Ear pain in children is often caused by a build-up of fluid and pressure behind the eardrum, in the area called the middle ear. The middle ear is connected to the nasal passages by a short narrow tube, the Eustachian tube. The Eustachian tube allows normal fluids to drain out of the middle ear, and helps keep the pressure in your ear equalized.

A cold or allergy can block the Eustachian tube due to inflammation and the build-up of secretions. This is especially likely in small children, because their Eustachian tube is shorter and more horizontal. When the Eustachian tube closes, the normal flow of fluid from the middle ear is prevented. The fluid begins to accumulate, which can cause stuffiness, pain, hearing loss, and an ear infection.

The symptoms of an ear infection may include fever, ear pain, fussiness, increased crying, and irritability. Many children will have temporary and minor hearing loss during and right after an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has.

Ear pain in a child or infant is not always from infection, however. Other causes include water from bathing, soap or shampoo retention, or ear canal irritation from cotton-tipped swabs.

Ear pain in adults is less likely to be from an ear infection. What you perceive as ear pain may actually be coming from another location, such as your temperomandibular joint, your teeth, throat, or other location. This is called "referred" pain.

• An object stuck in the ear or severely impacted ear wax
• An ear infection
  • Middle ear infection - acute (short and severe episode)
  • Middle ear infection - chronic (does not go away or recurs)
  • Outer ear (canal) infection - acute
  • Outer ear (canal) infection - chronic
  • Outer ear (canal) infection - malignant
• Ear injury from pressure changes (from high altitudes and other causes)
• Ruptured or perforated eardrum
• Tooth infection
• Sinus infection
• Arthritis of the jaw
• Sore throat with referred pain to the ears
• Temperomandibular joint syndrome (TMJ)

The following steps may help an earache:

• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give children aspirin.)
• A vaporizer adds moisture and humidity to keep the mucous thin.
• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• Over-the-counter ear drops are gentle and effective. Severe pain may require prescription eardrops from your health care provider.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position may help reduce pressure in the middle ear.

Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help.

For children, call your child's doctor if:

• The child's symptoms (pain, fever, or irritability) do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child under two, let the doctor know right away if the child has a fever, even if no other symptoms are present.

The doctor will perform a physical examination, which may include examination of the ear, nose, mastoid (bony part behind the ear), and throat. Pain, tenderness, or redness of the mastoid often indicates a serious infection.

During the examination, the doctor will ask questions about the ear pain, such as:

• When did it begin?
• Is it getting better, worse, or staying the same?
• Is the pain constant?
• What other symptoms are also present?
• Is there ear pressure?
• Is there drainage from the ear?
• Are there unusual ear noises?
• Is there a fever?
• Is there pain in the bone behind the ear?
• Is there hearing loss?

Possible diagnostic tests include blood culture or culture of the fluid drainage if the child is under age 3 and has a fever over 104 degrees F.

If antibiotics are prescribed, it is important to take ALL of the prescribed antibiotic on schedule. Ear tubes may be inserted for children who have persistent or recurring ear infections to re-establish the proper functioning of the middle ear. Inserting ear tubes is a simple and effective surgical procedure.

The following steps may help prevent earaches:

• Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
• Take steps to control allergies. In particular, avoid allergy triggers. Flonase nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.
• Take steps to prevent colds in children.