Earache is one of the most common complaints that children in the age group of 3–6 years present with. It can be caused by injury, infections or other conditions affecting the external auditory canal, middle ear or the mastoid bone. Sometimes, earaches may also be the result of referred pain. Let's look at some of the conditions that can cause ear pain.
Conditions that cause external auditory canal pain:
1. Furuncle (boil): This is an inflammation of the hair follicles caused by the bacteria Staphylococcus aureus. It is an acute condition, and may also cause fever and difficulty with chewing.
Examination of the ear with a furuncle reveals widespread swelling in the external auditory canal. Applying pressure over the tragus causes pain; this is called the tragus sign. Pulling the pinna, ie, outer ear, may also cause pain.
A furuncle is usually treated by incising and draining the pus, after which the ear canal is lightly packed with ribbon gauze soaked in icthamol glycerine. Systemic antibiotics and non-steroidal anti-inflammatory medications (NSAIDs)are also prescribed.
2. Otitis externa: It is a common condition that causes inflammation of the skin lining the external auditory canal. It is characterised by pain, itching and scanty discharge.
The condition is treated with aural toilet, ie, manual cleaning of the external ear canal to remove the wax and debris, and application of local antibiotic cream. The patient is sent home on systemic antibiotics and NSAIDs.
3. Otomycosis: This is caused by fungal inflammation of the external auditory canal, resulting in pain and itching.
Examination of the external auditory canal may reveal debris, which may be characteristically described as wet newspaper-like material.
Treatment consists of cleaning the debris and instillation of antifungal ear drops. Systemic antifungal antibiotics are not necessary Treatment is usually continued for a period of one week after the symptoms and signs subside to prevent recurrence.
Conditions that cause middle ear pain:
Acute suppurative otitis media: Progression of acute suppurative inflammation of the mucosal lining of the middle ear cleft causes acute suppurative otitis media. It usually occurs following an attack of cold or upper respiratory infection. It starts with an earache that is associated with fever and a blocking sensation in the ear. As the condition progresses, the pain increases and may become throbbing in nature.
Examination of the ear with an otoscope may reveal congestion of the tympanic membrane. But over time, fluid starts accumulating in the middle ear and the pressure causes bulging and eventual perforation of the tympanic membrane. This gives rise to mucopurulent discharge.
Initially, otitis media is treated with administration of systemic antibiotics and anti-inflammatory analgesics. In cases where the tympanic membrane is found to be bulging, a myringotomy is performed and the fluid is drained. But if the tympanic membrane appears perforated, then aural toilet is performed to clean the ear discharge. Antiseptic or antibiotic ear drops are then instilled for a period of 5–7 days, by which time the discharge subsides. The patient is instructed to keep the ear dry and is followed up till the perforation heals. If the perforation does not heal, a myringoplasty is performed to repair the ruptured eardrum.
Conditions that cause mastoid bone pain:
Acute mastoiditis: This occurs as a result of progression of acute suppurative otitis media to the mastoid antrum and the air cells. There is pain behind the ear, increased fever, and the posterior wall of the external auditory canal may appear bulging or sagging on otoscopic examination.
Parenteral antibiotics and anti-inflammatory analgesics are usually given to treat this condition. However, if the infection does not subside, cortical mastoidectomy may be performed to clear the antrum and air cells. Untreated acute mastoiditis may give rise to intracranial or extracranial complications.
This refers to a condition where the earache may be caused by pain originating at other sites like the throat, oral cavity or the temporomandibular joint.
Earaches can cause pain and distress to a child. If your child suffers from recurrent earaches, visit the doctor at the earliest to diagnose the cause and get it treated.