Doctor, my child is complaining of pain in the right ear since 3 days. Is it an ear infection ? Or is it a referred pain?Does he have fever? “Yes, Doctor.” (That suggests infective process.)Is there ear discharge? "No, Never.” (good that means eardrum is not perforated)Inspect the external ear with a good torch, pulling the ear upwards and backwards. Look for: Brown-black colored wax. White (Fungal) flakes.Boil in external ear. If pulling on the pinna is painful, the pain is due to external ear boil or infection. If external ear looks normal, it is very likely to be Otitis media. Inspect the eardrum for bulging or shininess. Press firmly over the mastoid process and look for mastoid tenderness.(Mastoiditis is a serious complication of otitis media and if mastoid tenderness is present, the child should be referred to ENT surgeon immediately)Ask: Do you get pain in the throat, or teeth? Inspect the Tonsils, Throat and Teeth. (a painful lesion here like Tonsillitis, caries in upper teeth can produce referred pain in the ear)Key points forEar pain: External ear infection, ear drum, mastoid tenderness, throat infection Action: WAX; Soliwax drops for 3 day, then clean with earbud or earwash. FUNGAL FLAKES: clean the ear earbuds and use clotrimazole drops.OTITIS MEDIA; Higher antibiotics, Anti-inflammatory drugs & Nasal decongestant drops in nose (Otrivin) to keep the Eustachian tubes patent
