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How to Evaluate Inner Ear Pain

Dr. Lyle Berkowitz explains when to consider telehealth vs. office visits for children with ear pain.  

Children under the age of 3 should always get seen in an office, while those 3-11 should go to the office if there is a high likelihood of a bacterial infection. Children over 12 can be more safely evaluated online, fortunately.

Parents, caregivers, and doctors alike, who look after the well-being of children, know that childhood earaches can appear out of the blue and have many different symptoms. Often the child is too young to communicate that they have ear pain or unaware that an earache is causing the pain. So, it’s essential to be able to identify the symptoms of an earache and address it quickly to avoid a more severe problem, including possible permanent damage.

Earaches are frequent in children because of several factors, including immature immune systems, and smaller eustachian tubes in the ear, which can cause a higher risk of becoming blocked with fluid. The National Institute on Deafness and other Communication Disorders (NIDCD), states, “Five out of six children will have at least one ear infection by their third birthday. Ear infections are the most common reason parents bring their child to a doctor.”

MDLIVE’s Chief Medical Officer, Dr. Lyle Berkowitz, provides the following advice for parents of patients on how to evaluate inner ear pain. He says, “The good news is, inner ear pain in children is frequently caused by non-bacterial sources, such as allergies and viral infections. Both of these can be treated symptomatically and without antibiotics. Using antibiotics in these situations can do more harm than good, causing side effects or resistance to antibiotics at a later time when they are needed.”

Here’s additional advice to help you in detecting ear pain in children.

Signs of an earache in children under three years of age

Detecting earaches and ear pain in babies or children who are too young to tell you what hurts is tricky. So, it’s essential to know what to look for in their behavior. Often the child will tug or yank on the ear that’s causing them discomfort, but not always. They also may become irritable, not eat well, or have trouble sleeping. Sometimes babies refuse their bottles because the pressure in their ears makes it hurt to swallow.

Our advice for any child under three experiencing ear pain is to get seen in a clinic for an in-person visit with a medical professional. Your child will then be seen by a medical professional who will look inside the child’s ear to confirm the diagnosis and decide on the best treatment options. While a telehealth visit is appealing to get a quick answer, it is not appropriate due to the higher risk of complications associated with this age group.

Signs of an earache in children ages 3 to 11

This group is a little easier to evaluate, as they can communicate better. The most telling sign of earache is sharp ear pain. Other minor symptoms may include trouble hearing, stuffy nose, discomfort while lying down, difficulty falling asleep, and poor appetite.

A telehealth visit can help with earaches due to allergies or viral infections in this age group. However, if you believe that your child has a bacterial infection, you should take them to a medical professional who can review in person.  Symptoms to look for are fever, fussiness, fluid oozing from the ear or symptoms similar to past bacterial infections. Note: to help avoid ear infections in the future, make sure your child washes their hands well and often, especially if near other sick children. Also, keep your child away from secondhand smoke and make sure they get a flu shot every year.

Signs of an earache in children 12 and older

Children twelve and older can tell you when they have ear pain, so the goal here is to find out what is causing it and how it can be treated. Colds and similar viral infections are common causes of earaches because they can irritate the eustachian tube in the ear and, can lead to bacterial middle ear infections.

For children who are 12 and older who complain of an earache, they should get evaluated either online or at an office. It’s important to note if they are also having any fever, sore throat, loss of hearing, or any discharge as well. Some over-the-counter medications like acetaminophen or ibuprofen can provide temporary relief – but never use aspirin in this age group due to a potential reaction they may have.

Telehealth visits are appropriate as long as the patient can communicate well with our doctors. The doctor can evaluate the situation and treat when the ear condition is not too severe. Sometimes they will still advise an office visit if they are concerned. Note: that after a telehealth visit, if your child feels worse in the next 24 hours or does not feel better in the next 48 hours, an urgent in-office evaluation and treatment is necessary.

Keep this advice on-hand for the next time your child is complaining of ear pain so you can get them on the fast track to feeling better soon.

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