Earpain

This week's guest columnist is Dr. Chris Johnson, a Family Practice resident at Ochsner University Hospital & Clinics here in Lafayette.

Kids' ears bother them for many reasons: their siblings screaming, their parents droning on about cleaning their rooms or other such nonsense. But sometimes, it’s an infection. My daughter was pretty healthy until age two. Then she began to get colds just when she started daycare.

Ears, noses and throats are all connected. They meet where nasal passages open to the back of the throat. Also back there are the Eustachian tubes, two spaghetti-thin hoses that run from the throat to just behind the eardrums. When you yawn to “pop” your eardrums, the jaw joints open those tubes and air rushes into the ear, making the pop-noise you hear.

These places are also commonly infected in kids. Children inhale cold viruses that their playmates cough and sneeze out. These viruses cause inflammation in the lining of noses and throats, leading to swelling (congestion), mucus production (runny nose) and irritation (coughing and sneezing).  The Eustachian tube openings also swell closed, trapping fluid behind the ear drum. If that fluid gets “superinfected” with bacteria (which love to grow in that nutrient-filled stuff), inflammation starts inside the ear as well. That inflammation and increased pressure hurts and can cause fever.

Is it time for antibiotics now? Maybe, maybe not. When kids come in with ear pain, there’s no way to tell if the inflammation we see through the otoscope is from a virus (not affected by antibiotics) or bacterial (which antibiotics kill). If the inflammation's mild, we’ll wait to see if the child recovers on their own, like viral infections do. If the inflammation causes high fevers, bad pain, or we see pus behind the eardrum, we’ll start antibiotics.

Sometimes ear trouble isn't pain. This quiet four year-old boy told mom his hear hurt, but when she looked, she thought she saw something green in there. When we looked with the otoscope, a plastic bead was wedged in his ear canal. “How did that get there?” we asked him. “I don't know,” he answered innocently, as if he was nowhere around when it happened.

I, however, had real ear pain. Having had many childhood ear infections, and can attest, they hurt! Imagine an inflamed boil inside your head. I had several rounds of antibiotics and eventually “ear tubes”.

Like we mentioned above, ear infections happen when the Eustachian tube, the hose that equalizes pressure between the throat and inner ear, gets clogged with congestion. Fluid builds up behind the eardrum and loves to grow bacteria. When we kill the bacteria with antibiotics, the fluid remains. Usually it drains away when the tube re-opens, after the inflammation subsides.

Sometimes the fluid recollects easily. Some kids have really narrow Eustachian tubes, or the tubes course through the head has some tight turns, therefore easily stopped up by the slightest cold or allergy. These kids get infection after infection. Such unlucky children get surgically implanted “pressure equalization tubes,” tiny plastic grommets placed in the eardrum itself, to drain fluid out into the ear canal.

When your children have ear pain, see their regular doctor. Walk-in clinics can diagnose ear infections, but can't make ENT referrals if kids have repeat infections. Also, unlike walk-in clinics, your doctor has records of which antibiotics worked and which didn't. Bad ears shouldn't be trusted to just anyone, even if it's just a plastic bead.