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Bill Klaproth (Host): Most parents can spot diaper rash or a runny nose with no problems, but ear infections may come with only a whisper of symptoms, yet three quarters of children will get one by the age of three. Here to talk more about ear infections and sinusitis is Dr. James Weekly with Columbus Otolaryngology Clinic. Dr. Weekly, thanks for your time. So, first off, what is an ear infection?

James Weekly, MD (Guest): Well, there’s different types of ear infections. Generally, when people think of ear infections, they think of the type that children get most commonly. This is known as an otitis media or middle ear infection. All that means is an ear infection that’s on the other side of the ear drum from the environment, so, in the middle ear. Anything outside, from the eardrum outward is called otitis externa or what people commonly call a swimmer’s ear.

The thing that we see the most, is otitis media, which again, is what children get. Fluid builds up in the middle ear and it can become infected. The route for that is the eustachian tube. The eustachian tube is what connects the middle ear with the back of your nose. It’s why occasionally when you blow your nose, your ear pops or they tell you to chew gum when you are flying in an airplane. Because that opens the eustachian tube.

The reason kids get these more commonly than adults, is because their eustachian tubes aren’t as efficient until they get older. So, they are much more likely to develop problems with clearing their ear, and pressure can build up or a vacuum can build up and then fluid eventually builds up in the ear and can get infected.

Host: So, because of the eustachian tube is not fully developed yet, it sounds like kids are more susceptible to ear infections. So, what are the common symptoms of an ear infection?

Dr. Weekly: Most commonly, pain. In fact, with the middle ear infection, that’s universal. Now you can have fluid in the middle ear which is not painful in and of itself. But it is also something that we need to treat because fluid in the middle ear causes a problem with hearing. It knocks out about as much hearing as a foam ear plug. So, it’s one of the two things that we see most commonly with children; one is chronic fluid in the middle ear that won’t clear and then number two, recurrent ear infections.

Host: So, Dr. Weekly, what causes this infection? How does it happen?

Dr. Weekly: The eustachian tube is connected from the middle ear into the back of your nose. So, it’s a very short route for bacteria in the back of your nose to get up the eustachian tube into the middle ear.

Host: And then that fluid that’s trapped up there, that’s what becomes infected?

Dr. Weekly: Correct. It’s an excellent culture medium and bacteria are very happy living in there. And when that starts to reproduce, your body sends white blood cells in to fight it and there’s some swelling and then the eardrum begins to stretch because pressure builds up and that’s what causes the pain.

Host: So, as children grow, they eventually grow out of this because their eustachian tubes develop and they are able to more easily clear that tube or clear the fluid built up in their ear through blowing their nose? Is that right?

Dr. Weekly: Yeah. Generally speaking, that’s correct. Most kids will outgrow it. Now, there’s a caveat there, where you will have children that have various allergic problems or immune deficiency problems where they may have a much more lengthy go of it and some kids never outgrow the need for ventilation. But the vast majority do.

Host: Okay. You said most children will outgrow this. Is there a certain age then when children should stop getting ear infections?

Dr. Weekly: It is extremely variable but there’s no specific age at which point you outgrow it. It all depends on what age it presents itself. Now we know from the data, that approximately 90% of kids never need a second set of tubes when you put tubes in. And tubes generally last one to two years. Kids generally, will see significant improvements within a couple of years. The problem is, we don’t know which kids those are. And 10% of them will end up needing a second set of tubes which now you are looking at three to four maybe five years of problems, unless they have tubes in.

Host: So, you mentioned earlier antibiotics and now we are talking about tubes. What are the different treatment options?

Dr. Weekly: Well, first of all, we always try to treat medically first. And even something as simple as avoidance. For instance, children in smoking households are much more likely to have ear infections because of the irritation to the nose and the nasopharynx, the back part of the nose. Even if the parents smoke outside the house, there’s still significant irritation to the airway in children in those households. So, sometimes something as simple as getting the parents to quit smoking, but also treating allergies if there is allergy present in the child, can help avoid ear infections. And then again, antibiotics are very commonly used.

Also, there is a certain number of patients that will respond to things like nasal steroids such as Flonase which helps decrease inflammation in the back of the nose. That’s particularly useful in kids with allergies.

Host: So, good to know there is a lot of treatment options. So, let’s switch gears and talk about another common issue you see in children, sinusitis. Can you tell us what that is?

Dr. Weekly: Sinusitis can be confusing in that so many people – of the many people that I see, the vast majority that come in with sinusitis complaints are actually complaining of their nose. And there’s a difference. The part of your nose that you breathe through is your nose. Your sinuses really have nothing to do with breathing. And patients will come in and say I cannot breathe through my nose. That is typically not sinusitis. That is more of an anatomical obstruction most likely and usually fairly easy to fix.

Sinusitis on the other hand, is an infection of what we call the paranasal sinuses or the sinuses that live around the nose. They are hallow cavities in the face and skull that we are not exactly sure why people even have them. But they are quite inconvenient in that they are a nice place for infections to occur. Some people think that they help lighten the skull, some people think that it helps our voice resonate, but we don’t really know.

The symptoms of sinusitis are a little different. When a patient comes in and says I cannot breathe through my nose, I’m usually thinking a deviated septum which is a crooked divider or large turbinates which are the fleshy baffles or even sometimes adenoids or polyps. Sinusitis, they will typically come in complaining of pain in the face, the upper teeth, and they also complain of drainage. Now drainage, that’s an entirely different subject because there are other things that can cause that, but the only way to truly diagnose sinusitis is with a CAT scan.

So, if a get a patient in that’s complaining of facial pain and the classic symptoms which I described; and physical exam with an endoscope will usually show us something coming out of there where the sinuses drain into the nose. Those are the patients that benefit from getting a CAT scan and seeing what’s going on in the sinuses themselves.

Host: Got you. So, look for pain in the face and the upper teeth. Now the condition is often confused with a common cold, is that because people can’t breathe through their nose? Is that right?

Dr. Weekly: Exactly. There are so many causes of nasal obstruction. They can be allergies, polyps, again a deviated nasal septum which is the divider, or crooked turbinates. Most commonly, if it’s a chronic, I can’t breathe through my nose type of patient, it’s a crooked septum and large turbinates and it’s very, very, very common.

Host: So, is there a way to help prevent sinusitis?

Dr. Weekly: It depends what’s causing it. Now certainly people with allergies, there’s always been a controversy that people with bad allergies don’t get a lot of sinusitis. I’ve certainly seen people with both. Anything that causes inflammation in the nose can interfere with the sinuses’ normal ability to drain. Just like the middle ear. And if that happens, fluid can build up, mucus, secretions and then these become infected. So, if there’s something – for instance, cigarette smoke kills the cilia which are the normal little cells that keep things moving in the nose. And that sets them up for sinusitis. They are more likely to get sinus infections. But also people that are around things that are chronically irritating their nose such as allergens and things of that sort.

Host: And what are the treatment options?

Dr. Weekly: Again, with sinusitis, we generally try to treat first with antibiotics and or avoidance therapy with in some cases, nasal steroids such as Flonase and Nasonex, things that help decrease inflammation in the nose. If you get a patient that you’ve tried everything else and the sinuses just continue to get infected regularly, they’ve been on lots of antibiotics; those are the patients that then we will move to surgery, but generally, surgery is what we do as a last resort. Certainly not first line when you are dealing with sinuses.

Host: And Dr. Weekly, is there anything else we should know regarding ear infections or sinusitis?

Dr. Weekly: Well as far as sinusitis, I tell people very frequently, they are scared to come in because they think anything to do with their sinuses, if they have it fixed is going to be something horribly painful. Sinus surgery actually is not painful. If you have your nose packed, yeah, that can be painful, but that’s generally not needed when you are doing sinus surgery, more than just a dissolving type thing. And again, I tell people you never have to live with a nose you can’t breathe through. That’s actually one of the easiest things to fix.

Children as far as ear infections are concerned, I think it’s perfectly reasonable to try to treat them with antibiotics for a while. But if you get to the point where you are in that four and five or more a year; those are the kids we generally start talking about doing intervention because there’s nothing magical about tubes, but what they do is they buy you a couple of years where these children aren’t suffering from ear infections.

Host: And that’s what it’s all about. Dr. Weekly, thank you for your time. For more information from Columbus Otolaryngology Clinic or to schedule an appointment, visit www.columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts. I’m Bill Klaproth. Thanks for listening.