I realize that I haven’t spend a lot of time on pediatric issues, so let’s talk about a common problem with kids: ear infections. It’s a rare parent who hasn’t had to deal with this problem at one point or another; in some cases, it’s a chronic problem that affects the quality of life of an otherwise healthy child.
The most common issue you’ll see relating to the ear is pain, especially in children. The ears are divided into the external, middle, and internal chambers. Inflammation of the ear is called Otitis, and is best diagnosed by the use of an “Otoscope”. The two most common ear problems you’ll see in children is in the outer ear (“Otitis Externa”) and the middle ear (“Otitis Media”).
Otoscope images courtesy of Jim, creator of the Dr. Mom Otoscope, copyright 2012
Otitis Externa, also known as “Swimmer’s Ear” is an infection of the outer ear canal, and most commonly affects children aged 4 -14 years old. Cases peak during summer months, when most (sane) people go swimming. Bacteria will accumulate and multiply in water or sweat caught in the ear canal, so hot and humid environments also play a role. The symptoms include:
- Pain and itching in the affected ear, made worse by pulling on it.
- Tinnitus (ringing in the ears) or decreased hearing.
- Thick drainage from the ear canal.
- Redness and swelling in the ear canal.
- drainage of inflammatory fluid from the ear.
An ounce of prevention is worth a pound of cure, so you want to always keep the ear canal as dry as possible. You can decrease the risk of the infection by using ear plugs or a tight bathing cap while swimming. Make sure to thoroughly dry your kid’s ears after they’re done swimming.
Ottis Externa Treatments
Home remedies for otitis externa may include a warm compress to the ear to help with pain control. An antibiotic/steroidal ear drop will be useful, and should be applied for 7 days. In order to get the most effect from the medicine, place the drops in the ear with the patient lying on their side. They should stay in that position for 5 minutes to completely coat the ear canal. Severe cases may be treated with oral antibiotics (such as Amoxicillin) and ibuprofen.
The most common cause of earache is an infection of the middle ear, called Otitis Media. Normally, the eardrum is shiny when viewed with an otoscope. When there is an infection in the middle ear canal, the eardrum will appear dull. This is because there is pus or inflammatory fluid behind it.
Otitis Media is caused when a bacteria or virus enters the middle ear, usually as a result of a cold or other respiratory infection, even strep throat. The passageway for the infective organism is the “eustacian tube”. The eustachian tubes are tubes than run from each middle ear to the back of the throat. Their normal purpose is to regulate the air pressure and to drain secretions from the middle ear. Blockage of the tubes causes accumulation of inflammatory fluid and, thus, an ear infection.These are more common in kids because their eustachian tubes are narrow and more horizontal than adults; as such, they are harder to drain.
Otitis Media is most common in infants and toddlers. This is why mothers are always cautioned against bottle or breast-feeding with their baby lying flat. You can expect it to present with one or more of the following: Otitis Media in children and infants will present with one or more of the following:
- Pain, more so when lying down
- Difficulty sleeping, crying, and irritability
- loss of appetite
- Loss of balance
Holding or pulling the affected ear
- Drainage of fluid from the affected ear
- Difficulty hearing from the affected ear
Using an Otoscope
The external ear canal is about 2-5cm long in adults, shorter in kids. In children, it’s relatively straight, but not in adults. It is not straight so you need to pull the pinna upwards and backwards to get a better view of the tympanic membrane.
Using an Otoscope
Always start by explaining to the child what you’re doing, and that it might feel “weird” but shouldn’t hurt. Choose an otoscope end attachment (called a “speculum”) appropriate for a child.
Always hold the otoscope in the left hand if you’re looking in the left ear, the right hand for the right ear. Holding the otoscope like you would a hammer seems to work best for me, as it allows me to rest my knuckles against the side of the head. You could hold the otoscope as you would a pencil also, and some people feel this gives you a better feel. Different strokes for different folks…
Pencil Grip Method
Examine the normal ear first. This will allow you to see what the normal anatomy looks like and also will prevent your transferring the infection from the infected ear to the healthy one. Be sure to have the light all the way up.
With your free hand, gently pull the ear up and back; this will straighten the external ear canal. This is important in an examination on an adult, but not as much in children; their ear canal is usually much straighter. Carefully introduce the end of the otoscope into the canal.
You will first see the external canal wall. Is there redness or swellness compared to the normal ear? Is there debris, excessive wax, or even a foreign object? Don’t be surprised if you see hair; this is normal. Now look at the eardrum at the end of the canal. A normal eardrum will appear pearly gray, shiny, and generally transparent. A yellowish color to the eardrum usually indicates fluid behind it; in the worst cases, the eardrum will appear to bulge out towards you.
Although severe infections are treated with antibiotics as well as Acetaminophen for pain. In extreme cases, surgery is done to place plastic tubes in the eardrum to facilitate drainage of pus. You can consider alternative remedies in milder cases, however, or in times of trouble. Here’s one method of dealing with it:
- Mix rubbing alcohol and vinegar in equal quantities, or alternatively, hydrogen peroxide
- Place 3-4 drops into affected ear
- Wait 5 minutes; then, tilt head to drain out the mixture.
- Next, use either plain warm olive oil, or add 1 drop of any one of these essential oils to 2 ounces of the olive oil: tea tree, eucalyptus, peppermint, thyme, lavender, garlic, mullein
- Warm the olive oil slightly and place 2-3 drops into the ear canal. This does not have to be drained or removed.
- A cotton ball with 2 drops of eucalyptus oil may be secured to the ear opening during sleep.
A good instructional video on Youtube:
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