Ear pain in children: video visits in Puerto Rico, for kids and adults

A middle ear infection (acute otitis media) is an infection of the space behind the eardrum. It usually comes during or after a cold, when fluid builds up behind the eardrum. It is one of the most common causes of ear pain in babies and young children, and older children and adults get it too.

Not all ear pain is a middle ear infection. With so many beaches and pools in Puerto Rico, older children and adults often get swimmer’s ear, an infection of the ear canal. Ear pain can also come from the throat; see sore throat. And an earwax blockage can cause pain or a blocked feeling in the ear.

Request a visit online 24/7 — we confirm your time by email or text.

Ear pain is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note after your visit is included at no extra charge.

We do not bill insurance; the pharmacy charges separately. See all prices. The service is run by The Health Initiative, a nonprofit.

A middle ear infection often shows up during or after a cold. The most common symptoms are:

• Ear pain, either sharp or a dull, throbbing ache
• Fever
• Trouble hearing
• Fluid or pus draining from the ear
• Headache
• In babies and toddlers: fussiness, crying, trouble sleeping or feeding

Many childhood ear infections clear up on their own, without antibiotics. For older children with mild symptoms, easing the pain and watching for a few days is often the right plan. For children under 2, with severe symptoms or if things do not improve, an antibiotic is more likely. The doctor decides based on age, how severe the symptoms are and her evaluation.

Ear pain rarely needs a lab test. If it comes with a sore throat and the doctor suspects strep, she gives you an order for a rapid strep test at a lab near you.

Before and after the visit:

• Acetaminophen or ibuprofen ease pain and fever. Dose by weight and use the device that comes with the medicine. Do not give ibuprofen to babies under 6 months.
• Never give aspirin to a child unless their doctor says so.
• Do not put cotton swabs in the ear, or drops or oils unless a doctor told you to.
• Offer fluids and let your child rest.
• To prevent it: vaccines up to date, no cigarette smoke around your child, breastfeeding for babies, and frequent handwashing to cut down on colds.

Babies: ear pulling on its own does not mean an ear infection; many babies do it to soothe themselves. If your baby also has a fever, is fussy or is feeding poorly, book a visit: we evaluate your baby by video with you on camera. For safety: a baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the emergency room right away.

Toddlers and school-age children: ear pain with a cold is very common. The doctor guides you to show the ear on camera and gives you weight-based dosing. See also fever in children.

Teens and adults: ear pain is often swimmer’s ear, or comes from the throat or a cold. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor visit for children.

For your safety, go to the emergency room or call 911 for these signs. See when to go to the ER.

• Swelling, redness or pain behind the ear, or the ear pushed outward
• A stiff neck or severe headache
• Fluid or pus draining from the ear with a high fever in a child who seems ill
• Very listless or hard to wake, or a seizure
• A fever with spots on the skin that do not fade when pressed
• A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher