Understanding Ear Pain & Infections
Ear pain can be caused by many different conditions, not just ear infections (acute otitis media). Common causes include:
- Middle ear infections (otitis media)
- Swimmer's ear (infection of the ear canal)
- Fluid buildup behind the eardrum without infection
- Earwax buildup or foreign object in the ear
- Teething or jaw pain (can be referred to the ear)
- Sinus pressure or allergies
- Throat infections (pain can radiate to the ear)
- Changes in air pressure (from flying, altitude changes)
Without being able to see inside the ear, healthcare providers rely on reported symptoms to assess what might be causing the pain.
Common Symptoms to Monitor
- Location and severity of ear pain (one ear or both)
- Fever, irritability, or sleep disturbance
- Fluid or drainage from the ear
- Pulling or tugging at the ear
- Balance issues or clumsiness
- Pain that worsens when lying down
Treatment Approaches
Treatment depends on your child's age and symptoms:
Watchful Waiting: Monitoring for 48-72 hours without antibiotics
- Often appropriate for children over 2 years with mild symptoms and one-sided infection
- We'll follow up with you during this period
Antibiotic Treatment:
- Typically required for all children under 6 months with a confirmed visualized ear infection
- Usually needed for children 6 months - 2 years with severe symptoms or infection in both ears (fever or pain not well managed with pain relieving medicine)
Home Care for Ear Pain
Pain Management
- Can use acetaminophen (Tylenol) for pain relief and fever reduction
- Give every 4-6 hours as needed (no more than 5 doses in 24 hours)
- Often preferred if your child is dehydrated or has stomach upset
- Can use ibuprofen (Motrin, Advil) for pain relief and fever reduction ONLY for children 6 months and older
- Give every 6-8 hours as needed
- May work better for pain with inflammation
- Keep your child comfortable with adequate rest
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When to Contact Us
- For initial assessment of ear pain or infection symptoms
- For children over 2 years with mild, one-sided ear pain
- If you're using the watchful waiting approach and need guidance
- If symptoms change or new symptoms develop
- For follow-up during treatment
- If you have questions about your child's symptoms or care
We can help by:
- Recommending pain management techniques
- Advising on over-the-counter medications
- Guiding you through watchful waiting with follow-up
- Possibly prescribing antibiotics based on symptoms for:
- Children under 6 months
- Children 6 months-2 years with severe symptoms or infection in both ears
- When symptoms worsen during watchful waiting
When to Visit Your Pediatrician
- For definitive diagnosis with an otoscope (required to confirm ear infection)
- If ANY of these warning signs are present:
- Fluid or drainage from the ear
- Swelling, redness, or tenderness behind the ear (possible mastoiditis)
- Severe pain that isn't relieved by over-the-counter pain medicine
- Fever lasting more than 2-3 days with ear pain
- No improvement after 48-72 hours of treatment or watchful waiting
- Symptoms worsen significantly despite treatment
- Recurrent ear infections (more than 3 in 6 months)
Risk Factors to Address
These factors may increase the likelihood of ear problems:
- Bottle feeding while lying down
- Exposure to secondhand smoke
- Allergies
- Delayed or incomplete vaccinations (especially pneumococcal and flu)
We'll check in with you 24 hours after your visit. If we're using the watchful waiting approach, we'll schedule another check-in at the appropriate time. If your gut tells you something is wrong, don't hesitate to reach out. Need help? Reconnect with our on-demand team of 24/7 Medical advisors.
