What a Pain in The Ear!

Who would imagine such a tiny space could cause such intense pain? If your child has experienced ear pain, you know that big pain in little spaces is definitely a reality. Alzein Pediatrics is here to help. 

What causes ear pain?

Ear pain in children is usually caused by infection, but can also be caused by injury or piercings.

Types of ear infections

Inner Ear Infection (Otitis Media)

An ear infection happens when the Eustachian tube in the inner part of your child’s ear traps fluid infected with a bacteria or virus. This causes pressure and swelling of the eardrum, resulting in pain. When your child has otitis media, they will feel discomfort in the inner ear that increases when laying down. When your child is very young, the Eustachian tubes are small and don’t run at an angle inside the ear, making drainage more difficult and increasing the likelihood of ear infection. As your child grows, the tubes get bigger and move to an angle, improving drainage of normal fluid.

Swimmer’s Ear Infection (Otitis Externa)

Swimmer’s ear occurs when bacteria grow because of water in the ear canal, where ear wax develops. This type of infection also occurs when something is put inside the ear, such as a cotton swab, damaging the inner layer of the skin in the ear canal. The pain in the ear canal increases when the outer ear is pulled or tugged.

Chronic Ear (Otitis Media) Infections

Your child may be experiencing chronic ear infections if they:

  • Have three or more ear infections in 3 months
  • Have four or more infections within a year
  • Do not respond to antibiotics
  • Have a hearing loss caused by fluid buildup
  • Experience a tear or hole in the eardrum

Is it a swimmer’s ear or an inner ear infection?

A swimmer’s ear often starts with mild symptoms such as itching, redness inside the ear, discomfort, and possibly a clear, odorless discharge. Symptoms of a swimmer’s ear can also include muffled hearing or a throbbing feeling. Sometimes, corresponding lymph nodes will swell on the same side of the head as the fluid buildup.

Call our office or click here for an appointment, or walk into Urgent Care for treatment. 

If left untreated, swimmer’s ear infections will advance, causing an increase in pain and discomfort as well as muffled hearing. When the infection reaches critical stages, the pain will throb throughout the face, the ear canal will become completely blocked with fluid, the lymph nodes in the neck will swell and a fever will develop. An immediate visit to Urgent Care is vital at this stage. 

An inner ear infection may cause a loss of balance and muffled hearing; your child may not respond to sounds. This infection will cause pain that worsens when laying down, making sleep more difficult. Ear infections are typically accompanied by a fever over 100° F. 

Sometimes, your child will experience an effusion, when only fluid will remain in the ear. We can treat an effusion with over-the-counter nasal spray, but your Alzein provider will monitor your child as effusions can become infected. 

If there is drainage, other than ear wax, from your child’s ear, call our office or click here for a same-day appointment or walk-in to Urgent Care. Your child will need an evaluation to determine if an eardrum has been ruptured. This can be treated to heal completely.


Children younger than 6 months of age must always be treated with antibiotics for inner ear infections.

Mild pain and/or fever can typically be treated at home with over-the-counter medicine, such as acetaminophen. 

If your child runs a fever for more than two days, call our office or click here for a same-day appointment or walk-in to Urgent Care

Antibiotics may be appropriate for swimmers’ ears, but many inner ear infections are caused by viruses, not bacteria. Viral infections will resolve on their own without antibiotics, which are irritating to the stomach and can damage the immune system. We may ask you to monitor your child at home for 1-2 days before starting antibiotics for otitis media.

Ear drops with antibiotics or steroids may be prescribed for the swimmer’s ear. Do not use an over-the-counter treatment until your child has been seen by your Alzein Pediatrics provider to ensure the eardrum is not punctured.  Never use oil, especially hot oil, as this can permanently damage the eardrum.

Chronic ear infections can be a serious problem. Because of the hearing loss, your child could experience delays in speech development and social skills and the infections may spread. Hearing loss could become permanent. Chronic ear infections require an evaluation by an Ear, Nose, and Throat (ENT) specialist. Alzein Pediatrics will refer your child to a trusted ENT who may discuss ear “tubes” being placed into the tympanic membrane of the ears to help drain fluid. These are tiny metal or plastic tubes surgically inserted into the eardrum to allow air into the inner ear, stabilize air pressure and drain fluid.


To prevent swimmer’s ear, dry ears completely after water play to discourage bacteria growth. Other prevention tips include:

  • Swim in clean water, avoiding natural bodies of water when the bacteria counts are high. 
  • Do not put foreign objects of any kind, such as cotton swabs, in the ear. This pushes bacteria farther into the ear canal. 
  • When swimming, wear ear plugs or a swimming cap to keep ears dry and therefore free from bacteria.

To prevent inner ear infections, encourage your child to blow their nose frequently when they have a runny nose or congestion. For younger children, use a saline nasal spray to help release congestion. Infants and toddlers should never be put to bed with a bottle as this increases the risk for inner ear infections. Bottle propping should also be avoided. 

The National Institute of Health notes that five out of six children will get an ear infection before their first birthday. While most inner ear infections cannot be prevented, proper and prompt care will ensure your child will retain their hearing, develop as expected and outgrow these infections by 3 to 5 years of age. With careful prevention, swimmers’ ears can be avoided, and prompt care can clear them up quickly. 

If your child is experiencing ear pain or an elevated temperature for more than two days, click here to make a same-day appointment, or walk into Urgent Care today.

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