21 Otalgia in Children The symptom of ear pain can be unilateral or bilateral, constant or intermittent, and mild to severe. It may present alone or in conjunction with hearing loss, aural fullness, vertigo, or otorrhea. This chapter outlines the causes of otalgia in children. Otitis media is the most common cause of otalgia in children. It is also the most common inflammatory otolaryngologic disorder in children and involves inflammation of the middle ear and mastoid spaces. Two thirds of children have had at least one episode, and one third of children have had more than three episodes of acute otitis media (AOM) by the age of 3 years. The diagnosis of AOM is defined by rapid onset, presence of middle ear effusion, and signs and symptoms of inflammation of the middle ear. The most common symptoms of AOM are rapid onset of otalgia, irritability, fever, lethargy, and otorrhea. Patients with AOM may present with severe otalgia that quickly improves after spontaneous perforation of the tympanic membrane (TM). Otitis media with effusion (OME) is experienced by > 50% of children during the first year of life, with a peak incidence at ~24 months. In young children having a single episode of AOM, OME is present 50% of the time after 1 month, 30% after 2 months, and 10% after 3 months. Although most cases of OME are asymptomatic (except for hearing loss), many children with OME have mild intermittent otalgia, especially at night, and may occasionally experience imbalance. Complications of otitis media, including intratemporal complications, include chronic suppurative otitis media (chronic drainage through a nonintact TM), acquired cholesteatoma, acute or chronic TM perforation, mastoiditis, labyrinthitis, petrous apicitis, cholesterol granuloma, facial paralysis, and external otitis, as well as intracranial complications: meningitis, lateral sinus thrombosis, otitic hydrocephalus, and extradural/subdural abscess, or brain abscess, may all present with, or be associated with, otalgia. Depending on the duration and type of complication, otalgia may be sudden onset or chronic, severe or just persistent, and may be hard to localize, especially when associated with an intracranial complication. In cases of intracranial complications, the pain may be severe and difficult to distinguish from headache (which may be present as a separate set of symptoms due to the intracranial process). If otalgia persists and/or is severe, and even if the physical examination of the TM is not extremely abnormal (eg, “only” serous middle ear effusion or very retracted TM is seen), the patient requires attention and probable imaging to rule out some of these complications. Additionally, some of the intracranial complications will present with otalgia and neurologic or visual changes; in these cases, the middle ear and mastoid need to be investigated until disease of these structures has been ruled out or addressed.
Otitis Media
Otitis Externa
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
