When the signs of an ear infection are apparent, check it out.

 

Mrs. X. made an appointment for her 11-month- old daughter Annie who shefeared might have an ear infection. Having two other children she was not one toover react. Looking over the chart I noticed that Annie had never had an earinfection before. Her temperature was 98.4 degrees.

 

Annie was sitting in mom’s lap and gave me a huge smile as I greeted them. Mom almost apologetically said, “I hope I’m not wasting your time, but I’m afraid that Annie may have an ear infection.” She went on to explain that the child had a cold two weeks ago, but got over it. The concern was that Annie is a great sleeper… until a week ago. Since then she has been waking up a couple of times at night and seems fussy. It is so unlike her.

 

Mom thought it might be a growth spurt and she was going to ride it out. But what worried her was that this all started after Annie had a cold. Could this be an ear infection? The final straw was that now she started rubbing her ear and pulling the lobe. This was new, and this prompted the appointment.

 

Mom thought it might be a growth spurt and she was going to ride it out. But what worried her was that this all started after Annie had a cold. Could this be an ear infection? The final straw was that now she started rubbing her ear and pulling the lobe. This was new, and this prompted the appointment.

 

After I told mom my findings she said, “I am so sorry for wasting your time.” I stopped her and explained that everything Annie was doing was an ear infection until otherwise proven. “But why was Annie pulling at her ear?”

  
I explained that this was a common complaint for an infant even though there was no ear infection. One of the more common causes has to do with the anatomy of the nerve that serves the face. As the nerve exits the skull near the temporomandibular joint in front of the ear, it branches into five smaller nerves. The temporal branch curves up and serves the area around the eye. The zygomatic branch courses across to the area of the cheekbone. The buccal branch serves the area around the mouth. The marginal branch innervates the chin region, and the cervical branch supplies a muscle in the neck region. It is felt that while teething, the discomfort that comes by the teeth erupting may cause a referred pain to the ear region through the facial nerve. There is no way to definitively prove this fact, but it makes sense.

 
Another cause of ear pulling may be a build-up of wax. But Annie had very little wax in the ear canal. It is also reported that soap or shampoo may get into the ear canal and act as an irritant which can cause ear pulling. As a general rule, the more “perfumey” the soap the more sensitizing it tends to be. Lastly, the ear pulling may just be a habit, especially when an infant is tired. While generally true, in Annie’s case, the head shaking made this less likely.

 

While we will never really know the exact cause of Annie’s ear pulling and rubbing, the bottom line is that she does NOT have an ear infection. I told mom that she did the right thing by bringing her in to be seen. She could now rest assured that she was not missing key signs of something that would need to be treated.