Last weekend, my son was playing outdoors with other children. Suddenly, he came inside crying hard. He was holding one ear. He said that it hurt badly and that his voice sounded funny. He was hard to console for about 20 minutes, the the pain seemed to go away.
What could have caused this? He had a cold, but he hadn't really been sick.
It may take good detective skills to determine the cause of sudden severe ear pain in a healthy child.
The fact that the pain disappeared as mysteriously as it arrived may be the most important clue in your son's case, but we'll get back to that.
What would we suggest to parents when this happens? First, look at the ear. Does there appear to have been any trauma? Is there any redness, swelling or bleeding that you can see? Ask some quick questions of the children. Were any objects -- for instance, sticks or stones -- involved in the play? Could one of these have found its way into the ear? Is there any reason to believe an insect may have crawled or flown into the ear? If the pain persists and an injury or foreign body in the ear seems at all likely, the ear will need a doctor's examination. Internal injury or an object in the ear may be detected.
Since your son's pain disappeared after some minutes of crying, we think it was caused by pressure changes in the middle ear, the part internal to the ear drum.
Pressure changes cause both pain and distortion of sound, as you'll remember if you've driven over mountains or taken an airplane ride lately.
While your son was playing, he probably did something that pushed a big bolus of air or mucous from the back of his nose into the middle ear through a tunnel called the Eustachian tube. Then the Eustachian tube collapsed and the material was trapped. It was left there pushing on the very sensitive ear drum. The pain went away when your son's crying or the passage of time opened up the Eustachian tube and the excess pressure stopped.
A cold, causing increased mucous and swelling of the tissues around the Eustachian tube, would have made this all the more likely, as could a developing ear infection.
In fact, an ear infection alone can cause sudden severe pain as fluid builds up in the middle ear. The pain doesn't usually disappear quickly unless the pus breaks through the ear drum, relieving the pressure. When that happens, you can often see a trickle of fluid draining out of the ear.
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.
Pub Date: 4/02/96