Ear pain in children may be a sign of an infection in the space behind the eardrum (middle ear ). Ear infections (otitis media) most commonly occur when cold symptoms, such as a runny or stuffy nose and a cough, have been present for a few days.
An ear infection may occur when the eustachian tube swells and closes and fluid accumulates in the middle ear. The combination of fluid and germs (from bacteria or viruses) creates a perfect environment for an infection. Swelling from the infection can cause pain from increased pressure on the eardrum. The pressure can cause the eardrum to rupture (perforate). A single eardrum rupture is not serious and does not cause hearing loss. Repeated ruptures may lead to hearing loss.
Middle ear infections are more common in children than in adults. Young children have short, soft, more horizontal eustachian tubes that are more easily blocked than those of older children and adults.
Ear infection is the most commonly diagnosed bacterial infection in children younger than age 7. Almost all children will have at least one ear infection by the time they are 7 years old. Most ear infections occur in babies between the ages of 6 months to 3 years. After age 7, ear problems may be related to inflammation, infection, or fluid buildup in the middle or external ear. Ear infections are more common in boys than in girls, and they most often occur in children who:
- Spend time in day care settings.
- Are bottle-fed.
- Use a pacifier.
- Live in households where parents or caregivers smoke.
- Have had a previous ear infection.
- Have problems present since birth (congenital abnormalities), such as cleft lip, cleft palate, or Down syndrome.
- Have allergies.
Fluid often remains in the middle ear (serous otitis, or middle ear effusion) after an ear infection. This may cause no symptoms, or it may cause a muffling of sound, decreased hearing, and mild discomfort. The body usually reabsorbs fluid behind the eardrum within 3 months, and hearing returns to normal. Recurrent ear infections and persistent effusion may occur in some children.
Even though ear infections are a common cause of ear pain, not all ear pain means an infection. Other common causes of apparent ear pain in young children include:
- A sore throat.
- An accumulation of earwax.
- An object in the ear.
- Air pressure changes, such as flying in an airplane.
- Fluid buildup without infection (serous otitis).
When evaluating ear pain in a child, remember that ear infections commonly occur after symptoms of a cold have been present for a few days. When other symptoms, such as fever, are present, ear pain or drainage may be less important than the other symptoms.
Ear problems caused by an injury to the ear can occur at any age. Common injuries include the following:
- A fall or a forceful, direct blow to the side of the head can burst the eardrum or damage the tiny bones in the inner ear that send sound to the brain.
- An injury during contact sports can cause an injury, such as "cauliflower" ear from wrestling.
- Loud noises or explosions can damage the eardrum (acoustic trauma).
- Atmospheric pressure changes (barotrauma) can cause problems with the eustachian tube and trap air in or keep air out of the middle ear. Middle ear problems can be severe (for example, the eardrum can burst or the middle ear can fill with blood or pus) or mild and only be felt as changes in pressure.
- Cuts or scrapes may injure the outside of the ear or ear canal. For more information, see the topic Ear Canal Problems (Swimmer's Ear).
- Cleaning the ear canal too often, too forcefully, or with a cotton swab, bobby pin, or sharp fingernail can cause irritation or injury.
- Burns or frostbite can cause ear injuries (thermal injuries).
- Objects placed in the ear can cause injury to the ear canal or the eardrum (tympanic membrane).
Check your child's symptoms to decide if and when your child should see a doctor.