Irritability, difficulty sleeping and ear-pulling, or head-banging in a younger baby, are all symptoms typical of teething. But they are also classic indicators of an ear infection. Here’s how to tell the difference. By Francoise Gallet
It is not uncommon for a mother to receive a diagnosis of a middle-ear infection (otitis media), only to rush to the doctor two weeks later with the same symptoms and be told it’s likely referred pain from teething, says ear, nose and throat surgeon Leon Nel. So how do you know which condition is which?
The reason for the confusion, asserts paediatrician Iqbal Karbanee is that both teething and middle-ear infections present with symptoms that are non-specific.
Sore gums can mean sore ears
The chief culprit for the common symptoms of irritability, sleeping trouble and ear pulling is referred pain. As a tooth erupts, the perforation can cause inflammation in the gum and subsequent pain that radiates to the adjacent ear, explains Karbanee.
If this is the root cause of your baby’s ear pain, symptoms of a poor appetite paired with fever, mucus, vomiting and coughing – indicative of a possible middle-ear infection – are unlikely and a mother could reasonably hedge her bets on teething-induced earache, Karbanee elaborates. But it seems that some babies deviate from a strict academic categorisation of symptoms.
Mucus, teething and ear infections
“Children with teething-induced earache may also have a low-grade fever – a fever below 38 degrees – which confuses the situation,” says paediatrician Nadia Khan. And, continues paediatrician Jeremy Dyssell, although there is no proven association between teething and ear infections, there could very possibly be a link.
Teething and the common cold may coincidentally happen together. The increased mucous or the swelling of the lining of the nasal passages caused by either, or both the teething and the cold, can subsequently block the Eustachian tube, explains Dyssell. The Eustachian tube is the narrow tube that connects your middle-ear cavity to the back of your nose and the younger you are, the narrower it is and hence easier it blocks.
When it does, a cascade of physiological reactions can cause ear pain. This is because the Eustachian tube is designed as a pressure-equalizing valve for the middle ear and so opens when you yawn and swallow. It also drains the mucous produced by the lining of the middle ear. When blocked, the middle-ear space becomes isolated from the outside world. The lining of the middle ear then absorbs the trapped air, creating a negative pressure that pulls the eardrum inward, causing a sense of pain or pressure.
In such a scenario, you can have a snotty-nosed, teething child with ear pain caused by the vacuum within the Eustachian tube and pull on the ear drum, rather than referred gum pain, explains Nel.
If the blockage persists, the lining of the middle ear secretes a sterile mucous to equalize the pressure. At this point the vacuum-induced pain goes away but if bacteria then contaminate that fluid; a painful middle-ear infection will result.
When to see the doctor
It’s then, says Dyssell, that a teething, snotty and irritable baby will suddenly develop a high fever indicative of a middle-ear infection. Which is why, says Khan, it is important to gauge your baby’s overall clinical picture – a child that is simply teething is not “systemically unwell”. Nonetheless, if you have fever-related doubt, go and see a doctor, advises Dysell.
Simple analgesics such as Paracetamol or Ibuprofen provide effective pain relief for teething-induced earache and middle-ear infections, advises Khan. Topical anti-teething solutions can be used for gum pain.
Do boys get more ear infections than girls?
“Acute otitis media is only slightly more common in boys than in girls. However being male does not increase your risk for otitis media,” explains Khan.
“There is no point fussing about the possible risk of an ear infection based on the sex of your child because intervention is based on the problem and not the sex,” counsels Nel.
Rather, suggests Dysell, focus on factors you can influence, such as:
Our experienced editors work with trained journalists and qualified experts to compile accurate, insightful and helpful information about pregnancy, birth, early childhood development and parenting. Our content is reviewed regularly by our panel of advisors, which include medical doctors and healthcare professionals. Meet the Living & Loving Team and our Online Experts.