Sore throat and ear pain are two of the most common signs of an infection. What exactly causes these symptoms? The answer is far from simple, as multiple illnesses can cause both symptoms.

To learn about the various causes of sore throat and ear pain in children, how pediatricians diagnose and choose the best treatment to help your child feel better, and when to seek further evaluation, please read on!  

Sore throat symptoms

Sore throats can vary from mild to severe pain, depending on the cause. The Mayo Clinic notes these throat pain symptoms:

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• A hoarse or muffled voice

Ways to soothe your child's sore throat >

Ear pain symptoms

As with sore throat, the symptoms and severity of ear pain may vary depending on its cause. Symptoms may include:

• Dull, sharp, or burning pain in one or both ears
• Muffled or diminished hearing
• Feeling of fullness in the ear
• Fluid drainage from the ear
• Popping sound or sensation in the ear
• Redness and swelling around the ear

Ear and throat pain often occur at the same time  

Ear and throat pain can stem from various conditions. Recognizing common triggers and symptoms is crucial in determining when to seek pediatrician care, what diagnostic tests to expect, and available treatment options. Let's delve into it!

Allergies

Allergies are a reaction of the body's immune system to a foreign substance like pollen, pet dander, and dust mites. They can trigger inflammation in the throat and ears, which may lead to soreness and itching.

Triggers 

Environmental factors, such as pollens, pet dander, dust mites, and mold, can trigger allergies. When these allergens come into contact with the body's mucous membranes in the eyes, nose, throat, or ears, they can cause an allergic reaction.

Symptoms

In addition to a sore throat and itchy eyes, exposure to allergens may also cause sneezing, watery eyes, and  itching of the nose, mouth, and throat. Symptoms may range from mild to severe and can last for hours or days. 

Diagnosis and treatment

If your child experiences itchy ears, sore throat, and other symptoms, especially if persistent, you should consult their pediatrician for proper diagnosis and treatment. Your doctor will ask questions about their medical history, conduct a physical examination, and may order tests to help determine the cause of symptoms.

Treatment will depend on the type and severity of allergies your child has. Common treatments may include medications (such as antihistamines), immunotherapy (allergy shots), and environmental control measures designed to reduce exposure to allergens.

Common Colds

Sometimes, your child’s sore throat may result from a cold. While colds are not a direct cause of ear pain, nasal congestion may cause ear pain and can sometimes lead to ear infections, which we discuss in an upcoming section.

Causes 

The Centers for Disease Control notes that more than 200 viruses can cause a cold, with the rhinovirus being the most common type. The primary risk factor for contracting a cold is close contact with someone who has a cold. Seasonality and age are also risk factors since colds are more common during fall and winter in babies and young children..   

Symptoms

Colds usually last 7-10 days, with the peak of symptoms occurring on days 2 and 3. Common symptoms include:

• Sneezing
• Stuffy nose
• Runny nose
• Sore throat
• Coughing
• Post-nasal drip (mucus dripping down one’s throat)
• Watery eyes
• Fever

Diagnosis and treatment

Rest and hydration are important remedies for treating a cold. You can also administer over-the-counter medications, such as decongestants or pain relievers, to help ease your child's symptoms. Many of these medications are age-dependent, so check with a doctor if you aren’t sure what is safe to give.

Sinusitis

Sinusitis, commonly known as a sinus infection, is an inflammation of the nasal passages (sinuses). Mucus builds up in the sinuses, allowing germs to grow and cause a multitude of symptoms.

Like colds, sinusitis is not a direct cause of ear pain but can lead to ear infections.

Sinusitis

Viral infections typically cause sinus infections, but bacterial infections can be the cause as well. Other risk factors include previously having a cold, seasonal allergies, and secondhand smoke exposure.

Symptoms

In addition to sore throat, common symptoms of sinus infections include:

• Stuffy nose
• Facial pain or pressure
• Headache
• Post-nasal drip
• Cough
• Bad breath

Diagnosis and treatment

Treatment for sinusitis depends on the cause. In cases caused by viruses, the main treatments are supportive care, such as nasal sprays to help clear mucus and decongestants to reduce swelling and relieve discomfort (in older children). Treatment may involve antibiotics if the source of infection is bacterial.

If the sinus cavities are inflamed for more than 12 weeks at a time, it indicates chronic sinusitis, and you should consult your child's doctor for treatment.

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Strep throat

Strep throat is a bacterial infection of the throat and tonsils. While the infection is not a direct cause of ear pain, it can cause referred ear pain.

Causes

Strep throat, also known as strep pharyngitis, is a bacterial infection typically caused by group A streptococcus. These bacteria are contagious and are spread through droplets of saliva when an infected person coughs or sneezes or when food or drinks are shared.

Symptoms

Strep typically manifests as a red, swollen, painful sore throat, which may be accompanied by a fever. In addition to swollen lymph nodes and white patches on the throat, children with strep may experience headaches, stomach discomfort, and occasional vomiting.

If your child displays symptoms such as runny nose or congestion, it is more probable that they have contracted a common viral infection rather than strep throat.

Diagnosis and treatment

The most effective method for diagnosing a strep infection is a strep test or throat culture. For children aged three and older, either you or your doctor can perform a throat swab test to determine if your child has strep. Children under three should not be routinely tested for strep since treatment is not usually needed in this age group.

During the examination, a gentle swab is used to collect a sample from the back of your child's throat and tonsils. If the diagnosis is confirmed, your child's pediatrician will prescribe antibiotics.

Tonsillitis 

Another reason for your child’s sore throat and ear pain could be tonsillitis. Tonsillitis is inflammation of the tonsils (two oval-shaped pads of tissue on each side of the back of the throat). 

While ear pain is not a direct symptom of tonsillitis, the irritation of the tonsils, throat, and lymph nodes can cause referred ear pain. 

Causes

Tonsillitis is a common throat infection caused by viruses and is most commonly seen in children between preschool ages and the mid-teen years. It can be spread through kissing, sharing drinks, or touching contaminated objects. 

Symptoms

The Mayo Clinic notes the following tonsillitis signs and symptoms: 

• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Fever
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled, or throaty voice

The Mayo Clinic also advises that younger children, who may not be able to describe how they feel, may refuse to eat or drool because it’s painful or difficult to swallow or be unusually fussy. 

Diagnosis and treatment

If your child has signs of tonsillitis, schedule an appointment with their doctor. The doctor will ask about your child’s symptoms and perform a physical exam. They may also recommend a throat swab to test for strep bacteria or to rule out other causes, such as viruses or allergies.

Treatment for tonsillitis may include over-the-counter medications such as Tylenol or Ibuprofen to reduce swelling and relieve discomfort, as well as cold fluids and rest. Antibiotics are usually only needed if tonsillitis is caused by strep.

Ear Infection

If your child begins experiencing ear pain after a cold or strep, they may have a middle ear infection. 

Ear infection causes

Ear infections are a common complication of viral infections, especially in children under three years old. When a child is sick, fluid may build up in the middle ear. If a virus or bacteria infects that fluid, it becomes an ear infection.

Signs and symptoms 

Common signs and symptoms of an ear infection include ear pain, fever, tugging at the ear, decreased appetite, difficulty hearing, drainage from the ears, and fussiness. 

Diagnosis and treatment

If you think your child may have an ear infection, you should have them evaluated by a pediatrician. A thorough examination of the inner ear canal and eardrum using an otoscope can help the doctor identify signs of an ear infection, such as redness, fluid accumulation, or increased pressure. 

Diagnosing and treating your child's throat and ear pain

The main take-home here is that your child may be experiencing throat and ear pain for many reasons! The best way to diagnose your child’s symptoms is to consult a pediatrician. Your doctor will examine your child's symptoms, run additional tests, and provide treatment guidance.

Want to consult a doctor from the comfort of home? With Blueberry Pediatrics, you can skip the in-person hassle of visiting your doctor and chat with board-certified pediatricians via text, call, or video. All of the conditions discussed can be diagnosed and treated by our pediatric team. Sign up here.

‍Sources

• Centers for Disease Control (2023). Antibiotic Use. Common Cold
• Centers for Disease Control (2019). Antibiotic Prescribing and Use. Antibiotic Prescribing and Use. Sinus Infection (Sinusitis)
• Centers for Disease Control (2021). Antibiotic Prescribing and Use. Sore Throat: Symptoms of Sore Throat
• Earwood JS, Rogers TS, Rathjen NA. (2018). Am Fam Physician. Ear Pain: Diagnosing Common and Uncommon Causes
• Kwon E, O'Rourke MC. (Updated 2023). In: StatPearls [Internet]. Chronic Sinusitis 
• Penn Medicine (2023). Conditions Treated (A-Z). Earache