• Dr. Amy Fan

Why ear pain in kids is not always an ear infection



'Tis the season of ear pain.


But is it really an ear infection? How come my kids keep complaining their ears hurt even though the doctor says it's not an infection? How do I tell?


I love this topic because it's a clear illustration of why kids are "not just small adults," as pediatricians like to say. The mystery of the middle ear, and why kids have more symptoms as well as ear infections, centers around anatomy.


If reading about anatomy makes you yawn and you'd rather see a visual representation, check out my video of this topic on my Youtube channel.


For everyone else, let's define a few terms first.

Acute Otitis Media (AOM) - what we colloquially refer to as "ear infection," is a true bacterial infection inside the middle ear. This will need antibiotics, and has very specific diagnostic criteria that includes a look at the tympanic membranes.

Otitis Media - This is just inflammation of the middle ear, which can include fluid, mucous, and even irritation of the membrane. There is no true bacterial infection, and antibiotics don't help.


Now let's look at a picture of these areas, and see why it's different for kids and adults


The Eustachian tube drains the middle ear, relieving it of fluid and pressure.


In you and me, that tube is thicker, more open, and at a more acute angle.

In kids, it's shorter, narrower, and sits more flat.

Therefore, gravity helps with drainage in adults, whereas kids often have congestion in the middle ear.


Any pool of fluid in the body that is more stagnant has more risk for infection, that's why kids get true ear infections more often. BUT, the symptoms of pain and pressure are the same whether there is a true infection or not!


That's why we must look at the tympanic membrane, which sits between the middle ear and the outside ear canal (where we put the otoscope in), and that's why your pediatrician takes one quick look and announces "ear infection!" or "just fluid!"


The ear infection was a founding issue that gave me the initial idea for Kinder - why not put this tool in parents' hands, teach them the easy technique to look and take a picture with a digital device from home, then we look at it together?


This digital otoscope was the first device I put into our Kinder clinic kit, and everything else grew from there. Technology has evolved to have the potential of making care so much more convenient, and with a much more empowering role for parents.


It is our mission and privilege to help families never have to leave their home again to find out if their child has an ear infection!


Much love,

Dr. Amy and the Kinder team

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