Ear pain resident survival guide (pediatrics)
Synonyms and keywords: Ear pain , otalgia , ear sore , otitis , ear infection , ear discomfort  and ear aches.

# Overview
Ear pain is the most common cause that affects children. Mortality rates are generally low, but acute otitis media and otitis media with effusion have high morbidity. the child can come with fever, restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite, rhinitis, nasal congestion, cough, hoarse voice, conjunctivitis, mucus vomiting.There are several causes divided into primary otalgia and secondary otologia .The primary otalogia including otitis externa (swimmer's ear), mechanical obstruction ,Otitis media ,otitis media with effusion, truma .The secondary otalgia including referred ear pain.

# Causes

## Common Causes

### Primary otalgia
The following are the causes of primary otalgia:

### Otitis externa  (swimmer's ear)
- Pseudomonas.
- Staph aureus.

### Mechanical obstruction
- Earwax
- Foreign body

### Otitis media
- Common cold or upper respiratory tract infection, common cold, or upper respiratory tract infection 
- Streptococcus pneumoniae
- Nontypable Haemophilus influenzae
- Moraxella catarrhalis
- Congenital ear anomalies(cleft palate)

### Otitis media with effusion
- Enter into group child care (Amounts of time spent)
- Exposure of smoking
- Period of breastfeeding

### Truma
- Air travel

## Secondary otalgia

### Referred ear pain
- Tonsillitis and Tonsillectomy
- Toothaches.
- Mumps
- Dental infections

# Classification of otitis media
- Otitis media can be classified as the following:
- Acute otitis media (AOM).
- Recurrent acute otitis media (RAOM).
- Otitis media with effusion (OME).
- Chronic otitis media with effusion (COME)

# FIRE: Focused Initial Rapid Evaluation
Parents are considered as the most reliable proxy for assessing ear pain at young children . If child come with  restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite and may be with fever we should think about ear pain .the help us to know the cause of ear pain is examination by otoscopy reveals the tympanic membrane if its bulging, retraction,fluid behind the eardrum o itf  there is foreign body.
Ear pain
- Abnormal tympanic membrane examination(otoscopy).
primary otalgia.
- primary otalgia.
- Normal tympanic membrane examination(otoscopy).
secondary otalgia.
- secondary otalgia.
- Imaging studies.
The IF Diagnosis is not clear from the history and physical examination.

# Complete Diagnostic Approach

# Treatment

# Table
Key differences in the 2004 and 2013 American Academy of Pediatrics guidelines for the diagnosis and management of acute otitis media (AOM)
Abbreviations: MEE, middle ear effusion; TM, tympanic membrane.
Signs and symptoms of middle ear inflammation include distinct erythema of TM or distinct otalgia (discomfort clearly referable to the ear's) that results in interference with or precludes normal activity or sleep).
bRecent: <48 hours.
Ear pain may be indicated by holding, tugging, or rubbing of the ear in a nonverbal child.
non-severe illness was defined as mild otalgia and fever <39C in the past 24 hours in the 2004 guideline; the 2013 guideline modifies this to mild otalgia for less than 48 hours and a temperature of less than 39C.
Severe signs or symptoms include moderate or severe otalgia or temperature 39C in 2004 guidelines; the 2013 guideline also includes otalgia for 48 hours.
Adapted from Lieberthal AS, Carroll AE, Chonmaitree T, et al. diagnosis and management of acute otitis media. Pediatrics 2013;131(3):e96499; and American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):145165

# Do's
- Otitis media
Vaccine
Pneumococcal vaccine prevents otitis media.
- Vaccine
Pneumococcal vaccine prevents otitis media.
- Pneumococcal vaccine prevents otitis media.
- Breastfeeding.
- When travel
(For child)Chew gum or suck candy or give your child acetaminophen or ibuprofen about 30 minutes before takeoff or landing.
(For infant ) breastfeeding, or sucking on pacifiers.
- (For child)Chew gum or suck candy or give your child acetaminophen or ibuprofen about 30 minutes before takeoff or landing.
- (For infant ) breastfeeding, or sucking on pacifiers.
- Otitis externa ( swimmer's ear )
Keep your ear drying by use a clean towel after swimming, or showering.
Use a cotton ball as an earplug while take a shower or swimming to protect the ear during healing.
- Keep your ear drying by use a clean towel after swimming, or showering.
- Use a cotton ball as an earplug while take a shower or swimming to protect the ear during healing.
- Use a cold pack outside the ear to reduce pain for 20 minutes.
- Use pain relievers such as acetaminophen or ibuprofen.
- The upright position can reduce pressure in the middle ear. 
- tonsilitis.
Drink more water.
If there is pain during swallowing, eat smooth foods like soups.
Wash your hands.
Gargles with saltwater.
Stay away from things that cause irritation in the throat like smoke.
- Drink more water.
- If there is pain during swallowing, eat smooth foods like soups.
Wash your hands.
Gargles with saltwater.
Stay away from things that cause irritation in the throat like smoke.
- Wash your hands.
- Gargles with saltwater.
- Stay away from things that cause irritation in the throat like smoke.

# Don'ts
- Do not use antibiotics unless necessary because widespread use can lead to resistent.
- Do not let child sleep during takeoff or landing because when he awakes he can swallow more.
- Don not use aspirin.
- Do not smocking near the children because it incresase the ear infection.