Rea­sons for ear ache & why it’s im­por­tant to be checked by your GP.

Great Health Guide - - CONTENTS - Dr David McIn­tosh

Par­ents of­ten ask me, ‘My child al­ways gets ear aches. Is this a prob­lem?’ When chil­dren com­plain of ear ache, par­ents of­ten won­der if the sit­u­a­tion re­quires med­i­cal ad­vice. Ear ache in chil­dren is of­ten over­looked by par­ents, think­ing that it is not very im­por­tant. How­ever, it is very im­por­tant that a GP check out any signs of ear ache in chil­dren. There are many rea­sons why chil­dren get ear ache but for­tu­nately there are only a cou­ple that are com­mon.

1. The most com­mon cause is teething, which is not so se­ri­ous.

2. The next most com­mon cause is a mid­dle ear in­fec­tion and this is po­ten­tially se­ri­ous.

Now telling the dif­fer­ence be­tween these two should be sim­ple, but this is not al­ways the case and so, these two main causes will be the fo­cus of this ar­ti­cle. How­ever, be aware that other causes of ear ache can in­clude con­di­tions such as sore jaw joints, a tooth in­fec­tion, a si­nus in­fec­tion, ton­sil­li­tis and air pres­sure on the ear drums (such as with fly­ing in a plane).


When the tooth starts to erupt and emerge through the gum line, this causes ir­ri­ta­tion to the mu­cous mem­brane lin­ing the gums. The sen­sory nerve then tells your brain that you have a toothache. There are also other nerve branches that tell the brain

when you have an ear­ache. Some­times those mes­sages get a bit mixed up and the brain thinks the pain is com­ing from the ear, when in fact it is from the mouth. This con­fu­sion about where pain is com­ing from is called ‘re­ferred pain’. It ba­si­cally means that the pain is orig­i­nat­ing in one spot and felt in an­other. This gum pain can be re­lieved and the ear ache will dis­ap­pear once the tooth has fi­nally emerged. If ear ache per­sists af­ter this time, then seek ad­vice from a GP.


Mid­dle ear in­fec­tions cause vary­ing de­grees of pain, de­pend­ing on the sever­ity of the in­fec­tion. When the in­fec­tion is present, it causes pain by two main meth­ods.

• The first is the lo­cal ir­ri­ta­tion and in­flam­ma­tion of the mid­dle ear.

• The se­cond is a build up of fluid that leads to a pres­sure build up on the eardrum. Some­times this pres­sure be­comes so high that it tears a hole through the eardrum. This is called a ‘per­fo­ra­tion of the eardrum’. When this hap­pens the child ex­pe­ri­ences an in­tense mo­ment of pain and then ac­tu­ally feels bet­ter due to the re­lease of all the pres­sure. Re­mark­ably though, some­times chil­dren get a per­fo­ra­tion with min­i­mal dis­com­fort. This wide spec­trum of pain ex­pe­ri­ences with ear in­fec­tions, makes it much harder to work out the causes of ear ache in chil­dren


One thing to check for, is the pres­ence or ab­sence of a fever. With an in­fec­tion, an el­e­va­tion in the body tem­per­a­ture is to be ex­pected. Un­for­tu­nately, when it comes to teething, there can be a mild fever as this is the nor­mal body re­sponse when there is in­flam­ma­tion, as hap­pens when the teeth come through the gum. The only real dif­fer­ence is that a sig­nif­i­cantly high tem­per­a­ture is in keep­ing with a mid­dle ear in­fec­tion as the cause of the ear pain. This is the time to worry about the ear ache in chil­dren as be­ing due to some­thing se­ri­ous and visit the GP to have the cause of the ear ache checked. The main con­cern with an ear in­fec­tion is that it usu­ally has other ob­vi­ous symp­toms, such as a runny nose, sweat­ing, notable ir­ri­tabil­ity and the child looks gen­er­ally un­well. A GP as­sess­ment can usu­ally clar­ify if there is any fluid build­ing up be­hind the ear drum. With ear ache in chil­dren it is bet­ter to be safe than sorry as symp­toms may ap­pear un­cer­tain. You know your child bet­ter than any­one, so if things are not quite right, don’t ig­nore the ear ache in chil­dren and have the cause checked out.

Dr David McIn­tosh is a Pae­di­atric ENT Spe­cial­ist with a par­tic­u­lar in­ter­est in air­way ob­struc­tion, fa­cial and den­tal de­vel­op­ment and its re­la­tion­ship to ENT air­way prob­lems and mid­dle ear dis­ease. He also spe­cialises in si­nus dis­ease and pro­vides opin­ions on the ben­e­fit of re­vi­sion of pre­vi­ous si­nus op­er­a­tions. Dr McIn­tosh can be con­tacted via this web­site

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