1 Does your child complain of severe earache or pull at his or her ear?

2 Does your child seem unwell or feverish?

3 Can you see a red lump inside the ear?

4 Does your child have a cold or a sore throat?

5 Did your child suddenly develop earache during or immediately after a flight in an aircraft?

6 Is there a discharge from the affected ear?

7 Is the pain much worse when you gently pull on your child's ear lobe?

8 Does your child have itching or irritation inside the ear?

9 Is the skin around the child's ear red and inflamed?

10 See your doctor within 24 hours

Possible cause A viral or bacterial infection of the middle ear is a possibility. The infection may have spread via the eustachian tube, which links the throat to the middle ear (see Structure of the ear in children).

Action Your doctor will examine your child. If an infection is confirmed, he or she may prescribe a course of antibiotics. Meanwhile, follow the self-help measures for relieving earache to ease your child's pain.

11

Possible cause A boil in the outer ear canal can cause severe pain. Consult your doctor.

Action If your doctor confirms the diagnosis, your child may need antibiotics. However, in most cases, the boil will burst, easing the pain. Self-help measures for relieving earache should help to make your child more comfortable.

12

Possible cause An infection of the outer ear canal is the likely cause. Consult your doctor.

Action If your child has an infection of the outer ear, your doctor may prescribe ear drops that contain a corticosteroid drug and/or an antibiotic drug. Meanwhile, follow the self-help measures for relieving earache.

13

Possible causes The eardrum may be mildly inflamed. However, in some cases a problem in the throat can cause pain to be felt in the ear.

Action Try self-help measures for relieving earache. If the earache worsens or persists, consult your doctor, who will check for ear infection.

14

Possible cause and action Barotrauma, damage to the eardrum resulting from a pressure difference between the middle and outer ear, is possible. The pain usually improves within 24 hours. If the pain persists for longer than this, consult your doctor who will examine your child's ear.

15

Possible cause An infection in the outer ear canal may cause a discharge as well as pain and irritation. Consult your doctor.

Action Your doctor will examine your child's ears. If there is an outer ear canal infection, he or she may prescribe ear drops containing an antibiotic drug and/or a corticosteroid drug. You should also follow the self-help advice for relieving earache.

16 See your doctor within 24 hours

Possible cause and action An infection of the middle ear may have caused your child's eardrum to rupture. This relieves the pressure built up within the ear. Your doctor will examine your child and may prescribe antibiotics. Self-help measures for relieving earache may relieve your child's pain. The eardrum will heal within a few days. There will be no lasting effect on your child's hearing.

17

Possible cause Certain skin disorders, such as eczema or seborrhoeic dermatitis, may affect the skin lining the inside of the ear. Consult your doctor.

Action Your doctor will examine your child's ears and skin. If a skin disorder is diagnosed, he or she may prescribe corticosteroid ear drops. Try to stop your child scratching the ear or the surrounding skin, which could prolong the condition and cause infection.

18

Possible causes Your child may have pushed a small object, such as a bead or small piece of food, into his or her ear. Alternatively, an insect may have flown or crawled into the ear. Consult your doctor.

Action Your doctor will examine your child's ear. If there is an insect or another foreign body in the ear canal, it may be possible for your doctor to wash it out. If the doctor cannot remove it, he or she will refer your child to hospital or a specialist to remove it.

19

Consult your doctor if you are unable to make a diagnosis from this chart.