EAR ACHE IN CHILDREN

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

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).

WHY DOES TEETHING CAUSE EAR ACHE?

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 AND EAR ACHE.

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

SO, WHAT ARE THE CLUES TO TELL ONE FROM THE OTHER, APART FROM SEVERE PAIN?

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