From the Guidelines
For a 7-year-old female with bilateral ear pain that began after nose blowing with a popping sound, I recommend treating this as barotrauma to the middle ear (barotitis media) with analgesics and supportive care, as the condition typically resolves within a few days. The patient's symptoms suggest sudden eustachian tube dysfunction with negative pressure in the middle ear, which can be managed with pain relief and measures to promote eustachian tube opening.
- Start with analgesics such as acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for pain relief, as recommended for pain management in general 1.
- Nasal decongestants like oxymetazoline nasal spray (1-2 sprays in each nostril twice daily for no more than 3 days) can help reduce congestion and promote eustachian tube opening, although their use should be limited due to potential side effects and lack of long-term efficacy for otitis media with effusion (OME) 1.
- Teaching the child to perform the Valsalva maneuver (pinching the nose closed and gently blowing while keeping the mouth closed) several times daily can help equalize pressure. The condition typically resolves within a few days with these measures. If symptoms worsen, persist beyond 3-5 days, or if fever, hearing loss, or discharge develops, the child should be reevaluated as this could indicate a secondary infection requiring different treatment, such as the consideration of tympanostomy tubes for persistent OME, especially in at-risk children or those with significant hearing loss, as per the guidelines 1.
From the Research
Diagnosis and Treatment of Bilateral Otalgia
The patient's symptoms of bilateral otalgia (ear pain) following a popping sound after blowing her nose, characterized by sharp and intermittent pain, may be related to otitis media (OM) or eustachian tube dysfunction 2, 3.
- The diagnosis of otitis media is typically made in symptomatic children with moderate to severe bulging of the tympanic membrane or new-onset otorrhea not caused by acute otitis externa 4.
- Treatment for acute otitis media includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral 4.
- For a 7-year-old female patient, high-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is first-line therapy unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis; amoxicillin/clavulanate is typically used in this case 4.
- Tympanostomy tubes should be considered in children with three or more episodes of AOM within six months or four episodes within one year with one episode in the preceding six months 4.
Eustachian Tube Dysfunction and Allergic Rhinitis
Eustachian tube dysfunction and allergic rhinitis may also contribute to the patient's symptoms 2, 3.
- Nasal inflammation due to allergen challenge results in classic signs and symptoms of allergic rhinitis and eustachian tube dysfunction 3.
- Antiallergic therapies may be used to augment symptom resolution and therapeutic response in the presence of allergic rhinitis 3.
Differential Diagnosis
It is essential to consider other potential causes of otalgia, including temporomandibular joint syndrome and dental infections, which are common causes of secondary otalgia 5.
- A thorough history and physical examination are necessary to establish the underlying cause of the patient's symptoms 5.