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Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Riverside's primary care nurse practitioner, Joanna Lambert, to talk a little bit about ear infections.

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Host: We're back with Joanna Lambert. Thanks for joining me today.

Joanna Lambert: Thanks for having me today.

Host: Of course. So, you've been on the podcast one time before, but in case folks didn't listen to that episode, could you just start by telling us a little bit about yourself?

Joanna Lambert: Absolutely. So, I am a primary nurse practitioner. I have been in family practice now for a little over 10 years. I got my degree from Olivet University. Before that, I was a labor delivery nurse, postpartum and nursery nurse. And I worked both here at Riverside Medical Center as well as Carle. And that degree I got from the University of Illinois Nursing Program.

Host: Great. Great. I feel like I've met a lot of NPs that started in Labor and Delivery. I feel like that's a common pipeline.

Joanna Lambert: You know, I think you're right because I do take a lot of students. And a lot of them are coming from Labor and Delivery.

Host: Yeah. Well, that's great. You guys are doing a great job. Thanks. So, let's get started talking about ear infections. They're really common, especially in children. Can you start by explaining what an ear infection is?

Joanna Lambert: Sure. So, the very basic definition of an ear infection would be when a virus or bacteria infect the space behind the eardrum. And this space is normally just filled with air. But when you get the infection, it'll fill with pus, and become inflamed, and there'll be inflammation in that area.

Host: Okay. Yeah. What are some of the most common, like, signs or symptoms that parents or adults should watch out for?

Joanna Lambert: Sure. By far, the most common symptom is going to be pain in the ear. Obviously, it's going to be different between older children and your infants and toddlers. Older children can verbalize and tell you they have pain in their ear, while infants and toddlers aren't going to be able to verbalize it so well. But you'll see certain behavior in them, pulling, rubbing on the ear, they'll become fussy during the day, very irritable. They won't sleep well at night. They won't be feeding as well. Some of them go on to develop diarrhea and fever. Definitely something you want to watch for in those little ones.

When we have these patients in our exam rooms and you ask the parents, you know, have they been sick recently in the last few days or a week, and more than likely, you're going to get an answer of yes, that they've had an upper respiratory infection, which includes that runny nose, nasal congestion, sore throat, cough, that kind of sets up the perfect environment for that ear infection to form, which we'll talk about later.

Host: Yeah. Yeah. So, can adults get it?

Joanna Lambert: Absolutely. Not as common.

Host: Okay.

Joanna Lambert: It's not as common, but I do see a few adults that will get it.

Host: Okay. So, are there different types of ear infections and how do they kind of differ?

Joanna Lambert: So, there are, and I'm just going to be very basic, but you have like outer ear infections and inner ear infections. And I think for this podcast, we're really focusing on those inner ear infections, but the outer ear infection, which we commonly call it a swimmer's ear--

Host: Okay.

Joanna Lambert: So, we kind of are coming off that season where we see a lot of it. But these are ear infections that happen in the external canal, so it's before that eardrum. When you see these patients come in, and it's common in both kids, adults, they have extreme pain in their ear when they touch it. On exam, the canal's swollen. There's discharge usually coming from that ear. When you ask these patients, you know, "Have you been swimming recently?" Most of the time, the answer is yes. I have found with my little kids that sometimes they'll say, "No, they're not really swimming." But when I ask them about bath time, these are the kids that are laying in the bathtub. And the only reason I even know to ask this is my daughter did this in the bath. She would just lie there, and the water would get in her canal and she would have frequent ear infections. She still will get them. And it's funny because she's a swimmer now, so I have to really watch her.

But then, the other one is these inner ear infections, which we'll talk about, and that's that infection behind that eardrum. And there's another word that gets tossed out there that patients will ask me about, but it's otitis media with effusion. Now, this is not an infection. This is the fluid buildup behind the eardrum. It doesn't cause that pain or the fever. You might have patients that come in and they say they feel like pressure behind their eardrum, or feeling like they're underwater, muffled hearing, but this happens. We see this on exam with patients that have upper respiratory infection. So, you'll see this a lot more with like adults that just have that sinus drainage that they have with allergies too. You'll see fluid build up behind the ear. But again, this is not an infection.

Host: Sure. Okay. We're going to take a quick break to talk about primary care at Riverside.

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So when should someone seek medical care for an ear infection versus trying home remedies?

Joanna Lambert: So especially with kids, and even adults, two-thirds of children will recover without antibiotics. What we do when we have patients come in, and this is really a conversation you're going to have to have between, you know, your provider and the parents and really come up with the best plan for these kids. But there is something called observational and watchful waiting. And you kind of have to fit a certain category to be able to qualify to do this. But children who are older than 23 months, they're immunocompetent, which means they just have a normal immune system, they don't have a history of these chronic recurrent ear infections. On exam, they're not having ear discharge, ear pain for less than 48 hours, their fever's less than 102.02, and their pain with the ear infection is managed with over-the-counter Tylenol or Motrin, they can do the watchful waiting.

Also, in this one, children between six months and 24 months, if they only have an ear infection in one ear, you can also watch them. This is harder. Because like I said, these kids aren't really going to be able to tell you, "Hey, my pain's more severe." And all that means is that what we'll do is watch these kids for 24 to 48 hours. If they improve, you don't need to give them an antibiotic. If they don't improve, then we go ahead and treat with antibiotics. And again, this is a discussion that you would have with your provider. A lot of times in my office, if this is something that the family wants to do, I go ahead and send the antibiotics so they have them. And that way, they can determine and not have to call back or anything. "Hey, my kid's not getting better. Let me go ahead and start the antibiotics."

And then, any child that's less than six months should be treated with an antibiotic. They're just too little.

Host: That makes sense. So typically, what causes the ear infections and are there certain risk factors that make someone more likely to get them?

Joanna Lambert: Sure. I think we touched based on this, ear infections are by far more common in children than they are in adults. And that is because of anatomy, honestly, in kids. So, their eustachian tubes don't function like ours. Their eustachian tubes are more horizontal, while an adult's will be more slanted. So when you have these upper respiratory infections and you have nasal congestion, runny nose, all of that is draining in your sinuses. And these kids, they have that horizontal eustachian tube. So, it's not draining, it's just kind of collecting behind that eardrum. And that is a perfect environment for bacteria. They love warm, moist, dark areas. And hence, the ear infections that are common in kids.

The other reason, and we see this in the little littles, like your infants and toddlers especially is because they have developing immune systems. So, their immune systems are just coming into contact with all these pathogens, these viruses circulating, their immune systems aren't used to fighting off so many. So, they do get sick. I feel like a lot more frequently, I know with my-- when they were young-- toddlers, I know daycare, you feel like your child's sick every other week. You get over one illness and then two, three days later, you're like, "Why is your nose running again?" But that's just because they have this developing immune system.

Children that are also like I said-- I kind of touch based-- but like in daycare, preschool programs, it's just they're around other kids, they learn to share and they share. And kids around like smokers, smokers in the house, that does increase that risk of developing ear infections as well.

Host: Okay. Does gender play a role in it at all? No. No. I was just curious. My mom always tells a story about how I have two older brothers and they would get ear infections all the time. Like, that was their sickness. And then, I never had one growing up. And she's like, "I don't know if it's a boy thing." I dunno...

Joanna Lambert: If you're an inanimate, your eustachian tube must have been more slanted than theirs.

Host: I was just the best, you know. So, are there things that parents or adults can do to maybe help prevent the ear infections?

Joanna Lambert: Sure. So, there's going to be a difference like in your infants when they're bottle feeding, you never want to keep them laying flat. You do want to kind of elevate them a little bit, avoiding the smokers in the house. We do talk with parents, especially if you have kids, young kids in there, that are asthmatic as well, this goes for them. But smoking outside of the home, making sure when they come back into the home, I always say, you do really want to change your clothes because you're going to snuggle the kids. You pick them right up and all that smoke's on your clothes. Avoiding long-term like pacifier use or like prolonged use during the day. So, sometimes telling the parents, you know, "You can maybe take that pacifier away when they're up and walking around, they don't need it." Just using it for like soothing when it's time for bedtime.

Breastfeeding younger babies, that does provide antibodies in the breast milk and that will help prevent it. However, I mean that's only if the mom can breastfeed. In older kids, it's going to be similar to preventing getting upper respiratory infections, which is just a difficult thing. But there are things you can do. Good hand washing. Teaching kids to cough and sneeze into their elbows. If they do cough and sneeze into their hands, yeah. Making sure they get to the bathroom and wash their hands. Trying to keep those toys disinfected at like the preschool, daycare settings. And again, I know that's so hard because they're playing with each other and they're sharing. I'm just trying to keep them away from sick people when you know they're blatantly sick. And that's another hard one because we're coming into the season where it's getting colder. We're all going to be inside together. And a lot of times, these viruses are super contagious right before you come down with symptoms. So, it spreads pretty quickly.

Host: That makes sense. For children or adults that might experience these, like reoccurring ear infections, are there next steps? Are there like kind of long-term treatments or referrals to specialists that can help them out?

Joanna Lambert: Yes. So, we do get kids that it seems like they get these recurrent ear infections. It's every other month, you're treating them with antibiotics. At that time, we do sit down with the parents and say, "You know, it's been six ear infections in six months or six in even a year." But getting them to the ear, nose, throat specialist, that will be the referral we'll place. That will be a consultation they'll have with that ENT and deciding if they're going to get tubes in their ears. Tubes in the ear prevent these reoccurring ear infections. They're great at what they do. It allows for drainage out of that ear as well. Like, the kids, they're not bothered by these tubes. I've had two adults that have had tubes, they could feel it in there. And children just never come into the office complaining about it.

Host: Are they permanent or...?

Joanna Lambert: They fall out.

Host: Oh, okay.

Joanna Lambert: They will eventually fall out most within two years. Gotcha. And then, a lot of the times they don't get them back. We'll just kind of watch them to see if these infections keep reoccurring. But by then, they've grown and things are a little bit different, like the anatomy. So, sometimes it just resolves the problem.

Host: Yeah. Well, that's awesome. I feel like we've really touched on all the different things. Is there anything you want to mention that we didn't cover?

Joanna Lambert: I guess the only other thing we talked about, like, watching for ear infections, on that other hand, there are certain groups of kids that you don't want to do that watchful waiting for. These would be kids six months and older with like severe ear infections. They're complaining of severe ear pain. They're not managing that with over-the-counter Tylenol and Motrin. Their ear pain has been now present for like 48 hours or more. Their fevers are running 102.02 or higher consistently. If anytime on exam we see ear discharge, there's a good chance that that eardrum ruptured, they need to be treated right away. And then, kids that are six months to two years, if they have an ear infection in both ears, they need to be treated right away with antibiotics.

Host: Yeah. If the eardrum ruptures, is there something different that you have to do to treat that?

Joanna Lambert: We treat them with antibiotics. And the eardrum should heal itself. A referral to ENT depending on what that looks like on exam, but yeah.

Host: Great. Well, thank you so much for joining us today.

Joanna Lambert: Thank you for having me.

Host: Of course. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.