Earache is not exactly the same thing as an ear infection; in fact, it has its own diagnosis code for a painful ear with no infection found (I am sure you find that just as interesting as I do). An ear that is aching and painful (or in the preverbal child seems to be) could represent any of the following:
- The ear that is actually infected
- the ear that appears normal is the most frustrating case, but this happens a lot: the pressure equalizing eustachian tube inside the head is blocked, causing a pressure differential (actually a vacuum or suction) behind the eardrum. Stretching the eardrum with gas pressure hurts just as badly as stretching it with the pressure of pus.
- earwax just doesn't cause ear pain
Other causes of ear pain or pain felt in the vicinity of the ear:
- teething of course likewise - no pain - maybe some ear rubbing (but who among us can remember)
- pain referred to the ear canal from the oral cavity - a toothache or gum problem
- pain that arises from the temporomandibular joint (TMJ) and is felt in the ear canal area
- scratch of the ear canal or trauma from an object inserted in the ear
- foreign objects like beads, stones, and wads of paper are commonly found incidentally in the ear canals of young children, but I cannot recall a child complaining of the foreign body being there; they are unaware of it
So if you take Junior to the doctor for his earache, and nothing is found - well, it happens. Neither Junior nor your doctor is pulling your leg! And you might get a surprise.