Is That Ear Infection Really New Teeth?

Like Veterinary Medicine

Infants can’t tell us much – not where it hurts, not how it hurts, not whether the treatment is making it better.

Many pediatricians say that diagnosing infants is like veterinary medicine for these reasons.

Ear infections (otitis media) in infants can be a challenging diagnosis. “Veterinary medicine.”

Most Common Diagnosis of Infancy

Let’s look at a common diagnosis of infancy: Otitis. Ear infections.

Parents bring their infants to their docs saying they think junior has an ear infection.

Why do they think there’s an ear infection? Because:

  • junior is running a low-grade fever,
  • is drooling,
  • is banging on their ears or putting their fingers in their ears,
  • is grumpy,
  • has not been sleeping well (or at all!)

Let’s look at what happens next in 90% of doctor’s offices:

  • The doc looks at junior’s ear drums – to be more accurate, attempts to look at junior’s ear drums.
  • Junior is understandably fussy. More than usual. Junior is not feeling well. Does not want this weirdo looking in his/her ears!
  • The doc is trying to examine the ears while junior is struggling to get out of Mom’s grasp, or while screaming bloody murder as if a leg has just been amputated without anesthesia.
  • The doc maybe gets a brief glimpse of an ear drum. Maybe.

Guess what an infant’s eardrum looks like when they are struggling or screaming – right: it’s red or pink.

  • As we are trained to do, the doc adds this all up: (1) low-grade fevers; (2) putting fingers in ears, hitting ears; (3) irritable; (4) not sleeping, and (5) red ear drum!!

Diagnosis? Acute Otitis Media – an ear infection.

Treatment? Antibiotics.

Not to malign doctors (I am one, after all), but this infant is teething. The symptom that was overlooked was drooling.

Don’t get me started on what all those unnecessary antibiotics are doing for developing drug-resistant bacteria!! I’ll save that rant for another blog post.

Teething can, and does, cause ALL of these symptoms.

The symptoms that confuse people are the “putting fingers in ears” or “hitting ears” symptoms. A brief review of the neuro-anatomy of the mandible and ear canal clarifies the situation (I know – nobody wants an anatomy lesson. I’ll make it brief).

Why Does Teething Cause Infants to Dig at Their Ears?

The ear canal and middle ear are innervated by several nerves, including some that also innervate the mandible (jaw) where new teeth are erupting.

These sensory nerves do not provide the same sensation that your fingertips provide. They do not provide accurate, pin-point sensation of pain. The pain sensation is vague, deep. It’s called “visceral” pain.

[For the anatomic drawings of how these areas are related, see earlier article on this blog, “Reflux and Otitis“: http://wp.me/pR4iB-fZ]

The pain that some infants feel from teething, or from the back of the throat, or back of the nose, can be perceived as deep ear pain.

Just ask anyone who has experienced the pain from a tonsillectomy. Deep ear pain is the #2 complaint after a tonsillectomy!

Teething infants simply feel that something deep in the region of the ear canal or throat is hurting. The most convenient thing to grab is the external ear.

Maybe the infant thinks, “Hey, maybe if I jab my finger down in there this horrible throbbing pain will stop.”

In my practice it is imperative – essential – that I get a good look at the ear drums of these children. Also important to perform “insufflation” with a puff of air to see how easily the ear drum moves.

Yes, that is challenging with a squirming, screaming infant. I’m not always successful.

But if the ear drum moves – and that’s most of the time – there is no fluid in the middle ear.

No fluid in the middle ear means no acute infection.

In those cases, those symptoms must be from something other than an ear infection.

That is worth repeating: Not an ear infection.

MANY of the infants who are sent to me to put “ear tubes in” are merely experiencing teething symptoms.

Most of the time it is teething pain!

So – What To Do About It?

Calming a teething baby is a bit like trying to calm a colicky baby.

Challenging.

See Dr. Greene’s blog post on teething pain for an excellent description of mainstream medicine’s approach to the problem (in Resources, below). I can’t improve on his comments so I won’t bother to repeat them here.

Since there are so few resources for natural options, let’s review some here:

Some Natural Options

Chamomile

Chamomile is soothing, calming. Make an herbal tea with Chamomile:

  • steep 1 teaspoon chamomile in 1 cup hot water for 10 minutes
  • strain, cool
  • 1 ounce every few hours for soothing effect

Topical Treatment

  • place 1-2 drops of clove essential oil in 1 tablespoon vegetable oil
  • apply to gums with cotton swab every couple hours for soothing effect

Aromatherapy

  • Calming, soothing essential oils include lavender, chamomile, and lemon balm
  • Place 2-3 drops in a steam vaporizer water for soothing effect

See earlier post on this blog regarding what to look for when buying a humidifier: http://wp.me/pR4iB-2X

Use CAUTION when setting up your steam vaporizer if you have infants or young children – keep it out of reach to prevent burns!

Keep essential oils AWAY from infants and children. They can be toxic if ingested in quantity.

That’s it.

If your little boogorhead is unusually grumpy, digging at their ears, drooling, and running a low-grade fever, consider teething as the cause. Consider trying some natural remedies to make things more comfortable for junior.

You might avoid a set of ear tubes!

These might also help you get some sleep.

____________________________________________________________

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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

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Resources

From littlestomaks.com, Do Milk Allergies Cause Ear Infections?: http://bit.ly/drUZYK

Dr. Greene’s blog post on teething pain: http://www.drgreene.com/qa/teething-pain

Image Credit: slinky789, on Flickr.com: http://www.flickr.com/photos/slinky789/4382012585/

For the Creative Commons image use guidelines: http://creativecommons.org/licenses/by-nc-nd/2.0/deed.en

Comments

  1. This article was very helpful to me…after my 10 month old having 2 ear infections in a row, her preschool teachers kept informing me that she was digging in her ears at school, though she seemed happy and healthy. It was good to find a possible answer to what may be going on.

    As far as labeling the teething pain as “visceral pain,” the definition is “Pain arising from visceral organs (e.g., heart, lungs, gastrointestinal tract, liver, gallbladder, kidneys, bladder)”…just not sure you can call internal ear/nose/throat pain visceral, can you?

    • Russell A. Faust, PhD, MD says:

      Hi Sallie!
      You are absolutely correct about the definition of “visceral” pain, but there really is no proper term that describes the internal neuralgia (nerve pain) that occurs from an jerupting tooth. It clearly is not skin sensory, but also not really an “internal organ”. I do the best that I can :))

      Regardless, I see more infants and toddlers with teething pain causing them to pull and dig at their ears (including my own children) – with perfectly healthy ears – than I see infants and toddlers with ear infections.

      Note that this is a controversial area of pediatric medicine. Some,very smart people simply refute the notion that teething can cause low-grade,fevers, diarrhea, grumpiness, sleep disturbance, or any of the other signs or symptoms that I see in my patients who are teething. Dr. Wendy Sue Swanson, @seattlemamadoc, for example, does not agree with me. She’s a smart and excellent pediatrician who I have great respect for. So we agree to disagree.

      You’ll need to make your own conclusions based on your experience, and perhaps on reading the clinical studies.

      Thanks so m UC for your kind comments, and please do keep us updated on your progress.
      RF (boogs)

  2. Thank you doctor for your valuable article.
    My 10 month old baby has suffered from 3 ear infections. Every time he was prescribed antibiotics. Now he is digging his ears again. He always got an infection after a cold however this time he doesn’t have one. I’m very scared. I can feel a tooth in his lower gum. Don’t wanna see my child in pain again. Please can you give me some remedies so that I can stop if an infection is just starting and I don’t need to give him antibiotics. Will be grateful. Thank you.

    • Russell A. Faust, PhD, MD says:

      In my own clinics, I have most of my “recurrent otitis” patients on a daily probiotic (I have written about the benefits of probiotics: http://www.boogordoctor.com/when-considering-probiotics-consider-this/); Xylitol also has benefits proven by clinical trials. The easiest way to administer Xylitol to an infant is the method I used for both my sons when they were in diapers: every time I changes a diaper, I would place drops of saline-containing-Xylitol in their noses while they were lying down. I used this Xylitol nasal spray, in soft plastic bottle, to dribble the solution into their noses: http://goo.gl/d9Gp6K My boys didn’t seem to mind, and it probably helps that the Xylitol tastes sweet.

      Both of those ‘remedies’ help to reduce the prevalence of pathogenic bacteria. In my clinic, that combination kept the majority of my patients from requiring surgery for placing “ear tubes.”
      Best success.

  3. Awesome timing coming across this article. Just recently my newly 1 year old was diagnosed with his 4th ear infection within 3 months. This time giving the same antibiotics he wasn’t getting better but also started getting a rash. Finally I got to thinking about it and realized every time he has an ear infection he also has a new tooth show through within the same week. His constant congestion, drooling, low grade temp, and fussiness (to put in nice terms) were also just symptoms of his teething. I immediately stopped the antibiotics and in a day and a half his rash was gone. He was better without this unnecessary medication. We also got referred to a ENT this time. Wondering about keeping that appointment. The only thing that gets me is that my child is usually calm when the doctor is looking in his ears..so they definitely get a good look and they always say it’s red in there. Also, is it actually common for a child to get a real ear infection from teething?

    • Russell A. Faust, PhD, MD says:

      Hey, thanks for sharing.
      Teething does NOT increase the risk of a real ear infection.
      Note that the reflex response of a pediatrcian, or any urgent care physician, given the set of symptoms that you describe, is to diagnose an ear infection (otitis media) – regardless of what they see in the ear! I would guess that 90% of physicians have no idea what a normal ear should look like. When I teach pediatric resident physicians (and even ENT resident physicians) in my clinic, and we both look into the same child’s ears, we report completely different things. During my normal clinical year of practice, I looked at more than 8,000 ears (two each, times more than 4,000 children). It’s pretty difficult for even a pediatrician to get that level of experience. And my focus is only the head-and-neck; a pediatrician has the entire body to cover. That’s a big difference. (one of the reasons I specialized – I love having my clinics full of children, but I just don’t think I’m smart enough to know everything about everything; a great pediatrician is super-smart!)
      Thanks again for sharing. Please keep me updated!

  4. I am an Audiologist and have a 7 month old that I believe is teething at the moment, tugging on his ear and putting his finger in his ear all the time. Just wanted to mention that if a parent is concerned, tympanometry is a very quick and easy test to see whether there is fluid in the middle ear. An easy way to know for sure if treatment is required. Thanks for sharing good information on teething.

    • Russell A. Faust, PhD, MD says:

      MB:

      An EXCELLENT suggestion! I LOVE automated tympanometry, especially for clinicians who are inexperienced with performing visual pneuamatic tympanometry using their otoscope.

      Unfortunately, in my experience, most pediatricians will (attempt) to look in the ear, and – due to perceived redness or inability to actually SEE the ear drum – will claim an infection and prescribe antibiotics. Even pediatricians with tympanograms may get it wrong: as you know, it requires a good air-seal at the external auditory canal … something that may challenge a hurrying pediatrician dealing with a squirming infant or toddler.

      Thanks for your kind comment, and for sharing your expertise! Best success with your little squirt!

  5. Hi Dr. Just in time I came through this post. My nearly 11 months baby has stuffy nose and fever (ranges from 38.0 to 39.4). The same symptoms were there before 2 weeks. (But the fever was in 38s). That time her fever kept coming back for 5 days. One GP prescribed antibiotic but we decided to wait for a day and her symptoms subsided Thank God we didn’t give her antibiotic. Now after 2 weeks, on Friday morning suddenly she had stuffy nose n fever (38.4). I went to see the GP today (Saturday) and he prescribed antibiotic noting that she has got redness of eardrum. My question to you is: “is it because we didn’t give her antibiotic last time, she got this repeat cycle of fever n stuffy nose? Can eat infection last for 2 weeks without any symptoms (plz not that between the 2 cycles of symptoms, she was a happy-healthy baby)? When should we consider giving baby antibiotic? Your response will be highly appreciated. Thank you in advance.

    • Russell A. Faust, PhD, MD says:

      S:
      So sorry, but there is simply no way for me to provide any valuable medical advice for your child over the internet. My best advice: you must find a pediatrician that you trust, and work with them to find the problem and solve it.

  6. Thankyou for this honest and detailed explanation as parents what we crave most about children’s health issues is knowledge. My gut said it was teething and your article makes perfect sense. Again Thankyou

  7. My son had an 3 ear infections last month, he has had check ups on his ear and every time his doctor tells me he has ear infection and prescribes different antibiotics. My son is calm, active, happy boy. He is not in pain. He has been drooling alot. I bought an otoscope and I see his eardrum red. So I do not know what to think if he has an infection or its teething.

    • Russell A. Faust, PhD, MD says:

      Hi Ashley,
      I wish I could help, wish I could see his ears myself. I’ll recommend the same thing I have recommended to mothers of my own patients for years: when in doubt, seek another opinion. Ears can look red for many reasons. Red ears due to infection are nearly always uncomfortable or down-right painful. It sounds like your boy is not experiencing any pain. If he isn’t experiencing fevers either, it is unlikely that he has acute ear infections (otitis media). But I can’t make that diagnosis, of course. Again, it may be time for another opinion. One last note: if an infant is struggling while you’re trying to look at their ear drums, the ear drums will look red.
      Thank you for sharing, and best success!

  8. My 15 months baby boy always used to keep fingers in his ears.sometimes when we call he responds but some time he can not.Is there any problem in his ears?

    • Russell A. Faust, PhD, MD says:

      Hi Swathi,
      The only way to know is for a doctor to take a look. In my experience, many infants / toddlers put their fingers in their ears, or actually hit their ears, due to the pain of teething (as you see in this article). But if you are at all concerned about your baby’s hearing, it is time for a hearing evaluation by a trained audiologist!
      Best success.

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