A child crying with ear pain is a frequent complaint of distressed parents seeking emergency medical help. It is most often related to a problem arising from the:

Outer Ear – External Otitis, related to the ear canal and/or the Auricle.
Middle Ear – Acute Otitis Media or Otitis Media with an Effusion.

Outer Ear:

When the External Ear Canal is the cause of pain, it is often associated with itching and discomfort while chewing. Fever is rarely present. Pain may occur when:

The skin is scratched or irritated and subsequently infected with swelling and some discharge.
There is a localized boil of a hair follicle in the skin of the canal with more severe pain.
There is a hard wax.

The canal skin is most often affected if:

The ear is cleaned with cotton buds or other objects.
The child is a regular swimmer.
Uses earplugs or insert headphones – common during COVID-19 times.
When the auricle or pinna of the ear is painful, the cause is often obvious. Blunt injury during a contact sport or an accidental elbow or even a slap may result in swelling and pain. An insect bite or contact with allergens may result in allergic swelling and pain.

Middle Ear:

Acute Otitis Media – is an infection of the middle ear, the space between the outer ear canal and the inner ear. The pain is severe, deep-seated, and is worse when lying down. A fever, decreased hearing, cough, and/or nasal discharge may be there. A baby or a toddler may cry incessantly, not sleep, and refuse feeds.

An examination of the ear is necessary to make a diagnosis. A bulging congested and swollen eardrum is seen due to a collection of pus within the middle ear. The drum sometimes bursts as the infection progresses and a discharge may be apparent in the ear. Sometimes, there is a pain but not huge bulging and redness. The diagnosis of Otitis Media with Effusion or Glue ear may be made. This is not due to an infection but due to Nasal Congestion and Eustachian tube blockage and, which disturbs the equalization of pressure in the middle ear.

For immediate relief of pain, the child may be propped up and a mild painkiller such as Ibuprofen given. Probing, attempting to clean the ear, and the installation of any ear drops should be avoided. To treat the cause of the pain, prevent complications, and side effects of middle ear infections, your child should best be seen by your ENT doctor.

There are many other causes of pain in the ear. Referred pain from the teeth, gums, tonsils, and throat is common. Continuous, severe pain, associated with other fever or headache calls for detailed examination by your ENT doctor.