Ear Pain in Merry Olde England

My daughter is in London, England, taking a summer college course.  She woke up last Sunday with “the whole left side” of her head hurting, particularly her ear.  She took two ibuprofens and then she and a friend went out in the unfamiliar city looking for medical care.  All the walk-in clinics were closed on Sunday so she ended up at an Emergency Department, what the british call “Accident and Emergency.”

An irish nurse took them in, radiating frustration.  Her attitude was “ear pain-this isn’t an emergency!”  However, the young indian doctor was quite kind, diagnosed an ear infection, and prescribed Amoxicillin.  Given that England has a National Health Service paid for by the government, her visit was free.  She had only to pay 8 pounds (about 16 dollars) for her prescription at the “chemist.”

This story highlights several points about ear pain in particular and health care in general. First, for ear pain, try some pain medicine.  So many times a mom brings a child to Emergency and I ask, “Did you give anything for pain?” and they say no.  My daughter felt much better after taking the ibuprofen. If the pain had started at night, she would have felt good enough to sleep and find a doctor in the morning.  If you give a decent dose of ibuprofen or tylenol to your child for her pain, give it a half hour to work, you often won’t need to schlep out in the middle of the night.  No one wants to wait in an Emergency waiting room at 2 am when they could have stayed in bed.

The second point is England’s more relaxed attitude about medical care.  Note that no walk-in clinics were open on Sunday, in the country’s biggest city!  Brits aren’t clamoring for care 24/7 like americans, and british doctors aren’t working seven days per week.  In an Emergency, their “A and E”s are there to help.  And again, with some pain medicine in your child, you too can wait until Monday to see your doctor about that ear.

When my daughter woke up with ear pain that morning, she took two ibuprofen tabs before setting out to find care.  She is an adult, but kids who weigh 90 pounds can take that much.  I had a mom yesterday question me on this- I recommended two ibuprofens for her 12 year-old boy’s ankle pain and she was shocked- TWO tabs??  I did not point out that the child (his football team’s lineman) weighed a hundred pounds more than me.

When I see a child in the Emergency Department with ear pain, I ask “Did you give some pain medicine, like ibuprofen or tylenol?”  If mom did, often she didn’t give enough.  Many parents are afraid to overdose their child.  Now this is a healthy fear: no one wants to accidentally hurt their child.  However, you do want to take care of their pain too.

Kids come in different sizes and have different needs for a dose of medicine that is just enough, but not too much.  We in pediatrics use algebra all day long to calculate drug doses (our math teachers were right- we will have a real-life use for math after all!).  I don’t expect parents to do that math though- it can be tricky.  However, the drug companies put doses-by-weight intructions on the package.  You can use that to know how much to give, but in the companies’ zeal to be safe they sometimes end up under-dosing a bit.  If you really want to know exactly how much to give, call your doctor.  The doctor or nurse can calculate the right amount for you.

So if your child wakes up with ear pain, give some pain medicine, and give enough.  Give the medicine a half hour to work and elevate the child’s head on some pillows or on the couch to take pressure off the ear.  Doing this often helps your child go back to sleep so you can wait to see your doctor in the morning.  Save the Emergency Department (or in England, the “Accident and Emergency”) for the emergencies.




Ears That Go Ouch In The Night

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.