improving with antibiotics. And I’ve only seen a handful of patient with mastoiditis. This means that $1000 ER bills for ear pain are an absolute shame. A simple glimpse on exam usually does the trick. Whether its a middle ear infection, an external ear infection, an ear full of wax, or a nesting moth, Pre-R certainly has the tools to get you or your child through the night.

And for you gadget people, have a look at cellscope.com

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