What are the causes of earache?

There are hundreds of causes. The most common is infection of either the ear canal (eg. swimmers ear), or die middle ear. These can develop very rapidly, and one of the most common causes for a 2 am call in general practice is the rapidly developing car pain from an infection.

Infections of the sinuses may also cause ear pain, as may a blockage with phlegm of the fine tube that leads from the middle ear to the back of the nose.

If you fly or climb a mountain with this eustachian tube blocked, the air in the middle ear will be at a different ptessure to that outside, the ear drum will become distorted by this difference in pressure, and pain will result. A common cold may be all that is necessary to cause this blockage.

The bones around the ear may sometimes become infected and cause earache, and the jaw joint which is just in front of the ear will cause ear pain if it becomes inflamed or injured. Impacted ear wax is another common cause of ear pain.

Dental disease can cause ear pain, and vice versa. Dentists often refer patients to a doctor for treatment of their ear or sinus condition after they have initially seen the dentist for toothache. The list goes on and on, so anyone with an eatache will need assessment and treatment by a doctot (or dentist!).

My baby is always vomiting, but when I took her to the doctor, he said it was a reflux problem and not vomiting. In what way does reflux differ from vomiting in babies?

Some babies are unlucky enough to have a defect in the muscle ring at the bottom of the oesophagus (gullet). This muscle ring is normally contracted shut, and only opens when food is swallowed. This prevents the acid and food in the stomach from running up into the oesophagus when lying down or bending over.

If the muscle is weak or defective, the acid in the stomach can burn the oesophagus, which causes considerable pain to the infant. This is known as reflux oesophagitis.

Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. This is usually in the form of a mixture which is given after every feed. More sophisticated treatments are available for intractable cases.

Why do babies vomit so much?

It is important to differentiate between vomiting, positing and reflux. Vomiting is not very common, and may be due to some disease process (eg. infection, food allergy). The vomitus is usually altered food and may be green in colour, indicating the presence of bile. It may occur several hours after a feed.

Positing occurs in most infants, and is the regurgitation of milk and food from the mouth, gullet and upper part of the stomach during or immediately after a feed. It is caused by over feeding, rapid feeding or burping, and it does not require any treatment.

Reflux is the regurgitation of the stomach contents immediately after a meal, and for some time afterwards. It is distressing to the child, as stomach acid is bought up, and this burns the gullet. This can be helped by posture feeding, slow feeding and mixtures (such as Infant Gaviscon) that may be given after a meal.

If you are unsure about the problem, have your child assessed by your GP.