3:30 am: Mom brings the three-year old into the ER. He awoke screaming with ear pain, crying about “buzzing.” I look in his ear with the otoscope and see a tan-colored insect, waving its floppy wings against the poor boy’s eardrum.
We lay the boy down and I go in with the alligator forceps, which look like skinny scissors with a tiny alligator-like mouth at the end. The boy is remarkably cooperative given that I am reaching deep in his ear and the fly is still squirming around. I make a grab with the forceps and come out with only a wing. Dang!
I make another grab and this time only a leg comes away. Next time another piece. I look back in with the scope and the bug is now still, but obviously delicate and won’t come out in one piece.
“Let’s flush it out,” I tell the nurse and we gather supplies. We then put a little plastic tube in the ear and flush warm water in with a syringe. Water pours back out and courses down my hand, carrying the fly body with it. When I see the flaccid bug wash over me, the brave doctor leaps back about five feet.
Ear pain is a common reason for visits to the ER, though ear pain and ear infections are rarely an emergency. When the child wakes up screaming in pain, though, some parents panic and head out immediately.
Most ear pain, unlike our unhappy child with the bug, is from ear infections. There are two kinds of ear infections. The most common winter ear infection is in the middle ear, called “otitis media.” This is an infection in the inner ear behind the eardrum, and is often treated with antibiotics by mouth. In the summer, we see a lot of “otitis externa,’ or “swimmer’s ear.” This is an infection of the skin in the ear canal. It is called swimmer’s ear because sometimes when water gets in the ear that wet, warm, dark environment loves to grow bacteria. This is treated with antibiotic ear drops. Both can be extremely painful. Imagine inflammation right inside your head!
Most ear pain is well treated by over-the-counter pain medicines like ibuprofen (Motrin or Advil), or acetaminophen (Tylenol). Over-the-counter ear drops are not very helpful for pain. Most parents can avoid a time-consuming, expensive ER visit by first giving the child ibuprofen or Tylenol. Give enough!- some parents are afraid to give the full dose recommended on the bottle, but if they follow the directions they will be very safe. When in doubt, you can call your doctor’s office (they should have someone to talk to at night) to double-check the dose. Then give the medicine time to work- a half hour or so.
Sitting the child up can help too- this can take pressure off the inflammation inside the ear. When my son had ear infections he slept sitting up against the couch arm.
Then call your doctor first thing in the morning. If the appointment is in the afternoon, that is ok. Ear infections hurt, but rarely are serious if treated within a day or two. Keep the pain medicine coming- that’s ok.
Finally, a common misconception among parents is that when a baby pull on her ears or cries when the ears are pressed, that means baby has an infection. However, ear pulling has little to do with dear pain. Babies usually pull on their ears for other reasons like curiosity, to comfort themselves, or just because an ear is something convenient to grab (babies like grabbing things.)
Next time your child awakes with ear pain, don’t panic and rush in. Give the pain medicine, prop up your child (babies are best elevated in a car seat or swing strapped in- never on pillows!) and settle in and wait. A half-hour awake at home is better than a two hour wait in the ER waiting room.