5 Common Causes of Ear Pain in Kids (It’s Not Always Swimmer’s Ear)

What Causes Ear Pain in Kids During Summer?

Ear pain doesn’t always mean an ear infection or swimmers ear.

As a pediatrician and a mom, I have seen it all: pool-related infections, toothaches that masquerade as ear pain, and even the occasional bug in an ear canal. (Yes, really.)

Here’s a summary of 5 causes of ear pain in kids, plus symptoms and what to do.

Ear anatomy

This post is going to make a lot more sense if we quickly go over the basic anatomy of the ear.

The ear drum separates the external (or outer) ear canal from the rest of the ear.

When we talk about the outer or external ear, we mean the canal, which is outside the eardrum. When we talk about the middle ear, we mean the area behind the ear drum (in other words, the part of the ear that is on the side of the nose).

Swimmers Ear (Otitis Externa)

What it is:
Infection and inflammation of the outer ear canal. It is often caused by trapped moisture, such as after swimming or bathing, or because of trauma to the ear canal, such as using a Q-tip. Bacteria (and more rarely, fungi) love pools of water, so any moisture left sitting in the canal provides a great breeding-ground for infection. It can also be caused by trauma to the ear canal, such as when a Q-tip is used.

Symptoms:

• Pain when touching or tugging the outer ear

• Itchiness in the ear canal

• Sometimes swelling, redness, or drainage from the ear

• Difficulty hearing or a sensation of the ear feeling blocked

• Usually no fever, although with severe infections, fever can develop

Treatment:
Prescription antibiotic drops, occasionally given with a steroid to reduce inflammation. In rare cases, oral antibiotics may be considered.

Diagnosis:
Usually can be seen by a clinician looking in the ear.

Prevention:
Dry ears thoroughly after water play. If your child gets these a lot, consider ear plugs or a swimming cap that covers the ears. Avoid cotton swabs, because trauma also creates a breeding ground for infection.

The Pediatrician Mom Tip: Two additional prevention tips:

• After getting out of the pool and drying the outer part of the ear with a towel, you can use a hairdryer on lowest setting to help dry. There are also specific ear dryers available.

• If you are sure your child’s eardrum is not perforated (and your child does not have ear tubes): you can also use homemade ear drops to help dry out the ear.

  • Mix equal parts rubbing alcohol and distilled white vinegar, and then put a few drops in each ear after swimming (Always discuss with your pediatrician before trying anything like this)

When to call:
If your child has ear tugging, pain, drainage, or worsening symptoms after swimming. In rare cases, the swelling may get so severe that the canal swells closed, or the infection may spread to the adjacent bone. This is serious. Otitis externa can cause hearing loss, so don’t blow it off.

Middle Ear infection (Otitis Media)

What it is:
An infection behind the eardrum, often a result of fluid collecting in that space after a recent cold, allergies or sinus infection. This is the type of infection we see more often in infants and toddlers. More information here.

Symptoms:

• Ear pain (usually does not worsen with moving the earlobe)

• Fever may be present, but not always

• Fussiness

• Often follows a runny nose or congestion

• Pain worsening with lying down

• Difficulty hearing

• Balance problems

The Pediatrician Mom Tip: Playing with or tugging on the ear does not necessarily mean there is an infection, although it can.

Diagnosis:

We can see the fluid and inflammation when looking in the ear.

Treatment:
Mild cases may improve on their own without antibiotics. Other cases need oral antibiotics. The decision process here depends on the patient’s history, age, severity of infection, and other risk factors. Pain relievers (acetaminophen or ibuprofen) do help.

Prevention:
As a child gets older, the ear canal becomes less susceptible to middle ear infections. Managing allergies, avoiding secondary smoke exposure, and minimizing pacifier use have all been shown to help. Otherwise, it’s the same prevention strategies you would use to prevent other viral infections: good hand-washing, staying away from sick people, etc.

When to call:
Sometimes it is hard to know if your baby has an ear infection. It is never wrong to get them checked out if you suspect one. Some red flags include ongoing pain or fever. More here.

Referred pain (from teeth, throat, sinus)

What it is:
Pain felt in the ear that’s actually coming from somewhere else. The most common culprits are teething or tooth infection, sore throats, or sinus infections.

Symptoms:

• Ear pain with no signs of infection

• Often on the same side as a teething tooth or sore throat

• No drainage or fever

Diagnosis
The diagnosis here depends a lot on the clinical history and what is seen on physical exam.

Treatment
Depends on the cause. Sometimes it is as simple as managing pain, but if the cause is a tooth or throat infection, antibiotics may be needed.

When to call:
If your child has persistent pain (especially without an obvious cause, but even if there is one), it is reasonable to have them checked out.

Bug / Foreign Body in Ear (yes, really)

What it is:
Every pediatrician has a story of something they’ve found in an ear or a nose. Peas (that was me!) Beads. Food. Balled up paper. But it is also possible for a bug (cockroaches, flies, ticks) to crawl into the ear.

Symptoms:

• Sudden pain or discomfort

• Complaints of buzzing, tickling or something moving around in the ear

• Possible drainage, bleeding, or hearing changes

Diagnosis:
We can see it!

Treatment:
More information here.

Prevention:
Remind kids not to put anything in their ears. But also… don’t feel guilty if this happens to you. Kids like to experiment (my own toddler recently put a sponge up his nose).

When to call:
If your child says there’s something in their ear, or you suspect a foreign object or bug, don’t dismiss them. Get them checked out!

Barotrauma (Pressure-Related Ear Pain)

What it is:
Ear discomfort caused by changes in pressure. This is usually from flying, diving, or altitude changes.

Symptoms:

• Ear “popping” sensation

• Pressure or pain during ascent/descent

• Hearing muffled or temporarily reduced

Diagnosis:
Usually made by examination and taking a history.

Treatment:
Chewing, swallowing, or drinking can help equalize pressure and decrease pain. Older kids can try yawning or blowing gently while pinching their nose ("Valsalva maneuver").

Prevention:
Nurse or offer bottles during takeoff / landing for babies. Try lollipops for older kids.

When to call:
If ear pain or hearing changes persist for more than a day after pressure changes.

Bottom Line

If your child complains of ear pain this summer, don’t panic. But don’t blow it off, especially if the pain persists. The right treatment depends on the right diagnosis, and your pediatrician can help sort it out.

Ear pain that doesn’t go away, worsens quickly, or includes drainage, fever, or hearing loss should always be evaluated.

And please, please, please, stop using that Q-tip.