Ear Pain

Myth #1: Ear pain always means my child has an ear infection.

False. There are many causes of ear pain and most children who complain of ear pain DO NOT have an ear infection. The most common reason children complain of ear pain is eustachian tube dysfunction. The eustachian tube is a small tube that connects the ears to the back of the nose. When this tube functions properly, fluid is able to drain out of the ears into the nose. However, in the setting of nasal congestion the eustachian tube may become blocked which keeps fluid from draining out of the ears. In some cases this extra fluid may be felt as pressure in the ears and cause slight discomfort.

Myth #2: Ear Infections require antibiotics to get better.

This is False. When you look through all the medical literature it is has been rather clearly established that roughly 81% of ear infections resolve completely on their own without any antibiotics. By using antibiotics you can increase than number to 93%, a meager 12% increase.

Myth #3: If my child has an ear infection and does not get antibiotics immediately something BAD will happen.

This is flase. As mentioned above, roughly 4 out of 5 ear infections will completely resolve even if you do not use any antibiotics at all. Many European countries wait a few days before starting antibiotics. If the symptoms (ear pain, fever, etc.) persist then they start an antibiotics. The meaningful outcomes do not seem to change by delaying antibiotics for a few days. However, the number of unnecessary treatments and the amount of antibiotic resistance is significantly less in these countries.

Myth #4: Ear infections cause permanent hearing loss.

False. Ear infection, treated or not, virtually never cause any permanent hearing loss.

FACT #1: Ear infections are painful.

True. An ear infection is essentially an abscess behind the ear drum. Just like any other abscess, it is painful. However, the ear pain is generally very responsive to oral pain relievers or in some cases ear drops.

Fact #2: If my child has ear pain for more than a few days I should see my doctor.

This is true. Ear pain that does not resolve in 2-3 days is more likely to require antibiotic treatment.

Fact #3: If my child has ear drainage or pain behind the ear I should see my doctor.

True. These are the two most common complications of ear infections. Both generally require antibiotics. The pain behind the ear is generally a sign of mastoiditis, which is estimated to occur in 1:1000 ear infections. Mastoiditis and ear drainage is easily treated.

Fact #4: You can use Over-the-Counter Pain medication to treat most ear infections.

Tylenol and Motrin are both good options for pain relief when your child has ear pain. They can be used together if needed. However, you should use them as needed, not scheduled around the clock. Remember that these medications are also fever reducers, and fever reduction is not always good. Read my page on fever for more information.

There is also good evidence to suggest that naturopathic herbal extract ear drops(NHED) are effective for pain relief and treatment in children and may be equivalent or superior to antibiotics.

When or if to treat infection has always been controversial. There are several important considerations. First the benefits: early resolution of infection and prevention of complications. This must be weighed against the risks: severe allergic reactions and development of antibiotic resistant bacteria. Below are some references to consider so that you can "decide for yourself."

References:

Pediatrics:2001

This study performed in 2001 looks at patients diagnosed with acute otitis media (ear infection) and the impact of antibiotics. The authors concluded that roughly 4 out of 5 children will get better without any antibiotics. Treating your child with amoxicillin only improves the failure rate (failure to improve after 7-days) from 12% down to 7%. Personally, I am not sure the modest improvement is worth the trip to the doctor, the expense, and the side-effects of the antibiotics - especially when 8 out of 10 kids will get better on their own.

Pediatrics:2003

This article compares Naturopathic Herbal Extract Drops(NHED), with or without topical anesthstic drops, with or without antibiotics in children 5-18 years of age with ear pain. Again the vast majority of kids get relief and improvement from simple observation with ear drops to sooth the pain. Antibiotics in this study did not appear to have any considerable benefit.

Remember ear pain is not always caused by ear infection. Also remember that most ear infections resolve on their own with no medications. However, if your child is complaining of ear pain these are my suggestions:

1. At first sign of ear pain I would consider giving your child a naturopathic ear drop. You can pick up these drops at your local pharmacy without a prescription.

2. If the ear pain persists and is interfering with your child's normal activities (like sleep, eating, etc.), then I suggest a trial of tylenol or motrin. Try one and if the pain persists try to the other. These medications may be given together and do not intereact.

3. If the pain persists despite tylenol and motrin consider giving prescription ear drops for pain. Your doctor can call these into the pharmacy without seeing your child. I routinely give these prescriptions to my patients when I see them in the ER so that they can get the medication when they need it without a trip to the ER.

4. In most cases the ear pain will resolve with any of the above treatments. If the ear pain is mild and not interfering with normal activities, I would repeat the above therapies as needed for 2-3 days.

5. If the pain is severe, despite the above therapies, if the pain lasts more than 3 days, or if the pain is associated with drainage from the ear or severe pain in the bone behind the ear, then a call to your doctor is warranted.

6. Using these simple guidelines will allow you to effectively treat almost all causes of ear pain and ear infections at home and also save you unnecessary, expensive trips to the doctors office.

7. Ear infections account for about $3 billion worth of medical expense in the U.S. Roughly 80%, or $2.4 billion of this expense is unnecessary.

Yes and Yes!

As mentioned above there is evidence that over the counter ear drops are just as effective as anything else for relief of ear pain and ear infection. There are many different options to choose from but most can be picked up at your local pharmacy or you can order them online.

I suggest the following online sites:

Homeopathic Ear Ache Relief Drops

Walgreen's Product Description and Reviews

Dr. Reynolds writes a blog at SmartParentsBlog.com, where you can find more information about fever and other topics of interest to you and the health of your child. Visit the Blog or click on the link below for eNews and Updates delivered straight to your inbox.

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It is important for everyone to understand that the purpose of this website is educational - to provide information. It is not a replacement for your doctor and I am not entering into a doctor-patient relationship with any of the readers of these pages or their children. It is my goal that by providing you with easy to understand information based on the latest research you will be empowered to work with your doctor to raise...healthy kids!