Ear infections are one of the most common conditions affecting up to 75% of children in the U.S. by the time they reach the age of three. This condition develops as a result of a buildup of fluid in the eustachian tubes, which connect the eardrum to the nose. Patients with an ear infection may experience earache, fever, ear discharge, headache and dizziness.
When are these conditions just part of building up immunity or just the common cold and flu symptoms, and when should parents seek additional care? In this podcast board-certified ENT Physician, Dr. Trisha Thoma, discusses ear, nose and throat illnesses in children and teens, and how best to recognize and treat them.
Welcome to Mason City, Docs on Call, a podcast series with North Iowa specialists who educate us about how to stay healthy. I’m your host, Carol Gifford.
It always seems like our kids are getting ear infections, runny noses, and sore throats. For instance, ear infections are one of the most common conditions affecting up to 75% of children in the U.S. by the time they reach the age of three. When are these conditions just part of building up immunity or just the common cold and flu symptoms, and when should parents seek additional care?
With us today is Dr. Trisha Thoma, a board-certified ENT physician at the Mason City Clinic, who will help us understand these sometimes chronic conditions in kids more thoroughly and the treatments available.
Welcome to the program, Dr. Thoma.
Thank you.
So I think the big question is; when are earaches or sore throats just that, and when are they more serious?
So you have to take each kid into consideration, but sore throats and earaches are certainly very common in kids. And we really look for symptoms indicating more severe infection when we’re thinking about which kids need to go in and be seen, be tested, and really ultimately be treated with some sort of medication.
We look at things like high fevers. We look at things like kids who aren’t eating and drinking well, not urinating regularly as being good indicators of kids who are more sick than just a run-of-the-mill earache.
Earaches are super common. And in fact, most kids are going to get an earache throughout their life. And getting a couple of these during a single cold and flu season is well within the realm of normal. We actually know a lot of times these earaches will just self-resolve and don’t even require any further workup, as long as a lot of those more serious symptoms are not associated with the earache.
So when you see a fever or some of those other symptoms you were just talking about, then the earache is progressing towards an ear infection?
It can mean just a more serious type of infection that might need something stronger, like an antibiotic, more so to help prevent other complications from arising.
So again, a lot of ear infections will resolve on their own, and a lot of physicians, pediatricians, or family care doctors choose not to treat those unless they’ve been persistent for 10 to 14 days. And that does fall within our clinical practice guidelines and what our board of otolaryngology supports as well. And that’s an adequate way to treat those infections in otherwise healthy kiddos.
But when we’re running into kiddos that, again, have other symptoms, of high fever that doesn’t come down with medication, significant discomfort, or are sick in other ways, we really want to be treating those kids because we don’t want that to progress to an even more serious infection.
Understood. So when are ear tubes necessary in children?
It’s a common question that we get and it’s a really important question. We’ve actually come up with guidelines to help us decide which kids benefit from ear tubes and which don’t. Again, I mentioned most kids are going to get a couple of ear infections per cold and flu season, that’s well within normal.
But more than normal means three ear infections within a six-month time period, six infections within a year. So we really track how many infections they’re getting. That’s a reason why it’s important for these kiddos to be seen, so that can be documented well by their primary physician.
But then we look at kids that have this fluid in their ears that never goes away, and maybe that causes a hearing loss or a speech delay. And so, fluid that doesn’t get out of the ears on its own for three months or longer also qualify for ear tubes. And then, we can take into account some other patient factors; do they have a family history of ear infections, because those kiddos are more likely to continue to get ear infections and likely will benefit from an ear tube placement.
What is the treatment process for installing these ear tubes in children?
In children, it does require a surgery. So it is a very short surgery. When we think of the spectrum of surgeries, it’s pretty straightforward. Kids don’t even need intubation. They do have anesthesia, mostly for comfort, but also so they hold still, so we can appropriately put the tubes in the ears. It’s a in and out surgery, come in and go home the same day. Downtime is about 24 hours, and then these kiddos are back on their feet, and usually feel a lot better, almost instantaneously.
And then, how long do the ear tubes stay in?
About one to two years. Every kid is a little bit different. The tubes are designed to extrude or fall out on their own, and we generally see that happening between the one and two year mark after they were initially placed.
Tubes can be removed for other reasons or need to be replaced for other reasons, but the vast majority of kiddos need that one set to allow them to grow a little bit bigger, allow those ears to reset back to a healthy baseline, and then they go on to live with healthy ears for the rest of their life.
So now, let’s talk about tonsils. What is the function of tonsils and how do they get infected? Back in the day, if anyone had infected tonsils, they came right out. Is that still the case?
Yeah. So there was a time period where we kind of joked that it’s like if you had tonsils, we remove them. And clearly, we don’t do that anymore these days. We really only want to remove those tonsils that are truly creating a problem. Tonsils are part of our immune system, so they’re just lymphoid tissue, the same type of stuff that lives in our lymph nodes, and they’re important in our immune function when we’re really young, they produce antibodies for us. But as our immune system matures, as we grow older, they really aren’t that functional anymore, which is why it’s okay to remove them. And when that tissue is just there, causing more problems than benefit, we know we can remove them safely, again, if they’re causing a problem.
So when we think about problems with the tonsils, we generally divide that into two categories. They’re either causing recurring or chronic infection, or they are causing obstruction. And again, a couple of strep throats a year, not that uncommon, and certainly well within the realm of normal.
But we’ve developed criteria for those kids that benefit from removing the tonsils. Seven strep throat infections within one year, that’s a really sick kid. But then also, five per year over two or more consecutive years or three or more over three or more consecutive years. And so, there is a little bit of a gradation there for these kids that just have those years where they’re missing a lot of school and on antibiotics but still could qualify to have those tonsils removed. Doesn’t mean they’ll never get a sore throat, but hopefully, we can reduce the frequency and the severity of the sore throats. And then, all the associated factors, again, missing school, being on multiple rounds of antibiotics, that just create a lot of other social issues and problems with those kiddos.
So the surgery to take out tonsils, is that an outpatient surgery as well?
The vast majority of the time it is. Of course, there are always special circumstances, but we treat these surgeries as a quick in and out procedure. You come in and go home the same day. It really only takes about 15 minutes to remove the tonsils. But the surgery itself, the whole process of it is about 30 to 45 minutes. A lot more downtime with tonsils, as opposed to ear tubes. So these kiddos are home from school for a full week.
Wow.
Two weeks of activity and dietary restrictions. It’s a surgery. And while it’s a very common surgery, a very safe surgery under regular conditions, it still comes with some risk. This is why we really want to make sure these tonsils are causing a problem, because tonsil surgery still needs to be treated like a surgery.
But the vast majority of kids, again, do just fine. They do very well, bounce back quickly, and we can get them feeling a lot better and not missing out on so much school and activity because they’re sick all the time.
When we remove the tonsils for sleep apnea, I don’t know if you had a separate question about that, but when we remove the tonsils for obstructive purposes, we’re thinking about kids who have signs and symptoms of sleep apnea or somewhere on the spectrum of sleep disorders or sleep disordered breathing.
So again, you can walk around with huge tonsils, but unless they’re really causing obstruction, we’re talking about snoring, waking frequently during the night, witnessed apneic events where they pause in their breathing while they’re sleeping, waking up in the morning not feeling like they got a good restful sleep, feeling very groggy and lethargic, requiring extra naps or having excess sleepiness throughout the day.
Interestingly, in kids, we actually see that they can have a lot of hyperactivity when they get overly tired because they’re not sleeping well. They get these extra cortisol surges in their body. It’s almost like an adrenal adrenaline rush in the body. And sometimes, these kids just bounce off the walls when in fact they’re really truly overtired, not hyperactive. So that can be a separate indicator of poor sleep. And in kids, about 90% of that can be attributed to the big tonsils and adenoids.
It’s so interesting with sleep apnea, because you hear about that in adults. Do you feel like sleep apnea is underdiagnosed in children and teenagers?
Yes.
Talk about that a little bit.
I think it’s just something that we associate with adults, and as especially overweight adults predominantly, and we don’t really think about it in kids. And we chalk kids up to being tired because they didn’t get a nap or they’re in all these activities. Or again, kids can have different symptoms where they might be having trouble paying attention in school or being labeled as hyperactive, when in fact it’s really just their body’s response to not getting good quality sleep. And we just have to know what to look for. When we know what to look for, and our primary care doctors have been excellent about screening for this, but looking for those signs and symptoms.
And when you start asking parents these questions, they go, “Yeah, they’ve snored since birth. I just thought that’s what they did,” and, “Oh, yeah. I do hear them gasping, or I kind of shake them a little bit to see if they’re breathing at night,” or, “Oh, yeah, they are hard to get out of bed in the morning.” A lot of the conglomeration of these symptoms coming together and that light bulb goes off and says, “Oh, my kid does have all of those symptoms. How did I not see this?” Well, you just have to know what to look for and you have to realize that it can happen in kids, and it’s not because they’re overweight or have other medical health issues. It can just be purely from a physical obstruction that we can easily fix.
Very interesting. So what other conditions of the ear, nose, and throat do you treat in children? Anything else we haven’t touched on?
This time of year, it’s nosebleed season. So in the winter, the cold, drier air just tends to be nosebleed season for kids and adults. But nosebleeds are super common in kids. A lot of kids are going to have a nosebleed from time to time, but it’s that recurring nose bleed or nosebleeds that take longer to stop than usual, that can be very problematic. And they always seem to happen at the least convenient times. And by the time they make it to our clinic, we can discuss things like cauterization. Moisturization helps a lot. Getting these kids to use a little bit of saline in the nose or ointment in the nose just to provide more moisture when the air is so dry, using a humidifier, things like that, can be really good preventative measures to help mitigate some of that, so we don’t have to go in and do anything more invasive.
So do patients, or parents of patients, can they come directly to you or do they need to be referred in by a primary care physician?
That truly depends on their insurance plan. I will say, most of our patients come referred from a primary care physician. Our primary care doctors are pediatricians, our family medicine doctors. They really do an excellent job of filtering through some of this stuff to understand when it’s a problem and when it’s within the realm of normal. So that’s how most patients come to our office.
I don’t know that we would turn anybody away if they wanted to come see us, we’d be happy to see and evaluate what’s going on. But the general pattern is that it kind of starts through the primary care office most of the time.
Ultimately, their insurance plan is probably going to dictate if that referral is truly required.
Well, thank you for being on the program.
Thank you for having me.
Thank you for listening to Mason City, Docs on Call. For more episodes, go to mcclinic.com/radio-podcasts.
At Mason City Clinic, our physicians have the skills and experience to treat your ENT problems locally. Many trained at the University of Iowa, which has one of the highest-rated ENT training programs in the nation, and they are still involved with the University of Iowa as adjunct staff members instructing ENTs-in-training. They stay current by practicing up-to-date medicine and performing leading-edge procedures for a variety of disorders. It is their goal to deliver compassionate, patient-centered and convenient care throughout our communities.
For more information, contact the Mason City Clinic ENT department at 641-494-5380.
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