Earache in children

Earaches are a common problem for children. About three-quarters of the little ones get it at least once during their first years of life. The causes of earaches in childhood can be of various kinds.

Mostly it is a harmless disease, but there are warning signs that parents and caregivers should be aware of. Although there are simple home remedies to treat the child, there should be no delay in seeing a doctor if there is no improvement or if the symptoms worsen. Serious illnesses that pose a risk to a child’s hearing must be excluded by the pediatrician or, in individual cases, by the ear, nose and throat specialist. Antibiotics do not have to be prescribed in every case and in most cases a well tolerated and age-appropriate symptomatic treatment is sufficient.

Causes

Earaches in children usually occur in connection with a cold. The so-called Eustachian tube is the connection between the middle ear and the oral cavity and serves to equalize pressure. When a child suffers from a cold, the mucous membrane in the area where this tube exits can swell and become misplaced, making it difficult to equalize pressure and causing earaches.

Another common cause of earache in children is acute or chronic inflammation of the middle ear, known as otitis media. This, sometimes very painful disease is caused by bacteria and viruses and can also be caused by a cold. In bacterial otitis media, the middle ear is usually colonized continuously via the Eustachian tube, whereas in viral otitis media the infection usually occurs via the blood.

Both forms result in inflammation of the sensitive mucous membrane of the middle ear, which is accompanied by severe, pulsating ear pain, fever, ringing in the ears and hearing loss. A disease that can occur in connection with inflammation of the middle ear is the inflammation of the mastoid process. This is the bony attachment of the neck muscles behind the ear.

This bony process on the skull contains air-filled cavities to a variable extent and is connected to the middle ear. Inflammation of the mastoid process, also known as mastoiditis, manifests itself in a renewed increase in pain as the inflammation of the middle ear subsides. In addition, there is sensitivity to pressure and a swollen redness behind the ear.

Due to the possible complications of mastoiditis, this cause of earache in children is one of those that require special attention. The external auditory canal may also become inflamed and cause pain. This condition, known as otitis externa in medical terminology, can be the result of an earwax plug, manipulation with pointed or sharp objects in the ear canal, or bacterial colonization of the skin of the external auditory canal.

The most common bacterial pathogens of otitis externa are the bacteria Pseudomonas aeruginosa and staphylococci. While staphylococci belong to the normal skin flora of humans and can penetrate the skin via the smallest injuries and cause inflammation, pseudomonas are wet germs that are mainly found in wet areas such as swimming pools. The causes of earache in children do not always have to be a disease of the ear itself.

In teething children, toothache can also radiate into the ear on the affected side. The same applies to inflammation of the palatal tonsils (tonsillitis). An inflammation of the parotid gland can also cause pain that is perceived by the child in the ear.

In children, the possibility that foreign bodies have been introduced into the ear at an unobserved moment or that the auditory canal has been injured by inserted objects must never be ignored. The latter can also lead to perforation of the eardrum. A barotrauma is when strong pressure fluctuations lead to a rupture of the eardrum.

Since these also occur when the ear is struck, they can be a sign of domestic violence. A malfunction of the Eustachian tube can lead to earaches during take-off or landing in the course of a flight. Due to the changing pressure in the cabin, a lack of pressure equalization can lead to sometimes severe earaches.

Children are particularly susceptible to this. Chewing gum or sucking sweets can help to stretch the Eustachian tube and thus equalize the pressure.The bacterial pathogen causing otitis externa includes the bacterium Pseudomonas aeruginosa. These are wet germs that usually settle on the softened skin of the auditory canal after a visit to the swimming pool or after bathing and can cause an infection. In children, infection with Pseudomonas aeruginosa is a common form of otitis externa and is therefore sometimes called “swimming pool otitis” or “swimmers ear” and is usually manifested by a blue-greenish discharge from the affected ear in addition to the pain.