Dr. Greene’s Answer:

When kids finish swimming and climb out of the water, the water doesn’t climb out of their ear canals. The angle of the ear canals can allow water to sit there for hours, setting up the ideal conditions for an infection of the skin in the canal. Getting the water out of the ears is the first step to preventing swimmer’s ear. To do this, tilt the head to the side, tug on the ear to straighten the ear canal and ‘break the seal’, and let gravity do its work. Repeat on the other side. If swimmer’s ear is a big issue for someone, you might consider drying with a blow dryer. You might even try to prevent water from entering the ear canal with a swim cap or headband.

In children with normal, intact ear drums, putting a few drops of white vinegar and/or rubbing alcohol solution into the ear before and/or after swimming and/or at bedtime can also help prevent swimmer’s ear.

Whatever else you try, avoid putting anything in the ear (fingers, cotton swabs) that might rub or scratch the protective layer in the ear canal.

Notice that I do not suggest reducing swimming. Swimming is a wonderful way for kids to enjoy active fun. Our goal is to enable them to be active safely, not to hold them back from it.

Related concepts:

External otitis; otitis externa

Introduction to swimmer’s ear:

Swimming can be a delight for children and for parents. Although water in the ear from swimming or bathing is not associated with most types of ear infections (even for children with tubes!), it can cause one kind of ear infection as well as exquisite pain.

What is swimmer’s ear?

Swimmer’s ear is an infection of the skin that lines the ear canal. A waxy, water-resistant coating usually protects this skin. Bacteria normally live on the surface of the skin with no ill effect.
If there is a break in the skin’s normal barrier, these bacteria can slip inside the skin, causing an infection called external otitis or swimmer’s ear. This is different from otitis media.
What creates a gap in the protective barrier of the skin?
If the ear remains wet for long, moisture penetrates the water-resistant layer and the skin becomes prune-like in the same way that one’s fingers and toes become soft and wrinkled when they remain in water. Bacteria can easily move into this soft skin.
Tiny scratches in the ear canal (usually from sticking a finger or some other object into the ear) also leave the skin vulnerable to infection.
The skin can even be breached as a result of the ear’s becoming extraordinarily dry, causing the skin to crack. Ironically, swimmer’s ear can be the result of spending time in desert conditions.

Who gets swimmer’s ear?

Preschool and school age children get swimmer’s ear more than anyone else. Babies and toddlers are usually spared from swimmer’s ear, even if their ears get wet. Adolescents and adults are at risk.
Children with eczema or seborrhea are at higher risk than their peers.
Swimmer’s ear is more common in people who swim in pools than in people who swim in lakes. Perhaps this is because the chlorine in swimming pools disproportionately kills the gentle, beneficial bacteria in the ear canal, giving the aggressive bacteria freer reign.

What are the symptoms of swimmer’s ear?

People with swimmer’s ear usually complain of an itchy and/or painful ear. The pain can be quite severe. The ear is particularly sensitive to the ear lobe’s being moved up and down.
The earwax may appear soft and white, and there may be a small amount of clear discharge.
Sometimes hearing is decreased during swimmer’s ear. Rarely the infection can become quite severe.

Is swimmer’s ear contagious?

No

How long does swimmer’s ear last?

Swimmer’s ear will usually disappear within 2 to 3 days of treatment.

How is swimmer’s ear diagnosed?

It may be diagnosed from the history and/or the physical exam. With severe infections, cultures may be necessary to identify the specific bacteria or virus involved.

How is swimmer’s ear treated?

Early or mild swimmer’s ear can often be treated with a few drops of white vinegar placed in both ears provided that the ear drums are normal and intact. Put the vinegar in one ear and leave it for about five minutes before turning that ear down in order to drain the vinegar solution. Repeat this twice a day for three days.
If the symptoms worsen or persist for over three days, prescription antibiotic drops may be necessary. They are effective the great majority of the time. Some prescription drops also contain topical steroids which can rapidly help pain and swelling in the ear. Sometimes oral pain medicines are also necessary.
Rarely, oral or even IV antibiotics are needed.

How can swimmer’s ear be prevented?

The first step to prevent swimmer’s ear is to make sure the ears get dry after being in the water. Turning the head and gently pulling the ear in different directions helps to drain water out of the ear. Try drying the opening of the ear very carefully as far as you can reach with a towel.
If swimmer’s ear becomes a recurrent problem in children with normal, intact ear drums, you can put a few drops of rubbing alcohol into the ears each time they become wet to facilitate drying.
Another good option is instilling a few drops of white vinegar. The acetic acid inhibits the growth of bacteria in the skin.
Controlling seborrhea or eczema can be helpful for affected children.

Related A-to-Z Information:

Ear Infection, Eczema, Impetigo, Otitis Media with Effusion (OME), Seborrhea (Seborrheic dermatitits)

Related concepts:

Serous otitis media, secretory otitis media, silent otitis media, ear infection, silent ear infection

Introduction to otitis media with effusion:

Parents are often surprised to learn that their child has an ear infection. The infection is discovered during a visit for another purpose altogether. Even though silent ear infections cause no obvious symptoms, the child’s hearing is decreased while fluid remains in the ear. Moreover, OME often comes during the same months when children are trying to make sense of the language they hear around them.
Fluid in the middle ear, which often goes undetected for weeks or months at a time, is an important hidden problem. OME is the leading cause of surgery in children, because this silent occupant of our children’s ears can have lingering effects years after the fluid has disappeared.

What is otitis media with effusion?

First, let’s discuss the structure of the ear. There are three main parts to the ear – the outer, middle, and inner ear. The outer ear includes the pinna (the visible portion of the ear) and the external auditory canal (the small tube you see doctors looking into). The external auditory canal is separated from the middle ear by the tympanic membrane (eardrum). The middle ear consists of three tiny bones that transmit sound vibrations. It is connected to the back of the throat by a tiny tube called the Eustachian tube. The inner ear consists of a hollow region inside the skull where sound vibrations are converted into nerve impulses—messages that travel to the brain.
Otitis media with effusion (OME) is the name for fluid in the middle ear without other symptoms. This fluid generally contains bacteria. Nevertheless, children with OME act as if they feel well. Because it is often discovered on routine well-child checks, it is sometimes called silent otitis media.
Acute otitis media (AOM) refers to fluid in the middle ear accompanied by signs or symptoms of an ear infection, such as pain, redness, or a bulging eardrum. Children with AOM act sick (especially at night) and often have fevers.
When children are taken to the doctor because they seem like they have an ear infection, the visit is about AOM. This article is about OME.
The Eustachian tube is a small canal that connects the middle ear to the back of the throat. When bacteria make their way into the middle ear, they are supposed to be flushed out through the Eustachian tube. When the Eustachian tube is blocked, or isn’t functioning properly, bacteria-containing fluid can become trapped in the middle ear. This causes OME.
Getting soap or water in a child’s ears does not cause OME (though in older children it can cause swimmer’s ear – a superficial infection of the skin in the ear canal).

Who gets otitis media with effusion?

OME is most common in someone who already has a cold or other upper respiratory infection. It commonly precedes an acute ear infection (AOM). In addition, OME commonly lasts for weeks or months (an average of 21 days) after an episode of AOM has cleared up.
When an ear is rechecked after an acute ear infection, fluid is often still present after the symptoms have gone. This is OME and usually does not benefit from extra rounds of antibiotics.
Children get OME much more often than adults. The highest concentration of OME clusters in the window between 6 and 24 months of age.
About a third of children get no ear infections; about one third have occasional ear infections (three or less in any one year); and about one third are prone to ear infections.
Children may be prone to OME for a variety of reasons. Some have immature immune systems; some have Eustachian tubes that are shorter, narrower, or less efficient; and some have other reasons that the Eustachian tube is more likely to become inflamed or blocked (such as GE reflux, or environmental irritants like tobacco smoke). Up to 40 percent of children with OME have allergies as an underlying cause.
In the Northern hemisphere, OME is most common between December and March, even in areas with a mild climate. It is least common between July and September.
OME is also more common among children in day care, especially if a child is exposed to more than six other children or if the child uses a pacifier.

What are the symptoms of otitis media with effusion?

Children with OME have fluid in the ear that causes mild hearing loss, but no other symptoms. An older child might comment on this, or on a feeling of fullness in the ear. A younger child might shake her head, pull on her ear, or give no sign at all.
OME is more likely if it is winter or if there is an obvious reason the Eustachian tube might be blocked (a current or recent cold, acute ear infection, or other upper respiratory infection, a change in elevation, teething, exposure to cigarette smoke, or drinking a bottle lying on the back).

Is otitis media with effusion contagious?

OME itself is not contagious. Nevertheless, the upper respiratory infections that often set up OME can be quite contagious.
The same upper respiratory virus might spread throughout a group of children. They might all catch colds, but only those who are otitis-prone might end up with OME, and the ear fluid in the different children might all contain different bacteria!

How long does otitis media with effusion last?

The length of OME is quite variable. Almost half the children with OME will no longer have fluid within one month. About ninety percent will have the fluid resolve within three months.

How is otitis media with effusion diagnosed?

A skilled observer can make the diagnosis by looking in the ears with an otoscope. To confirm the presence of OME, it is important to confirm the presence of fluid in the ear. This may be accomplished while looking in the ear with an otoscope by using a small rubber bulb to push air against the eardrum. Alternatively, this may be accomplished with automatic devices such as a tympanogram or an acoustic reflectometer.

How is otitis media with effusion treated?

In otherwise healthy children, OME is usually treated first with environmental control measures (breastfeeding, avoiding cigarette smoke, and reconsidering group day care). Sometimes a round of antibiotics is given, although this has not been proven to help.
Either way, these children should be followed until the fluid resolves.
A hearing test is indicated within 3 months if the fluid has not yet disappeared. A hearing loss greater than 20 decibels suggests that PE tubes could be beneficial. Children who have developmental disabilities or other limitations on language development may need a hearing test and specialist referral sooner.
Tube placement is recommended for most children, in any case, if fluid is still present after 4 to 6 months.
Laser myringotomy is a gentler, shorter duration option to PE tube placement.
Some children also need adenoidectomy for chronic OME.
The above time schedule may be accelerated for children with other conditions, such as repeated episodes of AOM, anatomic differences, immunity problems, or language delays.
Antibiotics, antihistamines, decongestants, and steroids have not been shown to be effective in treating OME, though they might be tried in some situations before tube placement surgery.
An important study was published in the Journal of the American Medical Association in 2006 showing that biofilms, collections of bacteria living within a sticky matrix, may play a role in chronic cases of otitis media, with or without effusions. It is still unclear, though, how to best treat these infections.

How can it be prevented? Preventing OME involves preventing acute ear infections and ensuring proper Eustachian tube function. Try:

1. Decreasing your child’s exposure to ear infection-causing bacteria
   • a. Keep day care size to six or fewer children (especially in the winter months for children under age 2)
   • b. Stop letting your child use a pacifier. Sucking on a pacifier can pull germs into the middle ear. Stopping the pacifier alone can drop ear infections by 50 percent for children in day care.
   • c. Xylitol is a natural sweetener found in raspberries and plums. Most sugars promote bacterial growth. Xylitol inhibits it. Gums, lozenges, and syrups containing sufficient xylitol have shown to be effective at reducing ear infections by almost half.
   • d. The respiratory infections that lead to ear infections are often spread by touch or by fomites. Frequent hand-washing and cleaning of toys are both helpful.
   • e. Respiratory infections can also be spread through the air. Avoid staying in small rooms with sick people and poor air circulation. Fresh air and HEPA filters can help.
2. Increasing your child’s immunity to ear infection-causing bacteria
   • a. Breastfeeding is quite powerful at reducing the number of ear infections. Nursing throughout the first year is best, but even a few weeks of breastfeeding results in fewer ear infections for the next three years!
   • b. The pneumococcal vaccine and the flu vaccine have both been demonstrated to help in the prevention of ear infections.
   • c. Good nutrition, plenty of sleep, and decreased stress all help to bolster immunity.
3. Ensuring proper Eustachian tube function
   • a. Avoid passive exposure to cigarette smoke. Up to 2 million ear infections are caused by passive smoking each year in the US.
   • b. Avoid having your child drink while lying flat on the back.
   • c. Drinking plenty of fluids thins the nasal secretions and may make blockage of the Eustachian tube less likely.
   • d. The Eustachian tube opens during swallowing. In older children, chewing sugarless gum may help support tube function.
   • e. Identify and treat allergies. Up to 40 percent of ear infections are caused in part by Eustachian tubes swollen by allergies. Dust is the most common airborne allergen. Allergies to food, especially dairy products, are more common in otitis-prone children.
   • f. Identify and treat GE reflux. Research published in 2002 suggests that in some children with frequent ear infections, undiagnosed GE reflux is responsible for the inflammation of the Eustachian tube.

Related A-to-Z Information:

Airborne Transmission, Allergies (Allergic Rhinitis), Common Cold, Contact Transmission, Ear Infection, Food Allergies, Gastroesophageal Reflux, Sinusitis, Swimmer’s Ear (External Otitis)

Related concepts:

Acute otitis media, otitis media, AOM

Introduction to ear infection:

Many parents are familiar with being awoken by a crying baby with an ear infection. Ear infections are the most common reason that children take an extra trip to the doctor, take antibiotics, or even have surgery.

What is an ear infection?

Ear infections come in several varieties. Most people use the phrase “ear infection” to refer to otitis media, an inflammation of the middle ear behind the eardrum.
Otitis media with effusion (OME) is the name for fluid in the middle ear without other symptoms. Children with OME act as if they feel well. Because it is often discovered on routine well-child checks, it is sometimes called silent otitis media.
Acute otitis media (AOM) refers to fluid in the middle ear accompanied by signs or symptoms of an ear infection, such as pain, redness, or a bulging eardrum. Children with AOM act sick (especially at night) and often have fevers.
When children are taken to the doctor because they seem to have an ear infection, the visit is usually about AOM. This article is also about AOM.
Many different species of bacteria and viruses can infect the middle ear. Some are quite aggressive; others are slow and stubborn.
The Eustachian tube is a small canal that connects the middle ear to the back of the throat. When bacteria make their way into the middle ear, they are supposed to be flushed out through the Eustachian tube. When the Eustachian tube is blocked, or isn’t functioning properly, germs can become trapped in the middle ear. This causes an ear infection.

Who gets ear infections?

Ear infections are most common in someone who already has an upper respiratory infection.
Children get ear infections much more often than adults. The highest concentration of ear infections occurs in the window between 6 and 24 months of age.
About a third of children get no ear infections; about one third have occasional ear infections (three or less in any one year); and about one third are prone to ear infections.
Children may be prone to ear infections for a variety of reasons. Some have immature immune systems; some have Eustachian tubes that are shorter, narrower, or less efficient; and some have other reasons that the Eustachian tube is more likely to become inflamed or blocked (such as allergies, GE reflux, or environmental irritants like tobacco smoke).
In the Northern hemisphere, ear infections are most common between December and March, even in areas with a mild climate. They are least common between July and September.
Ear infections are also more common among children in day care, especially if a child is exposed to more than six other children or if the child uses a pacifier.

What are the symptoms of an ear infection?

Even though ear tugging is one of the most common reasons that children are brought to the doctor, ear tugging is not a specific symptom of an ear infection. Young children like to tug on ears. They might tug more if there is fluid in the ear or if the ear feels funny. Nevertheless, careful research has verified that ear tugging by no means occurs exclusively in children with AOM.
AOM hurts. Pain builds as pressure in the ear builds. It may go away and then come back. The pain is usually worse at night. In an older child, “My ear hurts!” is the most reliable symptom. In a younger child, the best clue is evidence of pain, such as crying, screaming, fussiness (worse when lying down), or sudden increased difficulty sleeping.
Hearing is decreased and there may be a feeling of fullness in the affected ear. Again, an older child might comment on this; a younger one might shake his head or might give no sign of the fluid.
One-third to one-half of children with ear infections develop fevers. Fevers are more common in infants and toddlers. Although there are many other causes, the combination of fever and pain is most often an ear infection in infants and toddlers.
Some children with ear infections will have loose stools or vomiting or other symptoms of general illness. The symptoms listed above are even more suggestive if it is winter or if there is an obvious reason the Eustachian tube might be blocked (a cold or other upper respiratory infection, a change in elevation, exposure to cigarette smoke, or drinking a bottle lying on the back).

Are ear infections contagious?

Ear infections themselves are not contagious. Nevertheless, the upper respiratory infections that often set up ear infections are quite contagious.
The same upper respiratory virus might spread throughout a group of children. They might all catch colds, but only those who are otitis-prone might end up with ear infections. Nevertheless, these ear infections might all be caused by different bacteria and respond to different antibiotics!

How long does an ear infection last?

Once antibiotics are started, the symptoms should not continue to get worse. Fever and pain should be dramatically improved or gone within 48 to 72 hours. Painless fluid in the ear typically lasts for weeks or months following AOM, during which time the child’s hearing is decreased and the child is more vulnerable to another episode of AOM.
Most children with AOM would also get better without antibiotics. The time frame described above is typically delayed by one day at every point for children who are untreated (unless they develop complications). Most do not develop complications. Meningitis is a rare complication that can begin as an untreated ear infection.

How are ear infections diagnosed?

A skilled observer can make the diagnosis by looking in the ears with an otoscope. Ear infections tend to be over-diagnosed in young children with red eardrums. Eardrums can be red in AOM, but they can also be red from crying or from a fever.
To confirm the presence of AOM, it is important to confirm the presence of fluid in the ear. This may be accomplished while looking in the ear with an otoscope by using a small rubber bulb to push air against the eardrum. Alternatively, this may be accomplished with automatic devices such as a tympanogram or an acoustic reflectometer. If there is a hole in the eardrum, fluid may be draining through the hole.
When specific, accurate diagnosis is important, some of the infected fluid may be obtained with a swab (if there is already a hole) or with a needle (if the eardrum is intact). Culturing this fluid can pinpoint the species of bacteria involved and the best antibiotics for that particular strain. This is usually not necessary.

How are ear infections treated?

Many ear infections can resolve on their own, without antibiotics. Healthy, older children can often be treated with pain killers and close follow up. If symptoms are severe, persist, or worsen, then antibiotics are considered.
For children who are young or at risk for complications, antibiotics may be indicated to speed recovery, reduce pain, and prevent complications.
For children on antibiotics, if the child is not dramatically better within 48 to 72 hours, the antibiotics should be switched to something stronger. Beyond this, repeated changes or rounds of antibiotics are usually not helpful.
Whether or not they are treated with antibiotics, children with AOM deserve something to alleviate their pain (though usually this should not be needed for more than 72 hours). Choices might include oral pain medicines, anesthetic eardrops, or warm compresses on the ear.
Antihistamines, decongestants, and steroids have not been shown to be effective in treating AOM.

How can ear infections be prevented?

Preventing ear infections involves:

1. Decreasing your child’s exposure to ear infection-causing bacteria
   • a. Keep day care size to six or fewer children (especially in the winter months for children under age 2)
   • b. Stop giving them a pacifier. Sucking on a pacifier can pull germs into the middle ear. Avoiding pacifiers can reduce ear infections by 50 percent for children in day care.
   • c. Xylitol is a natural sweetener found in raspberries and plums. Most sugars promote bacterial growth. Xylitol inhibits it. Gums, lozenges, and syrups containing sufficient xylitol have shown to be effective at reducing ear infections by almost half.
   • d. The respiratory infections that lead to ear infections are often spread by touch or by fomites. Frequent hand washing and cleaning of toys are both helpful.
   • e. Respiratory infections can also spread through the air. Avoid staying in small rooms with sick people and poor air circulation. Fresh air and HEPA filters can help.
2. Increasing your child’s immunity to ear infection-causing bacteria
   • a. Breastfeeding is quite powerful at reducing the number of ear infections. Nursing throughout the first year is best, but even a few weeks of breastfeeding results in fewer ear infections for the next three years!
   • b. The pneumococcal vaccine and the flu vaccine have both been demonstrated to help in the prevention of ear infections.
   • c. Good nutrition, plenty of sleep, and decreased stress all help to bolster immunity.
3. Ensuring proper Eustachian tube function
   • a. Avoid passive exposure to cigarette smoke. Up to 2 million ear infections are caused by passive smoking each year in the US.
   • b. Avoid having your child drink while lying flat on his back.
   • c. Identify and treat allergies. Up to 40 percent of ear infections are caused in part by Eustachian tubes swollen by allergies. Dust is the most common airborne allergen. There may be an association between cow milk allergy and otitis media in a small number of children.
   • d.Identify and treat GE reflux. Research published in 2002 suggests that in some children with frequent ear infections, undiagnosed GE reflux is responsible for the inflammation of the Eustachian tube.

Related A-to-Z Information:

Airborne Transmission, Allergies (Allergic Rhinitis), Common Cold, Contact Transmission, Food Allergies, Gastroesophageal Reflux, Influenza (Flu), Nightmares, Sinusitis, Swimmer’s Ear (External otitis)

Related concepts:

Hearing loss, Conductive hearing loss, Sensorineural hearing loss

Introduction to deafness:

In that first golden moment when you gazed at your baby in the delivery room, he was already beginning an amazing journey of learning. And how do children learn? They take in the world by using their five senses. The sight of your face, the feel of your touch, the taste of your milk, the scent of your unique aroma, and the sound of your voice combine to teach your child about the world.
Some children enter the world in silence.
We now know that hearing loss can significantly impair the ability to learn — not just learning to speak but also to walk, to read, to write, to do well in school and to get along well with others.
The sooner hearing loss is detected and addressed; the better children will do overall.

What is deafness?

In a healthy ear, sound waves enter the ear canal and vibrate the eardrum at the end of the canal. The eardrum transmits the sound waves across the three tiny bones of the middle ear into the inner ear, where the information is converted to electrical impulses that travel along nerves to the brain, allowing us to hear.
There are two main types of hearing loss.
In conductive hearing loss, children have a problem transmitting sound waves through the outer ear, through the eardrum, or through the tiny bones of the middle ear.
In sensorineural hearing loss, the problem is with converting sound waves to electrical impulses, or in transmitting this electrical sound information along the auditory nerves to the brain.
Either conductive or sensorineural hearing loss may be present at birth, or may be acquired along the way. Hearing loss may be mild, complete, or somewhere in between.

Who gets deafness?

Usually severe sensorineural hearing loss in childhood is genetic (it runs in families – even if this child is the first). Sometimes, however, sensorineural hearing loss is a result of other problems, such as a rubella or CMV infection during pregnancy or meningitis infections later on.
Each year about 20,000 children in the United States are born with permanent hearing loss. Often this isn’t discovered until the children are 3 years old and their language is noticeably delayed.
But these 20,000 children with congenital hearing loss are only the tip of the iceberg. In April 1998, the Journal of the American Medical Association reported a staggering 7 million children in the United States with hearing loss significant enough to impair the ability to learn. Most of these children have temporary hearing loss, but even though the hearing loss is temporary, the impact can last a lifetime.
The most common cause for temporary hearing loss is the fluid in the middle ear space associated with ear infections. Whenever a child has an ear infection, germ-containing fluid enters the middle ear space from the back of the nose or throat. The eardrum can’t vibrate freely, resulting in a 15 to 40 decibel hearing loss.

What are the symptoms of deafness?

Hearing loss may be suspected in children who don’t startle to loud sounds or don’t turn to look for the source of sounds. Babies who don’t seem to notice you until they see you may have some form of hearing loss.
Speech development in babies with hearing loss may be unusual. They will often focus on gargling, vibrating noises that they can feel. Speech delay at any point suggests hearing loss as a possibility.
Language development during the first few years of life is nothing short of amazing! A child is born unable to understand any words, and yet is speaking in complete sentences within a few years. During this flowering of development, there are certain critical windows when different sounds are learned. For instance, someone who reaches 8 to 10 months of age without hearing Chinese will lose the ability to distinguish between some of the vocal sounds of that language.
Sometimes the language you miss out on hearing is your own! The most common age for temporary hearing loss is during that same precious time when the miracle of language development is unfolding.

Is deafness contagious?

Not directly.

How long does deafness last?

Some hearing loss is permanent. The most common form of hearing loss is quite brief – but casts a long shadow. On average, fluid lingers for 3 weeks following an ear infection, but it can remain for months at a time. Usually, 12 weeks of fluid is considered the cut-off for concern. However, some investigators have been able to detect long-term language delays (noticeable 9 years after the fact) in children who had 8 or more weeks of fluid between 6 and 12 months of age.

How is deafness diagnosed?

Without a newborn hearing test, the average age at which congenital deafness is diagnosed is 2 years old! Children whose deafness is treated in the first months of life gain critical time and perform far better on developmental tests than those whose diagnosis is delayed. It’s no surprise that the National Institutes of Health and the American Academy of Pediatrics both recommend that all babies have their hearing tested, preferably before they first leave the hospital.

How is deafness treated?

The treatment of hearing loss depends on the cause.
Temporary conductive hearing loss is often treated by properly managing the ear infections. For other types of hearing loss, treatment might involve reconstructive surgery, hearing aids, or cochlear implants (replacement inner ears). Sign language may become important to learn for the child – and for friends and family.

How can deafness be prevented?

All too often, hearing loss cannot be prevented. However, preventing congenital infections, preventing ear infections, preventing meningitis, and preventing hearing damage from exposure to loud noises can all help to preserve hearing.

Related A-to-Z Information:

Attention Deficit Hyperactivity Disorder (ADHD), Cataracts, Chickenpox (Varicella), Cleft Lip and Palate, CMV (Cytomegalovirus), Colorblindness, Depression, Ear Infection, Encephalitis, Glaucoma, Meningitis, Rubella (German measles), Streptococcus (Strep)

Related concepts:
Upper respiratory tract infection, URI, Nasopharyngitis, Viral rhinosinusitis.

Introduction to a common cold:

It’s called the “common cold” for a reason. Your child will probably have more colds than any other type of illness. Most kids have had eight to ten colds by their second birthdays and they continue throughout childhood (and their parents get them – usually from the kids). It’s the most common reason that children miss school and parents miss work. If anything, using the term “common” with cold is an understatement.

What is a common cold?

The body has a relatively small number of symptoms with which to respond to an ever-changing, wide variety of viruses. These symptoms are often the body’s attempt to get rid of the virus and to minimize damage. Sneezing ejects the virus from the nose, coughing from the lungs and throat, vomiting from the stomach, and diarrhea from the intestines. Fever makes it difficult for the virus to reproduce.
The common cold is our name for a specific constellation of symptoms, a pattern of illness that can be caused by a variety of different viruses.
Over 200 different types of viruses can cause a cold! Rhinoviruses, which means “nose viruses,” are the most common. Respiratory syncytial virus (RSV), adenoviruses, enteroviruses, and a host of others can produce colds.
Most people are sick with each specific strain of cold virus only once in their lives.

Who gets a common cold?

Colds are the most prevalent infectious disease. Children average 3 to 8 colds per year (younger children and boys are on the higher end of the range).
Children are the major reservoir of the many cold viruses. They usually get colds from other children. When a new strain is introduced into a school or day care, it quickly travels through the class.
Parents get about half as many colds as their children do. Moms tend to get at least one more cold per year than dads.
Colds can occur year-round, but they occur mostly in the winter (even in areas with mild winters). In areas where there is no winter, colds are most common during the rainy season.

What are the symptoms of a common cold?

The three most frequent symptoms of a cold are nasal stuffiness, sneezing, and runny nose. Throat irritation is often involved (but not with a red throat). Adults and older children with colds generally have minimal or no fever. Infants and toddlers often run a fever in the 100 to 102 degree range.
Once you have “caught” a cold, the symptoms usually begin in 1 to 5 days. Typically, irritation in the nose or a scratchy feeling in the throat is the first sign, followed within hours by sneezing and a watery nasal discharge.
Within one to three days, the nasal secretions usually become thicker and perhaps yellow or green. (This is a normal part of the common cold and not a reason for antibiotics.) During this period, children’s eardrums are usually congested and there may be fluid behind the ears (OME), regardless of whether or not the child will end up with a true bacterial infection.
Depending on which virus is the culprit, the virus might also produce a headache, cough, postnasal drip, burning eyes, muscle aches, or a decreased appetite. Still, if it is indeed a cold, the most prominent symptoms will be in the nose. (By the way, forcing a child to eat when he or she has a decreased appetite due to a cold is both unnecessary and unhelpful- but do encourage them to drink plenty.)
For children with asthma, colds are the most common trigger of asthma symptoms. They are also the most common precursor of ear infections.

Is common cold contagious?

When someone has a cold, the nasal secretions are teeming with cold viruses. Coughing, drooling, and talking are all unlikely ways to pass a cold. Sneezing, nose-blowing, and nose-wiping are the means by which the virus spreads. You can catch a cold by inhaling the virus if you are sitting close to someone who sneezes, or by touching your nose, eyes, or mouth after you have touched something contaminated by infected nasal secretions.

How long does a common cold last?

The entire cold is usually over all by itself in about 7 days, with perhaps a few lingering symptoms (cough) for another week. If it lasts longer, consider another problem, such as a sinus infection or allergies.

How is a common cold diagnosed?

A cold is defined as a short-term, contagious, viral illness with nasal stuffiness, sneezing, runny nose, throat irritation, and little or no fever. The diagnosis is based on identifying the appropriate symptoms, exposure, and time course.
Sometimes it is difficult to distinguish a cold from other problems such as allergies, influenza, strep throat, or sinus infections. A history and physical exam, sometimes with supporting lab work, will usually make the distinction.

How is a common cold treated?

Antibiotics should not be used to treat a common cold. Thick yellow or green nasal discharge is not a reason for antibiotics, unless it lasts for 10 to 14 days without improving (possible sinusitis).
New anti-viral drugs could make runny noses completely clear up a day sooner than usual (and begin to ease the symptoms within a day). It’s unclear whether the benefits of these drugs outweigh the risks.
Most cold treatments are aimed at controlling troublesome symptoms. Over the counter cold medications are no longer recommended for children under 2 years of age, and are strongly discouraged for children under 6 years of age.
Chicken soup has been used for treating common respiratory illnesses at least since the 12th century. A study published in the October 2000 issue of Chest explains why this home remedy has held on so long — it may really help! In addition to the infection-fighting benefits of the heat, hydration, and salt that have previously been described, these researchers looked at the direct biologic activity of the soup itself.
Buckwheat honey (a form of dark honey) can help calm coughs caused by the common cold. One study found that buckwheat honey was better at treating coughs than dextromethorphan (a cough suppressant found in common cold medications such as Robitussin DM). The recommended dose is ½ teaspoon for children 2-5 years old, 1 teaspoon for children 6-11 years old, and 2 teaspoons for children 12-18 years old (Arch Pediatr Adolesc Med.; 2007; 161(12):1140-1145). Honey should not be given to children under 1 year of age, however, as it is associated with infant botulism.

How can a common cold be prevented?

It might seem overwhelming to try to prevent colds, but the number of colds can be decreased. Children average 3 to 8 colds per year. It is certainly better to get three than to get eight!
Colds can be spread by airborne, contact, and droplet transmission, as well as by fomites. They can be prevented, both by decreasing the exposure to germs and also by boosting your child’s immunity.
Here are 5 proven ways to decrease germ exposure and the number of colds:

• Switching: Using a day care of 6 or fewer children dramatically decreases the germ exposure (and illness), especially in the winter months. Unfortunately, this is not the most practical option.
• The Not-So-Secret Weapon: We all know that hand washing is a good idea, but when a day care actually does wash children’s and provider’s hands at key moments, the results are spectacular. Key moments? The most important times are after nose-wiping, after diapering or toileting, before meals, and before food preparation. Before a child picks his or her nose would be nice but is not quite practical.
• Instant Hand Sanitizers: Talk about convenient! A little dab will kill 99.99 percent of germs without any water or towels. It uses alcohols to destroy germs physically. It is an antiseptic, not an antibiotic, so resistance can’t develop. And here’s the cool part–it’s fun. Many kids think it’s a treat to get to use it! We asked our son’s day care to try it, and they began washing at all those important times.
• Disinfection: Cleaning commonly touched surfaces (sink handles, sleeping mats) with an EPA-approved disinfectant has been proven to decrease the number of colds.
• Paper Towels: Use paper towels instead of shared cloth towels.

Here are seven proven ways to prevent colds by supporting the immune system:
Avoid Unnecessary Antibiotics and Antibiotic Soaps: The more kids use antibiotics, the more likely they are to get sick, with longer, more stubborn infections caused by more resistant organisms.
Breastfeeding: Breast milk is known to protect against upper and lower respiratory tract infections even years after the breastfeeding is done. Kids who don’t breastfeed average 5 times more ear infections.
Cigarette Smoke: Keep your child as far away from it as possible! Exposure to second-hand smoke is responsible for many health problems, including millions of colds.
Sleep: Late bedtimes and poor sleep leave children vulnerable.
Water: Getting plenty of fluids supports immune function.
Yogurt: The beneficial bacteria in active yogurt cultures can help prevent colds (as well as tummy aches, diarrhea, food poisoning, food allergies, eczema, sinus infections, bronchitis, and pneumonia – among other things).
Zinc: Children who are zinc deficient get more infections and stay sick longer.

Related A-to-Z Information:

Adenovirus, Airborne Transmission, Allergies (Allergic Rhinitis), Asthma, Bronchiolitis, Conjunctivitis (Pink eye), Contact Transmission, Cough, Croup, Droplet Transmission, Ear Infection, Enteroviruses, Fomites, Headache, Influenza (Flu), Nosebleeds (Epistaxis), Otitis Media with Effusion (OME), Pertussis (Whooping cough), Pneumonia, Respiratory Distress, RSV (Respiratory syncytial virus), Sinusitis, Strep Throat, Tonsillitis, Wheezing

Related concepts:

Nasal allergies, Allergic rhinitis, Hay fever, Seasonal allergic rhinitis, Perennial allergic rhinitis, Pollen allergy, House dust allergy, Pet allergies, Mold allergies

Introduction to allergies:

Children with allergies tend to get more ear infections, more colds, and have more sleepless nights than their peers. Far too often, the underlying allergies are missed and children are treated for each symptom as it occurs.

What are allergies?

The lining of our noses contains tiny guardians called mast cells, whose purpose is to protect us from harmful particles in the air we breathe. People with allergies have hypersensitive mast cells that sound the alert in response to relatively harmless particles such as pollen, dust, or pet dander.
When pollen sticks to the membrane of a mast cell of someone with pollen allergies, the cell begins to swell and swell. Finally the mast cell bursts, spilling histamine and many other potent chemicals into the surrounding tissue. These produce the sneezing, swelling, itching, and congestion associated with allergies.

Who gets allergies?

Developing allergies involves a genetic and an environmental component.
Allergies tend to run in families. Asthma, eczema (atopic dermatitis), and allergic rhinitis (hay fever) often occur in the same families. Boys, firstborn children, those with eczema, those with food allergies, and those whose parents have nasal allergies are all more likely to develop nasal allergies. Early wheezing does not appear to increase the chances.
The environment also makes a difference. Allergic rhinitis is an over-exuberant response to substances in the environment. Both too much and too little immune response is unhealthy. Experiences in early childhood can teach the body to set the level of immune protection ‘just right.’
Children who are raised on a farm have a significantly reduced risk of asthma, eczema, and hay fever. Children in day care, those with older siblings, those with pets, and those who get plenty of colds are also less likely to develop nasal allergies.
Parents are often told that their children are too young to have allergies. While allergies do become more common from ages 2 to 7, they certainly can be present earlier.

What are the symptoms of allergies?

Nasal allergies typically feature a clear nasal discharge with sneezing. There may be itchy, watery eyes and/or a dry cough. Parents often notice a “rabbit nose” — a child crinkling her nose to relieve the itchy sensation inside. The “allergic salute” — rubbing the nose with the hand, sometimes leaving a horizontal crease on the nose — is another common sign. “Allergic shiners” — dark circles under the eyes — have long been associated with allergies, but are less predictive than the other symptoms.
The symptoms tend to be seasonal if exposure to the triggers is seasonal (like pollen), and year-round if the exposure is year round (like pets).

Is allergies contagious?

Probably not. However, we have discovered that some allergic reactions (hives) can be spread by blood transfusion.

How long does allergies last?

While some children outgrow nasal allergies on their own, most will continue to have nasal allergies unless they are treated with immunotherapy.

How is allergies diagnosed?

A careful allergy history and physical exam will usually point to the right diagnosis. Looking at a swab of the nasal secretions under the microscope can confirm the diagnosis.
Common triggers include pollens, molds, house dust mites, and animal dander (their shed skin cells, not their hair or fur!). Identifying your child’s specific triggers can be very important. This can be accomplished with skin testing or with a blood test (RAST). The skin test tends to be very sensitive with immediate results to a broad range of allergens. The results will be affected by allergy medicines the person is taking. The RAST test is less sensitive, more consistent, and offers something of a quantitative analysis of the results.
In infants, a positive result with either test is likely to indicate a real allergy, but a negative test does not give much information. In older children, the opposite tends to be true. A negative test tends to rule out an allergy, while a positive test does not prove one.
Most people think of specific allergies as black and white — something you either have or you don’t. The truth is much more complex. Being allergic to something is a continuum and that continuum changes over time. Most, but not all, food allergies get better over time. Most airborne allergies get more common as children get older. Some allergies peak before puberty and then disappear. Others don’t even begin until puberty is over. Most people who do get tested for allergies have a single round of skin testing. This can provide a valuable snapshot of allergies at a single moment in time, but this just ‘scratches the surface’ of a child’s long-term allergy story.

How is allergies treated?

Treatment revolves around avoiding allergens and irritants, immunotherapy to desensitize people to allergens, and medicines to control symptoms.
If antihistamines are to be used in children, non-sedating antihistamines (such as Claritin, Allegra, or Zyrtec) are usually the best choice in order to minimize the impact on learning. Your pediatrician may recommend nasal sprays and/or eye drops as very effective treatments for decreasing allergy symptoms.

How can allergies be prevented?

Breastfeeding is very effective at decreasing the risk of allergies. Exposure to other children and animals in the first year of life can also lower the risk of allergies.
Once some allergies have developed, avoiding known allergens can calm the immune system and decrease the risk of new allergies.

Related A-to-Z Information:

Adenovirus, Asthma, Common cold, Conjunctivitis (Pink eye), Ear infection, Eczema, Food allergies, Hives, Nosebleeds (Epistaxis), Peanut allergy, Poison ivy/oak/sumac, Sinusitis

The results of the 74 randomized, controlled studies of  ear infections published between 1966 and 1999 were analyzed and reported in the August 2001 issue of Pediatrics. About 78% of children with acute otitis media (AOM) who do not receive antibiotics will recover without complications within a week. Of the 28% who did not get better, many would still have ear infections even if they did receive the antibiotics.

The benefit of antibiotics is small but real. About 8 children need to be treated for one child to have gotten better because of the antibiotics. The antibiotics do decrease pain in most kids, but there are gentler ways to do this.

Not all kids with ear infections need antibiotics. For children who appear well enough on my exam, I favor watchful waiting with pain control for 48 to 72 hours before starting antibiotics, if needed.

Dr. Greene’s Answer:

Earaches and ear infections overlap each other, but are not identical. This often causes confusion. An earache is the feeling of pain in the ear. Ear pain can have a number of different causes.

When doctors say that a child has an “ear infection,” they are usually referring to an infection in the area behind the ear drum. Not all of these ear infections cause pain, but some do. Those that cause pain are often treated with antibiotics by mouth. An earache can be caused by an ear infection, but there are also other causes.

Stretching the eardrum can lead to pain. The tube that drains the middle ear (aka. eustachian tube) can become plugged, leading to pressure changes in the ear that can painfully stretch the eardrum. A common time for this to happen is when flying in an airplane (during the final descent). The elevation change causes the ear tubes to close off. We feel as if our ears need to “pop”. In some people, especially young children, this really hurts. When we yawn or swallow, the motion opens the ear tubes, relieving the pressure and pain.

These ear tubes can be plugged by things that cause swelling around them. Second-hand cigarette smoke, hay fever and colds are common reasons that ear tubes become blocked. These earaches do not require antibiotics if there is no infection.

One other common cause of ear pain is swimmer’s ear. Here the skin inside the ear canal is infected and tender. This is usually treated with drops in the ear.

Every earache deserves attention, but not all earaches benefit from antibiotics. A visit to the doctor’s to have the ears examined will help pinpoint the cause of pain.

Dr. Greene’s Answer:

Dear Dr. Fitzgerald, Thank you for sharing your concern. Although I have at least two readers review every answer before it is posted, I welcome additional input. It is an honor for me to be “reviewed” by other physicians.

After receiving your email, I re-read the answer you are referring to. It is to a reader who was concerned about when ear tubes should be used. That answer used to say, “This pressure-equalization (PE) tube provides a temporary, extra Eustachian tube to allow bacteria and fluid to drain from the middle ear.” This statement was a shorthand summary of a more complicated process. I agree with you that it could lead parents to be concerned about fluid continually draining out of the ear. I have changed that entry to read, “This pressure-equalization (PE) tube provides a temporary, extra Eustachian tube which can help in several ways.” That statement is linked to this page for a more complete explanation of how ear tubes facilitate the drainage of bacteria and fluid from the middle ear.

Here is an excerpt from my book, The Parent’s Complete Guide to Ear Infections:

In the first half of the twentieth century, it was noticed that spontaneous holes in the eardrum often cured ear infections. These spontaneous holes, however, appeared and closed unpredictably. Several innovators tried various ways of keeping the holes open, including inserting fish bones, lead wires, and gold rings. Since 1954, the practice of intentionally making a small hole in the eardrum and inserting a small tube to keep the hole open has become very common. Today, more than 2 million ear tubes are implanted every year in the United States (Pediatric Clinics of North America, December 1996).

Ear tubes are made from a variety of materials, including ceramic, gold, plastic, Silastic, stainless steel, Teflon, and titanium. There is no proven advantage of one material over another.

A tube in the eardrum improves drainage of the middle ear space. Years ago, when a can of soda was opened with a can opener, a hole was made on both sides of the lid. While fluid poured out one hole, air was able to enter the can through the other, thus improving outflow. Ear tubes function in much the same way. When the middle ear space is closed, a suction effect prevents easy clearance of the contents down the eustachian tube. A blocked eustachian tube makes this even more difficult. When a tiny hole is made in the eardrum, the contents of the middle ear space flow far more easily either down the eustachian tube or out the inserted ear tube.

Unfortunately, this can also make it easier for bacteria to enter the middle ear space. It is easier for the contents of the nose and throat to travel up the eustachian tube if there is an opening at the other end. Also, bacteria can enter through the outer ear. Studies have shown, however, that for most children, improved drainage far outweighs the increased vulnerability.

It is my editorial goal to make every entry on Dr. Greene’s HouseCalls the best piece of its length, for parents, that is available on the Internet or in print. Thank you, Dr. Fitzgerald, for helping me achieve my goal.