Ear-Nose and Throat Doctor (ENT) Questions Ear Infections

My child has frequent ear infections. Why is this happening?

My son is 4 years old and in the last 2 months he has complained around 5 times of ear pain. Every time I take him to an ENT specialist, nothing major is detected. The doctor prescribed some painkillers, but the recurrence of this pain is now worrying me. Any idea what could be the cause of this pain?

3 Answers

We see this all the time. Unfortunately, not all ear pain is caused by the ears. If the child has ear pain, but his ear exam performed by an otolaryngologist, and his audiogram/tympanogram are completely normal, then the ear pain is not being caused by your child's ear. Pain from your teeth, jaw and tonsil can all radiate pain to the ear. Unfortunately, when patients present to the ER, urgent care or even their primary doctors and complain of ear pain, often the physician (or nurse practitioner) will "see
fluid". It's basically the power of suggestion. The patient says it hurts and the healthcare provider sees fluid or infection that is not really there. If your child is really getting that many ear infections, then he/she may benefit from tubes. In order to meet criteria though, first they need to have one abnormal tympanogram to prove that the infection/pain is really from the ear. Typically, a tympanogram will be abnormal for at least a week (sometimes up to 6 weeks after an infection). What I do is have these patients follow up with me as soon as they can after the next ear infection/ear pain. Normal tympanogram, then we know it is not the ears, but pain from elsewhere. If that tympanogram is abnormal, then can proceed to putting tubes in the child's ear and hopefully prevent all of the ear infections. If you put tubes in the child's ear, but the pain is caused by the teeth, or the tonsils, then the ear pain will persist and the child will have had a surgery that they really did not need.
If there is ear pain, but the ear is normal, then the two possibilities are either TMJ, or Eustachian tube dysfunction. A good history and physical exam can distinguish between the two. I hope this answers your question.
Recurring viral infections is most common in children who go to daycare. Hygiene problem. Takes three months for ear to recover from each infection. Other causes include smoke exposure, reflux, immune deficiency, etc.