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Ear Infections in Children
Kelly Ochoa, MD
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Middle Ear Infections, The Midnight Pain in Kids
So painful, and always in the middle of the night, middle ear infections are the worst for the little ones! However, there is a huge misconception out there that ear infections always need to be treated with antibiotics. Antibiotics are WAY overprescribed for otitis media (fancy word for middle ear infection). Typically the middle ear area is able to drain into the nose through a little tube that connects this part of your ear to the inside of your nose. But when children have colds and congestion in their nose, fluid gets backed up into the middle ear and causes pain and pressure. This pressure builds up and is notoriously worse when the child lays flat to sleep, hence waking up at midnight crying in pain and holding their ear. Usually this is from a virus. Now sometimes, bacteria can grow there and these infections can progress to become more serious bacterial infections. At this point they would need antibiotics, as true bacterial infections can spread into the bone behind the ear. However, in most cases your body does its job fighting the virus, and it will resolve after a few days on its own.
Treat the Ear Pain
That doesn’t diminish the fact that they are still super painful. Whether caused by a virus, a bacteria, or just fluid and mucus, they most certainly HURT. I advise ibuprofen (over 6mo old) every 6 hours, and definitely right before bed, if your child seems to have ear pain or is waking up in the middle of the night crying. Use our calculator at healthepediatrics.com to determine the correct dose for your child.
Outer Ear Infections
Swimmer’s ear is an infection of the outer canal part of the ear, which is the outer part that you can sort of look into if you stare into the ear, and the part people shouldn’t but do clean out with a q-tip. Typically you will see pus discharge coming out of the ear, and it will be painful to lift the ear up and down. With a middle ear infection, moving the ear doesn’t change the pain. When this canal stays wet, bacteria love moisture and cause irritation and pus in this canal. These infections usually clear up with some mild antibiotic drops.
Wait, There Are Other Reasons for Earaches
Not all ear aches are infections. I felt so bad for my sweet teenage patient at 6am one morning who came in with an ear ache. Looked in her ear with my scope to find a magnified eyeball staring right back at me! What a way for her (and me!) to start out our morning. Needless to say I removed a live bug immediately – can you believe she didn’t want to keep it as a souvenir?! I have looked in so many ears in my day, and kids put everything in there! If your child is complaining of ear pain or has discharge from their ear without any common cold symptoms, you may want that ear looked at by their doctor to make sure there is no bead, or bean, or fuzz, or bug or who knows what else in there!
Cerumen – That is Just Ear Wax
Ear wax is natural, and not “dirty”. Ear wax, aka cerumen, helps keep the ear canal healthy and clean. Your body removes ear wax on its own. Sometimes, however, it can build up and harden, becoming itchy and irritating, or cause decreased hearing. If this is the case, it may need to be removed. There are drops that can help soften the wax, so it falls out naturally, or your doctor can remove it with a special tool. You should NEVER USE A COTTON SWAB, pen cap, paperclip, or anything else that looks like it could be stuck in the ear to pull out wax. This area is delicate. Doing this may cause damage and pain to the ear canal or deeper more important hearing structures.
Ear infections are most certainly painful, but antibiotics are not always the answer. Often the body can fight these infections off on its own, and the best treatment for your child is pain medication only. Use our calculator at healthepediatrics.com to maximize the dosing of ibuprofen for your child. And ear aches are not always infection – think about something your toddler may have thought fun to put in their ear, bugs, or wax causing discomfort as well!