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Fifteen-minute consultation: A structured approach to the assessment of a child with earache
  1. Edwin Halliday,
  2. Nicola Wooles,
  3. Joe Grainger
  1. Department of Otolaryngology/Head & Neck Surgery, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Edwin Halliday, Birmingham Children's Hospital, Birmingham, UK; edwin.halliday{at}


Earache, or otalgia, in children is common. Diagnosis can be challenging due to the range of causes. Assessment involves a thorough history and examination. Identification of associated otological symptoms, including discharge, hearing loss, vertigo and facial nerve weakness, is helpful and can aid diagnosis. Examination should involve looking at the external ear, otoscopy to assess the ear canal and tympanic membrane and documentation of facial nerve function. If otological examination is normal, further examination looking for non-otological causes may be guided by the history. Investigations are often unnecessary but may include blood tests, audiology and imaging. Most otalgia is caused by an acute infection, which is self-limiting and can be managed in the community. However, ear, nose and throat (ENT) advice and input may be required for systemically unwell children or those who fail to improve despite appropriate medical therapy.

  • audiology
  • deafness
  • emergency care
  • paediatrics
  • primary health care

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  • Contributors The original draft of the article was written by NW, with the second major revision including clinical cases written by EH. Significant edits to the article were made by all three authors. All three authors approve the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note All the tympanic membrane photographs were taken with an endoscope. This allows an excellent view of the entire tympanic membrane and is useful for teaching. It is important to remember that when performing otoscopy, the view of the tympanic membrane will be much more limited and you will only be able to see a small section of the tympanic membrane at one time.