EDP column by Dr Ketan Dhatariya

“My 3 year old son gets terribly painful earache every time he gets a cold. Why is this?”

Earache in children can be very distressing for the child and the parents alike. The anatomy of the ear is slightly different in adults and children. There is a narrow tube called the Eustachian tube that runs from the part of the ear behind the eardrum (the ‘middle ear’) to the back of the throat. There is always a little fluid being produced in the ear that needs to be drained away. In adults this tube is longer and at a greater downward angle than children. This means that gravity can help to drain any fluid that may build up in the middle ear. In children the short, more horizontal tube means that drainage is more difficult, and if there is an infection – often a viral infection – then the fluid builds up, causes the ear drum to bulge, causing pain. The doctor may see this as a bulging, red eardrum.

Because earache in children is painful the best treatment is painkillers. This can be either as paracetamol or ibuprofen – never give aspirin to a child. Because the most common cause for earache is viral, there has been a debate amongst doctors as to whether antibiotics are useful to treat the condition. Currently, it is felt that early use of antibiotics is not useful. Using antibiotics too early can cause problems at a later date by the development of antibiotic resistant bacteria.  

If you have ever been on a plane and your ears have hurt as you ascend or descend, the reason for this is that the Eustachian tube is blocked. You can try and re-open it by closing your nose and straining as though you wanted to pass wind. This helps to equalise the pressures on both sides of the ear drum helping the pain to ease. This may need to be done several times as the pressures change. Chewing also opens up the entrance of the tube at the back of the throat allowing the pressure to equalise, and this may also help any pain go away.

Earache may not always be due to an infection. Other causes include ear canal irritation from cotton-tipped swabs, or water, soap or shampoo staying in the ear after bathing.

As always, if you are concerned, it is always a good idea to see your GP to have a look in a painful ear.

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