The
most common earache, by far, to cross a doctor's threshold,
is acute middle ear infection (otitis media) in children. Most
children, at some time, have otitis media, usually following
a cold. The pain is distressing, the child crying pitifully,
a hand clasped to the side of the face. Fortunately it does
not usually last more than 2 or 3 days, sometimes relieved by
the eardrum bursting and the ear discharging. Sometimes infants
and toddlers may be feverish and unwell but it is not until
examined by a doctor that an underlying otitis media is discovered.
Otitis media in adults is not uncommon but a first, unexplained
attack of otitis media in a middle-aged, or older, person should
always be investigated lest there is a significant underlying
cause, Earache in adolescents and younger adults is very often
not an ear trouble at all but pain from the temporomandibular
(TM) joint immediately in front of the ear. This joint can become
very painful following damage by nocturnal teeth grinding, chewing
on hard objects, abnormal bite etc. and the pain appears to
come from the ear but it is the area in front that is tender.
The canal between the middle ear and the outside can become
infected, discharge and is, sometimes, painful, but more often
itchy. This infection (otitis externa) often comes during holidays
as a result of swimming in dirty swimming pools, polluted sea-water
etc. Never poke in the ears with a cotton wool bud or anything
else. Wax can be pushed down onto the drum and cause great discomfort.
Glue ear ( secretory otitis) so often a cause of deafness in children is not usually painful. Barotrauma, earache particularly whilst flying, is very common and can be very distressing for children. It is due to a difference between the cabin pressure and the pressure within the middle ear. This pressure is usually equalised by the eustachian tube, which joins the middle ear to the nose. If blocked, pain, usually worse on descent, will result. Some people get earache at ground level if they have a blocked eustachian tube, as the air in the middle ear is absorbed and pressure falls. Injury to the eardrum, usually, in the less enlightened past, from a "clip around the ear", is most often now seen in sporting injuries. Pain can be referred from other places such as the teeth, and throat. Pain at the back of the ear, over the mastoid bone, should be taken seriously as should any earache associated with deafness or dizziness.
Children with otitis media should see a doctor. Antibiotics by mouth are usually given, painkillers such as paracetamol advised. The child is usually more comfortable sitting up than lying down. Otitis externa is usually treated with antibiotic ear drops. People prone to otitis externa, which can be very chronic, should avoid getting any water in the ear by using earplugs when swimming etc. as should anybody with a known perforated eardrum. Wax, if present, can be softened with a little warm olive oil or drops from the chemist, and may need syringing out. People with TM joint problems should consult their dentist. Barotrauma is so distressing that children with ear infections or blockage should not fly. Decongestants, sprays, mild painkillers used some while before take-off and descent are helpful. Simple measures may help like chewing a sweet, repeated Valsalva manoeuvres (pinching the nose and blowing the cheeks out) or drinking through a straw with the nose pinched. |
