Dr Phil Kieran: My teenage son has ongoing ear pain 

"I stand by the adage “Never put anything smaller than your elbow in your ear”..."

A strong wave at surf school caught my 13-year-old son, and he has been complaining of ear pain since. The GP says it’s not an ear infection, and the pain will probably ease. But two weeks later, he’s still in pain. I’m treating him with ibuprofen. Is there anything else I can do?

Ear pain is a very common issue. Although most people think it’s an infection, there are many other causes, and it’s a good idea to know them.

Our ear is made up of three parts:

• 1. The outer ear is the bit we can see on the side of the head (the pinna) and the ear canal up to the ear drum.
• 2. The middle ear is a small cavity in the skull connected to the back of the throat by a small tube and houses three tiny bones. These bones transfer sound from the ear drum to the inner ear, where the signals are sent to the brain.
• 3. The inner ear is the organ inside your skull, which converts sound waves into electrical signals for your brain to interpret.

Pain in the ear usually comes from either the outer ear or the middle ear. In this case, the most likely issue is that the ear canal and eardrum were compressed when the wave hit your son. This compression causes a sudden build-up of pressure in the ear canal and eardrum, causing immediate pain and leading to issues over the following weeks. The most common cause for these types of injuries is people using cotton buds. I stand by the adage “Never put anything smaller than your elbow in your ear” for this reason.

When we swallow, yawn or chew, the tube connecting the middle ear to the throat is meant to open. This is the “popping” sensation as the pressure inside the middle ear equalises with the pressure outside. Trauma can cause the skin lining this tube to swell, making it more difficult to equalise the pressure. If this happens, a vacuum forms, pulling on the eardrum, or fluid accumulates in the space, causing discomfort. Either of these can take three to six weeks to settle down.

There is also a risk that the eardrum can burst with sudden pressure events, which your GP would have seen when he examined him. If this happens, you will be advised to keep the ear meticulously dry for at least two weeks, and the GP will check to ensure it is healing.

Ear infections involving the middle ear cause fluid and pressure to build up. This build-up is why you can have all the symptoms of an ear infection, but trauma rather than bacteria is the cause.

I’m not too surprised that your son’s symptoms have not fully resolved at this stage, but they should be getting slowly better. If they aren’t, then you need to see the GP again.

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