Hi. I’m Dr. Jared Nielsen here Heber City, Utah. I’d like to talk to you today about the importance of children’s health care. Specifically, we’re talking about the ears and the importance of protecting the ears, and then what to do when a child experiences an ear infection.
Whenever you look at the child’s ears, especially in the newborn, the toddler, we really need to make sure that the child is responding to sound. A newborn infant will respond more quickly to sound even than before their eyes begin to track. Simple things like snapping to just see if their head will turn toward the source of the sound is a quick way for parents to be able to reference, “Does my child hear?”
It’s often missed, because the child may not make audible sounds or simple cries that would be indicative of a hearing loss as the child matures or grows.
The sounds that typically a baby would make of the ‘ooh’s and ‘aah’s, may still be made even to the child that can’t hear well. Again, the parent may miss, but then, as developmental delays in speech become more apparent, that hearing may be we’re missing the ability to actually communicate.
As you see here your newborn child or you look at the developing child, please just take a moment and make sure that they’re responding equally with their head responding to the source of the sound. If you suspect a child has an earache, often they’ll tug at their ear or be fussy. It’s difficult, at times, to ascertain is this really an earache or an ear infection.
A simple test is to just touch in front of the ear or just behind the ear very, very gently and see if there’s a withdrawal response or a fussiness associated with that. If there’s pressure in that ear, the child will often respond adversely or directly to that. Because there’s often a fever linked to ear infections or earaches, the child may, then, have that irritation.
Commonly, it may be misconstrued because of the teething that’s often associated with that timing. Again, evaluate if the teeth are trying to erupt. If you can determine is this more ear versus sensitivity on the gums. That can give us a good window into which direction do we need to go.
When you look at a child that has an earache or an ear infection that’s actually been diagnosed, we can take a moment and look inside the ear with an otoscope. That’s a clinical responsibility that we have.
When looking in the ear, for those who are clinicians or even parents who’ve had some experience looking in the ear, you always hold the scope and look into the ear from a direction as if the canal would come at an angle toward the opposite jaw. You’re looking forward and slightly downward to determine that angle.
When you look inside of the ear, you’ll see the eardrum. If we were looking at the eardrum from the right side – actually, me mirroring you – let’s say the left side now. Your left. As you look into that left side, what you should see is that the ear itself will have a presentation where the membrane or the tympanic membrane should have a grayish color to it.
Right in the center will be a little ossicle, or ear bone. You’ll see this little raised bump there. There should be what we call a cone of light that’s a reflection. When the light shines into the ear, there will be a cone of light that’s directed forward in the ear. In other words, you’ll see what looks like a little triangle, or a cone, that points forward in that canal.
It gives you a quick reference. As you look into that ear, you should see a cone of light. Even when you’re with the pediatrician, ask him, “Did you see the cone of light?” If he can’t see that cone of light, if there’s pressure behind the ear drum, it’ll push the eardrum forward and you won’t see that clearly demarcated light reflection. That indicates pressure behind the eardrum.
Also, when you look into the ear canal you’ll see redness and irritation that can be noted as otitis media, or the middle ear, or otitis external where you see this inflammation outside of the ear. More commonly associated with a swimmer’s ear.
When the pressure builds up behind the year, also asking them, “Do you see bubbles behind that tympanic membrane?” which is indicative of fluid in the ear. Commonly, though, what we see is that the pressure has built up in there, and it’s not able to equalize. The anatomy of the ear itself, you have the ear, the external ear. Then you have the ear canal.
Then you have the tympanic membrane. Inside or behind that tympanic membrane are three small bones that, actually will then oscillate based on concussion of waves that hit the tympanic membrane, and then give a reflex to the internal ear that gives us the sense of hearing. Also associated with that inner ear is the ear canals that have to do with our sense of equilibrium or balance.
It’s a righting reflex. If you notice a child that has a severe ear infection, they may even be tipping or feel off-balance. That type of an inner ear congestion is linked as we go beyond that canal to what we call the eustachian tube.
The eustachian tube is an equalizing pressure mechanism that allows an open channel of communication for drainage to occur from the back of the ear into the back of the throat. As you look into the back of the throat, you’ll see what we call the pharynx, or the uvula, hanging down. Behind that are the pharyngeal arches. Referenced behind that are the tonsils.
If you open your child’s mouth and have them say, “Ah,” the tonsils should be hidden behind the palatal arch or pharyngeal arch. We grade the tonsils if they start to peak out behind that arch. Here’s the arch. We start to grade it as a one, a two, a three, or a four, breaking that canal up into four regions.
If it gets more and more swollen, then once we get to a four the tonsils will almost kiss, or, in other words, touch to where it feels like it’s blocking the airway and, also, the ability to swallow. What’s very interesting is, again, you view that tympanic membrane from the observation of looking into the canal.
If you don’t see the cone of light, then the eustachian tube is likely blocked. Either the retropharyngeal tonsils, those tonsils behind may also have tonsillar tissue that’s adjacent to that, will block off or squeeze down that retropharyngeal space where the eustachian tube comes in.
This will give that sound that some people have noted almost like a clicking sound when you swallow or try to open your mouth and you hear a little click, click sound. As those tonsil tissues and that retropharyngeal space is opened, it will make almost a kissing or a clicking sound.
When you observe that presentation, that eustachian tube will fill up with a waxy type of a material like a blockage that we consider either not truly wax but more of a mucus type of a blockage. Some researchers and some pediatricians or clinicians will refer to that as a glue ear, meaning that wax or that mucus will start to create a plug in the eustachian tube.
That will back up and that’ll create pressure inside the ear that doesn’t allow it to balance. This is the little child that screams when the airplane is landing. You hear that little child in the back of the plane that’s just screaming in pain and the mother can’t seem to console it.
The child’s in a tremendous amount of pain because the eustachian tube that we could simply chew or clear our ears with as if we were going deeper in a swimming pool…You can clear your ears because those eustachian tubes [inaudible 26:21] are open. When that blocks off or that gets stuck together because that’s kissing so tightly or there’s a glue ear, then we see that that child’s in a lot of distress or discomfort.
The tonsils are actually a manifestation of the entire system. A lot of people think, “I just have tonsils here in the back of my throat,” or, “I have adenoids in my sinuses.” The reality is our whole digestive system is lined with these lymphatic tonsils, if you will. The tonsils here, in the back of the throat, are a reflection of what’s happening in the body. Most children that have food sensitivities will develop glue ear.
The most common thing that we see as an irritant for that is when the young child has begun too soon on dairy, particularly cow’s milk.
What will happen is the GI system will develop an irritation or antibodies against that, which causes inflammation in the lymphatic tissue throughout the GI system. Then, it will manifest as inflammation in the back of the throat. You’ll see that child has a lot of phlegm. That phlegm can build up, if you will, or that mucus will build up into that eustachian tube, causing then the glue ear.
One of the first recommendations, when you see a child is in immediate distress associated with that blockage, we want to get them off of dairy for a minimum of two weeks to allow that tube to open up again. Even if they don’t have a true earache but they can’t quite open up those ear canals or get that balancing system righted because of the pressure.
The next thing that we look at is when you are aware that there is a fever with an earache. Most commonly, ear infections are associated with a virus, not a bacterium. The nice thing to differentiate in that is, again, the fever. The treatment, then, is not the antibiotic.
The pediatricians now have acknowledged that the antibiotic used for ear infections has been way over-prescribed in years past and, consequently, will lead to other consequential infections.
There are a couple of homeopathics that are very, very effective up-regulating the immune system and targeting viruses that commonly afflict the ears and will cause that fever and the red inflammation associated with the ear infections. Many times, pediatricians still will offer antibiotics, more as a palliative effective.
It quickly does reduce the inflammation and allow the child to begin to recover. Because they feel a relief of the symptoms, they can begin to eat again. The challenge, though, is when we introduce the antibiotic too soon in the child’s life, we create an antibiotic resistant strip or staff infection. This is where most adults will say, “Yes, I did have a lot of antibiotic therapy.”
When you look in the adult or the teen child, you’ll see large tonsils that have what look like craters of the moon presentation. They’ll develop little, white stones. We call them tonsilloliths. They smell horrific because that’s actually an old staff infection that’s antibiotic resistant, and it’s pushed deeper into the system. The body uses those tonsils as a means to push that out.
If that’s a case that you’re dealing with, there’s a simple supplement that we use from Standard Process called Congaplex. Congaplex has a great benefit in the adult who’s had this history of chronic ear infections to eliminate that type of an infection. When we look at staff infections that are old and antibiotic resistant, their number one pal becomes the strep infections.
When you look at the child that gets this recurrent streptococcal infection or strep throat, it’s interesting because typically they’ll have been precluded by some type of an ear infection that’s been mistreated with the antibiotic prematurely. Now, we have an antibiotic resistant staff, and it’s companion becomes the strep infection.
Now they’re on this cycle of an every three to six month antibiotic through their toddler and into their young pediatric life up to age eight. Then, commonly, what ends up happening is the tonsils are removed because of the kissing tonsil presentation and the recurrent strep throat.
The challenge in that is just because we’ve eliminated the tonsil doesn’t mean we’ve eliminated the infection. The adult may continue to manifest a myriad of health concerns. The biggest thing that I see consistently is when we have tonsils and adenoids removed is we develop lower and upper GI distress. Commonly, food sensitivities.
This is where we start to see more consistently, again, the dairy sensitivities, the gluten intolerances or grain intolerances, and then the other intolerances that lead to leaky gut. As you’re looking at your child, think proactively. What are the things that we’re feeding them in order to assist their well-being into life and into adulthood?
What are some things that we could do to actively engage their body in healing rather than trying to take care of, in the moment, their immediate distress? Always a child should be alleviated of their pain. That’s one of our greatest responsibilities as parents. We want our children to be comfortable. Tylenol’s, according to pediatricians now and acknowledge by the pediatricians, Acetaminophen as the Tylenol chemical formula impairs liver functions.
We should remove Tylenol from our home first aid kits. Ibuprofen, if you need, is a better choice to be able to treat that fever if you need or to reduce the pain or de-stress the child. There’s also a drop you can use, Echinacea Hydrastis, to be able to reduce fever.
That really is effective at helping to monitor or regulate fevers. When we look again for the child who’s in distress, we want to check their temperature. We want to make sure that their temperature is within an appropriate range.
A simple temporal thermometer, excellent to be able to quickly evaluate the child’s temperature. Keeping your child’s temperature, remember, below 104 is really a healthy temperature. A lot of people are surprised that, again, 104 degrees is safe for the child. A sustained temperature above 106 for greater than four hours is really a concern, but up to 104 is safe.
A lot of patients or parents will say, “I’m not comfortable with that.” Using even a temperature marker of 102 or 103 drops that range back to a safer target. When you look at that, the baby’s temperature at 102, the baby is not in distress or in any distress or potential neurological injury.
In summary, let’s talk again. Parents, when you’re looking at your child, make sure that your child is able to hear, respond to the source of the sound. If your child is actually in distress and you’re not certain, because, again, young children who are reaching the teething age or teething stage, check their gums versus gently checking in front of it or behind the ear to evaluate if there’s a withdrawal response because of the pain that’s maybe there.
When looking inside the ear, ask the pediatrician, did they see the cone of light? Is there so much pressure that that cone of light now is flattened and you don’t see it well-demarcated in the ear or if there’s actually fluid behind the tympanic membrane or ear drum itself?
Remember that Eustachian tube that comes to balance or allow pressures to be regulated in the back of the throat to the ear canal itself is called the Eustachian tube. That Eustachian tube can often be blocked by inflammation associated with the virus, can chronically be blocked by a food sensitivity and most commonly find that to be dairy in the young child.
Eggs are common with that also. In developmental states, there may be some other things that could develop some food sensitivities but then we’d be looking more for the eczemas or the vomiting. When we’re looking at the Eustachian tube and the condition called Glue Ear, we actually are looking at a more common allergen associated with dairy.
I recommend two weeks off of that dairy for the child to be able to recover. If they have a true sensitivity, maybe, longer. For those parents, who even in themselves, know that in past, they’ve had a long standing infection, we recommend Congaplex for the adult. This one is just a swallow-able capsule versus in the young child who may have had the history of ear infections but still can’t swallow a whole capsule.
The chewable Congaplex is potentially a means of helping to eradicate the antibiotic resistance staph infection with its co-infection of strep. We use those together again for approximately 90 days. As you consider again, “Is my child in distress?” Remember more often the ear infections are caused by virus not by antibiotic.
Fever is the best means of allowing that body to actually eliminate the viral infection. A safe target range, 102 to 103. 104 truly is safe, but we’ll want to keep in that target range.
If you want to set an upper limit of that goal, once you’ve checked their temperature and you monitor that, with that staying in that 102, 103 range if you feel safe there. 104 again safe. 106 that’s kept under a duration of four hours is still a safe range.
I’m Dr. Nielsen. Thanks for taking the time to listen to this and share this information with you, and your family, and your friends. Have a great day.