Earache: If it’s Not Infected, Then What is It?

Earache is probably the most common complaint I see in kids. However, just because it hurts doesn’t mean it’s infected.

Wait, what??

Yep. Not every earache is an ear infection, which means not every earache needs an antibiotic.

So, if it’s not infected, what is it?

There are two ways an ear can hurt. The pain can come from the ear itself, called primary otalgia. Or, the earache may be referred pain. It comes from somewhere else, which is called secondary otalgia.

Primary Otalgia:


Cerumen impaction

This is when a bunch of earwax gets stuck in the ear canal. It can harden into a wax rock that can adhere to the ear canal. The wax blockage can cause pressure changes in the ear canal, which is painful. Earwax also tends to make ears itchy; not painful, but definitely annoying.

Foreign body

This one is kind of a no brainer. When something that doesn’t belong in the ear, goes in the ear, it typically hurts. Whether it’s a bead, a bug, or a q-tip, foreign bodies can damage the ear canal or the ear drum itself.

Otitis media with effusion

Fluid behind the eardrum that is not infected, but is pushing on the eardrum causing pain. This one confuses people sometimes. The fluid is basically snot that can’t get out. You know that feeling when your ears need to pop? Or the way it feels when you jump into really deep water? That’s what fluid behind the eardrum feels like. As adults, we know you just have to yawn or move your jaw to make them pop. But kids, don’t know this, so it just hurts.

Secondary otalgia:


Mouth and throat pain

Soft palate irritation from hand, foot, and mouth ulcers, cavities, teething, and tonsillitis all can cause ear pain. These kids have normal ear exams despite an earache.

Sinus infection

The sinuses and ears are all connected. In small kids, the sinuses aren’t completely developed yet, and they make an adult amount of snot in a little tiny kid space. So, they tend to get ear infections because all that snot gets stuck in the ears. As the sinuses develop, there are fewer ear infections, but since everything is connected, the ears may still hurt when the sinuses fill up.


Swollen lymph nodes can also radiate pain to the ear. Basically, the lymph nodes in the head and neck share similar nerves. So, if a lymph node in the neck is swollen and pushing on the nerve feeding the ear, then the pain is felt in the ear.


Earaches are no fun. Finding the root cause of the ear pain is key. The pediatric experts at KidMed can help!

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