In this weeks episode of Ask Dr Jessica, pediatric ENT Dr Ali Strocker joins and she gives many helpful tips to help your child's ears stay healthy this summer. We talk about how to help prevent swimmer's ear, how to best handle ear wax, and how to help the ears stay comfortable during travel. Thank you to Dr Strocker for sharing your wisdom!
Dr Stroker is an ENT, specializing in children of all ages with ear, nose and throat problems. Dr Strocker received her medical doctorate with high honors from the UCLA School of Medicine in 2001 and was inducted into the Alpha Omega Alpha honor society . She completed a residency in Otolaryngology-Head and Neck Surgery at UCLA. Dr. Strocker was an assistant clinical professor of Otolaryngology-Head and Neck Surgery at USC-Keck School of Medicine and has been an attending surgeon at Children’s Hospital Los Angeles.
She is currently works in private practice in Tarzana, California. For more information or to schedule a visit with Dr Strocker, more information can be found on her website:
https://socalent4kids.com
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com
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Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.
The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
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Transcript
Episode Transcript
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Unknown (00:00):
Hello and welcome to ask Dr. Jessica, the podcast
(00:03):
that discusses common paediatricquestions answered by experts.
So Summer is here and withsummer I get many questions
about the ears. Whether it beabout swimmers Ear, ear pain
from travel, or even ear wax. Onthis week's episode, I am joined
by a wonderful paediatric Ear,Nose and Throat specialist, Dr.
Ali Strucker. I'm excited foryou to hear her words of wisdom
(00:25):
on how to best protect yourchild's ears. Also, if you know
anyone who may benefit fromhearing this information, please
send it along. Your support iswhat helps this podcast grow.
Thank you for listening. Hi, andwelcome to another episode of
Ask Dr. Jessica I have awonderful guest today Dr. Ali
Stroker. She's an e and t andshe practices very close to
where I work. And I'm so happyto have her here. I have so many
(00:48):
patients that see her andthey're so thrilled with the
care that she offers. So how areyou Ali? Nice to have you here.
Thank you for having me on theshow. And I'm very excited to be
here.
Tell us about what you do.
You're a paediatric anti. Whatdoes that mean and who do you
treat?
So being a paediatric VNT meansI finished my full end residency
(01:09):
and then subsequently did afellowship to specialise in CARE
for Kids. So my whole practiceand my whole office is based
around kids from newborns, I'dsay till 18. But honestly, it
goes well on beyond that tillabout 25 years or so. Because
kids have different needs arenot just small adults as as you
know, as a paediatrician ortheir needs are very specific.
(01:32):
So we have extra training andtaking care of them. And also
just extra care given to thepatient and to the parents.
So I was thinking With summercoming up, there's a lot of
questions that come up aroundchildren and protecting their
ears, between going in the pooland being on vacation travelling
on aeroplanes. So I wanted toask you about how to protect our
(01:54):
kids ears. So the first thingthat comes up a lot is swimming.
Children tend to get aninfection called swimmers ear,
sometimes they get water intheir ears. Do you have any
general advice for parents onhow to protect their children
when they're swimming?
Um, yeah. So as we move into thesummer season, it's something
that I started to see a lot as akid start swimming every day a
(02:15):
few times a day. So yes, watertends to get trapped in the ear
and the outer ear canal. Andbecause your ear canal is dark
and warm, it's a perfect spotfor bacteria to grow. Especially
if kids have some ear wax intheir ears, it tends to sort of
give them like a food and thenyou have the kids aren't really
scratching at the year whichintroduces some bacteria, and
(02:36):
then you get swimmers ear. Soone of the best things I tell
parents as long as the child'seardrum is normal. So it's not a
child who has tubes or a hole intheir eardrum is you actually
can use either the over thecounter swimmers ear drops,
which are actually almost purealcohol and that dries the ear
out. Or you could actually makeup a mixture on your own of
half, rubbing alcohol and halfwhite vinegar and put a couple
(02:58):
drops in after the day ofswimming. And that'll dry the
ear and re acidify the ear canalprevent the swimmers ear.
Honestly, I usually recommendthat to kids who are getting a
lot of swimmers ear because noteverybody gets it. But if you
have a child who's getting it atleast once a summer, that might
be something you want to do sothat your child doesn't have to
have a summer of pain.
So just to clarify, you wouldtake over the counter swimmers
(03:21):
ear drops or you'd make aformulation from home. And then
you would put a couple drops ineach ear right after swimming
and for how long would the childhave to stay on their side with
the drops in. Um,so I typically say just do it at
the end of the day because rightmost kids are in the pool and
wonderful out of the pool sothat every time they come out,
that would be a lot but at theend of the day when you're done,
you're packing up to go home oryou're gonna go inside from
(03:42):
swimming pool in your backyard,I would have them kind of lay on
their side or lay across yourlap, pull back on their ear, but
about four or five drops in, rubit around and then tip their
head over and let it drain out.
They don't need to stay therevery long actually want it to
sort of wash the ear canal anddrain out to help dry it out.
And that should be all you haveto do.
(04:03):
And what about hydrogen peroxidethat's a popular one that people
use is that as helpful as well.
Hydrogen peroxide is good forbuilding with excess earwax. So
if you're if your child tends tohave a lot of earwax, it is
something you can use it issomething probably be used
pretty regularly because it justsoftens the earwax. If you have
a big mound of earwax and yousoften it guess what it just
(04:23):
slips into the ear canal. But ifyou if you notice your child
tends to be about a year Mexiaonce a week it can put a little
hydrogen peroxide and use it tohelp the earwax come out. Again
I would caution you make sureyour child doesn't have your
tubes or a hole near thembecause otherwise those things
will burnthat's a good cautionary
reminder. Now what about signslooking for an outer ear
infection or swimmers ear whatwhat signs tip you off that
(04:45):
child may may have swimmers earyeah so um your outer ear
infections and swimmers you'revery different than say them
from middle ear infections. Sothe way that we can kind of tell
a lot of times just by talkingto some before I even touch them
is onset so to Typically they'vebeen swimming a lot or in the
water, the lake, the ocean, someof that. And then it's really a
lot more pain on the outside ofthe year. So when you have an
(05:06):
outer ear infection, likeswimmers ear, the ear canal
itself swells, and thentherefore the outer part of the
child's ear gets very tender aswell because it's all connected.
So kind of tell us what you meanby gently pulling on their outer
ear. And if that hurts, that'susually a sign that there's an
outer ear infection, middle earsactually hurt more internally,
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so the child might complain inthe back of the head or deep
inside that separates the twoof those. Okay, and then just to
distinguish a clarify middle earinfection, what typically causes
a middle ear infection.
So middle ear infections tend tooccur typically after the
child's had some sort of cold,so you get a cold, you get
swelling in the nose and nasalcavity, the Eustachian tube,
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which was what drains yourinternally on the other side of
the eardrum, that part thatEustachian tube gets blocked,
fluid backs up into the middleear space. And that's the middle
ear infections. That's the oneswe see a lot of during the
winter, some of the summer aswell. But when we get to all the
kids are getting all theseviruses that are bombarding us,
that's when we usually see themgetting ear infections.
That's a great explanation. Ilike to distinguish the two
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because I think it's confusingfor parents, especially because
with with middle ear infections,we prescribe antibiotics. And
for swimmers ear, we don'tprescribe oral antibiotics.
And that's a very good point. Somiddle ear infections must be
treated with an oral antibioticbecause between the outside of
your ear canal and your middleear space, you have your
(06:33):
eardrum, so anything you put onthe outside is not going to get
in there to treat that middleear infection. middle ear
infections hold middle earswollen eardrum swelling, you
got it, you gotta go internallyand treat that with oral
antibiotics. outer ear infectionis very different. You actually
only want to treat with dropsand 99% of the time because the
drops when I locally treat theinfection, and usually actually
(06:55):
oral antibiotics don't work verywell. So it's only really severe
cases where the infection isactually starting to spread we
get some called cellulitis wherethe whole ear canal and outer
ear is infected. That's the onlytime we used to do oral
antibiotics because most thetime the drops are gonna work
great.
Okay, yeah. So so and just tobring that up, you said drops
what what typical drops canparents expect as treatment for
(07:16):
swimmers ear infection.
So this is definitely somethingif you think your child has or
your need to go see yourpaediatrician or if it's really
severe and come see us. So weusually use typically we use
something called superdex.
There's a couple of variationsof that, which is ciprofloxacin,
antibiotic and a steroid. Thesteroid is actually very
integral because it helps bringdown the swelling and gets the
antibiotic to work. And there'sthey have a couple other
(07:39):
steroids as well asCiprofloxacin with trying to
sing along. It's all the samething. We're basically an oral
ciprofloxacin, which is reallygood for the ear canal and to
treat the ear canal infectionand the steroid to bring down
the swelling.
It's great. And so can childrenexpect to feel better pretty
quickly after taking the the eardrops a superdex?
(08:01):
Yeah, I would say typicallywithin 24 to 48 hours they
should feel relief. So as soonas as soon as you get into see
your paediatrician then youstart the drops, they usually
within about a day or so startto have some relief as that
swelling comes down. The reasonwhy it's painful, you have a
swollen ear canal in his bonyspace. Now, the reason I said is
if it's really severe, sometimesthe paediatricians will send
(08:21):
children to us because a lot iswe actually have to clean out
the ear. If there's a lot ofdebris filling the ear canal,
that's where I come in, I have amicroscope and suction to clean
out that stuff. And then reallysevere cases, the ear canal will
swell shut. And we have to putwhat's called a Wiccans a little
cotton piece goes down in theear canal helps open that you're
gonna also get the drops justlike a candle that helps the
(08:43):
drops to get down to the deepestpart of the ear canal. Wow.
Got some good tricks. Okay. Nowa couple common questions that
parents asked me with regard toswimmers ear. The first one is
sometimes parents have troublegetting the drops in their
children's ears, the childrenare either in pain, they don't
want to sit still, do you haveany advice to put in ear drops?
Yeah, it can be challenging,because part of that is
(09:05):
evolution before you have toactually pull back on the ear
itself to try and get the canalto open up. And if it doesn't,
then that's when you know thecanal drops won't get down to
the deepest part of the canal.
So gently, you've gently pullback and then do have to rub a
little on the fret. Now a lot oftimes what I'll do with a older
child, let's say maybe five orsix years old is ask them to rub
it for you. So to have themeither take their hand or then
(09:27):
and show them and they can rubit around. That rubbing that
kind of pumping machine gets thedrops to go further down in the
ear canal.
That's a great tip. That's agreat tip.
And now it's not perfect, it'sstill it's still be
uncomfortable. And they can usethings like Motrin and Tylenol
for that first 24 hours whilethey're still having a lot of
pain.
I've also heard that you can puta cotton ball in the ear canal
(09:48):
and put the drops onto thecotton ball so that the child
feels a little more comfortableas the as the moisture gets into
the ear canal.
You really gotta make sureenough, enough drop As you're
getting down there, so I mean,you could sort of leave the
cotton ball there afterwards, wereally got to make sure you're
kind of saturating it. And andthe other thing is, if you're
their parents are really havingtrouble as those drops are not
(10:10):
going down, they're pooling thatmight be cut time to come see me
to clean out the ear and maybemaybe even need to work. If it's
a really blocked, it doessometimes happen. It's not and
you're able to get those drops,and you kind of slowly the other
thing that we sometimes dorecommend is warming the drops
up a little bit, put in yourpocket, and sometimes that feels
(10:32):
better. And it's not so cold tothe bodies a lot warmer,
especially that ear canal isgoing to be hot with the
infection. That might feel alittle bit better for them as
well.
Yes, or I'll say like rub, rubthe drops in your hands. Warm it
up that way. Okay, that's a goodtip in the pocket. I like it.
And I appreciate you saying thatabout the cotton ball. Because
you're right. You have to becareful that you're getting
enough medication into the earcanal.
(10:52):
Yeah. And otherwise, you'llyou'll end up saturate the
cotton ball drops. Soabsolutely, yes, yes. Miss the
treatment. Okay, another commonquestion I get about swimmers
ear. Now, a lot of these kidsare avid swimmers and parents
want to know, when is it safefor them to get back into the
pool.
So you need at least probablydepending on the severity, the
(11:12):
infection, at least probablygood five days on the drops,
trying to keep the ear dry, thatyou're still draining a lot. The
drops are struggling to get in,you're going to try and have to
keep that air dry once the dropsare going in pretty easily. And
Charles no longer having a lotof pain, you could probably
start to resume swimming again.
Okay. Okay, so on average, you'dsay about five days,
yeah, I get depending on theseverity, most employees need to
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follow up either paediatricianor with us and make sure that
things are getting better, andlooking good and that you can
resume swimming.
There's nothing worse than whenyou tell a kid they can't go
swimming, and they're about togo on vacation, or that they
can't get their head under thewater they look at you like give
them the worst news.
It is heartbreaking. And that'sone thing too, if you you also
find your child gets a lot ofear infections, a lot of times
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I'll have patients come to seeme in June before swim season
starts, let me clean out the theear canal, let me get that ear
wax out. So because a lot oftimes again, that your wax traps
the water in there. So thosekind of kids, it might be
beneficial to have a good earcleaning at the beginning of
summer, hopefully decreasing thefrequency of swimmers ear.
Okay, so this is really helpful.
I mean, while we're on the topicof ear wax, maybe we can talk
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about this a little bit more,because I do get mixed messages
on on earwax and when to when toleave it alone when it might be
harmful for kids. So can we talkabout ear wax? What what is your
general feeling on ear wax? Andwhen does it need to be taken
care of.
So your wax is normal. It'sactually the ear canal is
(12:41):
protective mechanism. It's likethe oil on our skin. Some people
make a lot. Some people don'tmake very much at all again,
just like oily skin and dryskin. So it's in general ear wax
is not a problem. And I tellparents, you can clean the ear
the outside part of the ear andjust at the opening of the ear
canal does every parentespecially the Moms always want
their kids to be totally clean,right? No one wants to see the
(13:04):
wax on their kids. But don't besticking the Q tips down into
the ear canal on. And the reasonfor that is most of the time
people want to pushing the waxin deeper and scratching the ear
canal and then setting them upfor an ear infection, outer ear
infection. So clean the outsidepart. If your child is one who
has a lot of earwax inpaediatrician will clean in
their office, if it's reallybad, they'll send them to us
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we're happy to clean ears. Itdoesn't it doesn't usually have
to be removed except for thefact that two things one it
makes it hard for us to seeright you have to see the
eardrum you know if this childhas an ear infection, we need to
clean the ear for that. And theother part is if the ear is very
full of wax, yes, sometimes thatsets them up for things like
swimmers ear because that wax isgoing to trap the water and and
it's frustrating. If you everhad a lot of ear wax, get some
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water and you can't hear becauseit swells. So if your child has
truly excessive earwax, thenwe're happy to see them and
clean their ears. I havepatients who come once a year
some patients come every sixmonths or so every three months
if they really have a lot. Soare there are there ways to
remove wax from home?
Yeah, so if your child has, youknow, tend to have a lot of
(14:10):
earwax, you can use things likedebe rocks, which is an over the
counter drop. It's actually amixture of hydrogen, hydrogen
peroxide, and some oils,basically to soften the earwax.
The same caveat I mentionedbefore, you have to use those
pretty regularly. If you have alot of wax and you put that in
it softens it and most of time,it just loops down onto the
eardrum and then the ear canalis full. So I tell people if you
(14:33):
want to use it once a week,remember maybe every Sunday bath
put put that in before the kidsbath. And that will keep the ear
wax softer and coming easiercome out. Some kids also just
have very small ear canals andthey're more likely to have wax
get trapped. And again, that'sthe kind of patients we see
we're using our microscope andable to clean the ear canal and
visualise what we're doing whilewe're doing it.
(14:54):
So just to sort of clarify andhow deep rocks works, parents
put the drops in once a week andthen that your wax will soften
and sort of fizzle out and drainon its own.
Yes, exactly. So same sort ofmechanism of applying the drops,
you put it in at the start ofthe bath, kind of rub it around,
and it'll start to loosen it up,you might not see a big chunk
come out. But again, this issort of maintenance, you would
(15:15):
do this all the time, and it'lljust soften the wax. And if you
see stuff come out, then yes,cleaning the outside with either
a Q tip or a cotton ball.
Okay. And when a patient comesto see you for earwax removal,
what can they expect? How do youactually remove the earwax.
So we unfortunately have amicroscope in the office and a
little exam bed, we lay the kiddown, we actually decorate our
(15:37):
ceiling with stickers, we givethe kids something to look at
while they're lying on theirback. And then using the
microscope and which allows meto use both of my hands, I can
gently touch the ear, outer earand usable either a curate,
which is like a little tinyscoop, a little spoon or a
suction to basically remove thewax that way,
it's great that you can seethe visualisation using a
(15:59):
microscope, which really givesme both eyes but looking at it's
a lot easier than trying to doit with just an otoscope. So, or
ever.
Do you ever ear flush,I don't ever flush the years, I
actually kind of hate it. Ithink it's uncomfortable for the
patient. It's usually like thisrush of water in the air, they
don't like it. And the otherthing is I've seen kids get
(16:19):
either traumatised from doingit, but also trauma to the ear
canal. So sometimes you can getactually get an ear infection
from all that water or the orthe syringe irritating the ear
canal. So I like to just do itdirectly visualising what I'm
doing, using the scoop, we'reusing a section depending on the
quality of the wax, and usuallycan get almost every kid get it
all at one time, sometimesreally severe cases, I'll have
(16:40):
parents do some deep rocks for aweek or two and then come back
to the last little bit. Butthat's pretty rare that that
happens.
That's great to soften it aheadof time. Yeah. And then come
see, you know, I agree you'reflushing we you know, we do have
an ear flushing. We do have earflushing equipment here in the
office. And it works. Butparents, but a lot of times kids
don't like how it feels theyfeel a little dizzy afterwards.
(17:03):
So I'm glad that you have a moreexact method.
And it's you know, it'ssomething relatively simple for
us to do. And we're happy to doit, we're happy to have that
service for people to come in.
It's safe and it's clean. Andkids usually do very well with
it, get their lollipop on theirway out and are happy
just to clarify a myth. A lot ofpeople like to use the ear wax
(17:26):
candles to get wax out. Doesthat actually work? No, you're
right, that is a myth. Sobasically, when you use that,
like people say, Oh, I see stuffcoming on the paper. Well, it's
the wax and maybe the front ofthe candle, excuse me that and
then maybe a little bit of waxfrom the inside, but you're not
really getting it out and therisk of burn injuries and just
(17:48):
it's ineffective so thatpatients a candle in their ear
canal still full of wax.
So what is it exactly? They puta candle in the ear?
It's like a little cup basicallypaper and then yeah, there's
like a little candle it sits inthere and candle wax melts down
and warms that year. And thetheoretical thought is it pulls
the wax out of the ear canal.
I've never seen it work and theidea of putting fire that close
(18:12):
to a child's ears is petrifyingto me so
well, thank you for clarifyingthem. And I there's a lot of
people that swear it's helpingand I think just visually they
see what they think is wax andit's not. Right. Right. Okay,
thank you so much for that. Allright. So so so I guess the big
take home message is if you havea lot of earwax, I would
(18:33):
definitely go see your end. Yes.
Or you can try debe rocks firstand then see your end. Okay, now
question about travel. I get alot of questions about how to
protect ears, from pressure thatresults from aeroplane rides
from the ascent in the descentor from you know, from cars. If
someone's travelling up into themountains. Do you have any
(18:53):
advice for parents on how theycan protect their children's
ears from being uncomfortable?
Definitely. So children ingeneral have poor Eustachian
tube function. As we get oldereustachian tubes work a lot
better. It's why everyone who'sbeen on a plane and there's a
crying baby. And most of that isactually the change in pressures
(19:13):
is bothering their ears. Andthey can't clear their ears like
we can popping our ears andswallowing. So what I usually
recommend with little ones isbreastfeeding or bottle feeding,
especially in the descent. Sowhen we rise up in a plane when
you go that your pressureoutside is lower than it was
when you were down on theground. So the pressure in your
(19:34):
middle ear actually drains out.
It's not it's not terriblyuncomfortable as we come down
versus you go from low pressureto high pressure and that's
usually when the eardrum willnow get sucked in on that low
pressure. And that's when theyreally will cry. So most
important is trying to get thelittle infants on the breast or
the bottle for the descentbecause they're too young to
(19:55):
really understand your oldertoddlers and preschoolers Have a
little juice boxes, get them inthe airport, you can travel the
volume of liquid, but pick up alittle juice box, have them set
from Australia same thing thatswallowing really helps I tell
people, as soon as it plays,there's a good answer to have
them start taking sips all theway down until the plane lands.
Obviously older kids, you can dothe chewing gum and second
(20:18):
lollipops and those sorts ofthings. Again, the swallowing is
really what opens the Eustachiantube up. If your child has a
little bit of a cold whileyou're flying, you can use a
little nasal spray likesomething called Neo synephrine
was like aspirin. They have amild version. So again, it only
use that in the case of a childwho's actually sick. That'll
(20:39):
help decongest the nose to helpthat Eustachian tube as well.
Okay, and that child, you wouldspray in the nose. Yeah. For the
scent.
Yeah, so Exactly. So it's a longflight right before you said, if
you're doing a short flight,let's say from here to San
Francisco, or someone that youcould probably do it at the
start because that thosemedications lasts for a few
hours.
That's really helpful. Yeah. I'mjust thinking I remember many
(21:03):
plane flights where my ears feltso uncomfortable as a kid.
Yeah. And the boys were adultstoo. So if you're flying and
you're having too bad allergies,or a little bit of a cold when
you're flying, then yeah, youcan use a little bit like a
little spray bath. And that'lljust help unblock the the nose
and unblock the Eustachian tubefor the descend. But the real
key that I do every time I flyis I get a bottle of water in
the airport. And as soon as Ifeel the plane going out, I just
(21:25):
keep drinking because even evenas an adult that pressure is not
very comfortable.
So continued sips. Okay, you gotit. That's good. Yeah, and I
know sometimes patients will askme about taking medications like
Benadryl or I guess painrelievers can be helpful,
potentially. But yeah, you canuse some pain relievers. You can
use things like Benadryl or, butthey're really the thing is
(21:46):
like, would it have to be like aSudafed type of medication. And
we don't really love using thosein kids, or even in adults, for
that matter. So unless a childwas really sick, which hopefully
you won't be flying, anyhow,it's not really going to be very
helpful. If there are somethingcalled your planes that I know
some people use, it's basicallylike a little earplugs you put
in your ear, and some peoplehave really bad Eustachian tube
(22:09):
function just discovered thatthat actually helps a little
bit. It basically helps modulatethat change in pressure. So
there's not as much pull on theeardrum, probably not as you
can't use it on a baby ortoddler. But again, that the
older child who's 70 years oldand beyond who's still really
struggling with the pressure,you can you can purchase those.
(22:30):
Another question that comes up alot. Children will have ear
infections and parents areconcerned about the flight Do
you usually tell parents thatthey can't fly or can fly when
they have an ear infection?
So if your child has an earinfection, I recommend not
flying and I've actually hadthis happen with my own
daughter. Because when you havea middle ear infection so like
(22:50):
we're talking about this isdifferent than the outers,
people will come to me and theirtoes. Swimmers ear, can we fly?
Yes, you're gonna fly withswimmers ear, because that's the
outer ear, we're not worriedabout the eardrum in the middle
of your space. But if it's amillion infections or your child
had a cold, they got congested,boom, fluid got up in the middle
ear, it got infected. Whathappens is that Eustachian tube
gets blocked by the infection,your eardrum is now bulging,
(23:13):
almost like imagine a bigpimples, we have all this plus
in the middle ear that you'redoing bulges out. If you go up
in the plane that all thosepressure changes we talked about
happen, a couple of things canhappen be your gym can actually
rupture, the pressure gets sointense that your general pop
will elbow that sounds awful, isactually the best of all case
scenarios because the infectionwas venturing out into the ear
(23:34):
canal. But the bad scenarios arethat pus under pressure that
middle ear space can actuallybreak through the other way. So
you can actually injure youryour inner ear. And that
shouldn't can cause permanenthearing loss. It can also travel
upwards into the bone and rightabove your ear is your brain. So
we we see this every once in awhile kids will have infection
or up underneath the brain inthe sinuses, the little blood
(23:56):
vessels that drain the ear upthere. And they're they're life
threatening there. These arethings where kids have to get
hospitalised they have to getdrained. So if your child has a
new ear infection,unfortunately, no no air travel
until the infection resolves nowOkay, that's
good to hear. Don't want that.
Yeah, no, definitely get go seeyour paediatrician get on
antibiotics right away. Now,after a few days, when the
(24:21):
infection is now clear that pusis no longer under pressure, we
look we see we might still see alittle bit of fluid in the ear.
But we don't no longer see pusor red eardrum than it actually
is okay to fly your child mightbe more uncomfortable because of
the pressure there. But thatrisk I was describing where the
infection could spread orrupture the eardrum or damaged
the inner ear. That risk is nowgone.
(24:41):
So it sounds like it might be agood time to see your
paediatrician if you're not surebecause if it's slightly red or
there's not pus behind theeardrum, it sounds like it's
okay to fly. But if there'ssignificant fluid pass, don't
want to goback as well. But when patients
I sometimes end up coming to seeus with an active ear infection
three The antibiotics, you know,if you have a flight coming up,
(25:01):
or let me see you back beforethen, you know to make sure it's
resolved before you get on theplane.
Okay, no very helpful advice.
Now, speaking of keeping the earsafe, sometimes I'll have
patients very typically are moremore typically than then you
might expect or not you expectDr. Striker, but for people
listening, where kids like toput objects in their nose in
(25:23):
their ears. When children putthings in their ears, is that a
reason to see an end right away?
Or are there ways that parentscan try at home to remove things
from the ears? What's youradvice?
Um, so yes, it is actually quitecommon. We see this a lot. And
actually, my husband who's notmedical at all was shocked once
(25:44):
we were together, how frequentlyI got this phone call about
something in the ear orsomething in the nose. He never
realised that this was a thing.
But after being with me for ashort while he realised Yes,
this happens quite a bit, I seeat least a couple times a month.
Why kids do it. We don't knowthe whole there, right? It's
fun. It's interesting. Like,let's let's explore our bodies.
Most of the time, it's not anemergency. So what I would, what
(26:05):
I recommend is, wait, call usfirst thing in the morning, my
staff knows right away, we'llfind you a slot that same day
we'll get you in to removewhether it's from the ear or
from the nose, because most ofthe it's not going to go
anywhere, it's usually stuck. Ifyou go rush off to the ER,
unfortunately, you're gonna endup by sitting around obviously,
right? There's a lot of stuffgoing on in the ers right now.
(26:26):
It's not super high priority.
And the other thing is theydon't have the same equipment.
So again, I have my microscopefor the ear. For the nose, I
have multiple different devicesto be able to take whatever the
object is, usually it's a beador a piece of food. You get all
those things out. The onlycaveat the only time where I
tell people you really do needto go right away to seek medical
(26:49):
attention whether from erpaediatrician or something that
day is if it's a battery. Sothose small coin batteries,
they're a huge danger anywherethey go. But even in an ear
canal Orna knows that acidinside the battery can leak out
and it can damage the ear canalskin or can damage the nose, the
septum, the cartilage in there.
So if you think your child mayhave put a small coin battery,
(27:09):
that little disk batteries rightaway, see your paediatrician
come call us same day. But foryour child who maybe put a bead
in their in their nose. And it'sSaturday afternoon, you can
wait. Call us Monday morning andwe can get you in and get it
out.
That's great advice. So if it'sif there's a battery in the ear
(27:29):
and the nose, that's anemergency where you want to see
an EMT or go to the emergencyroom, but otherwise, it can wait
until your office is open. Yes.
Sounds like no, I have to tellyou there's so many times I've
been surprised where I'll do aroutine, you know, physical
examination, I'll look in theair and lo and behold, there's a
there's a Lego, or there'ssomething shiny or there's some
playdough so I'm definitely I'msurprised at how often things
(27:51):
are put in the ears or nose, butit is I mean, I will never
forget when I was in training upat all of you Medical Centre,
and there was we got this urgentconsult. There was a child that
they thought had a tumour in theear they actually even had done
an MRI and all the stuff and itwas very you know, small tumour
(28:11):
looking at your canal on I gotmy microscope and looked. I said
I got this and slid out and whatit was was a top of a little
pencil eraser, but no one hedidn't say anything. They had
gone for routine physical, thepink fleshy thing look like a
tumour, right, this wholeprocess of happen. The moms in
tears thinking her child's up,you know, I'm gonna give her
death, you know, like a cancerdiagnosis for a child. And then
I said, Well, here's, here'syour little eraser. And
(28:34):
obviously, there's no tears ofjoy at that point. But, you
know, it's funny that it is verycommon to put stuff in their
ears and nose.
That's why we love kids. Right?
Always interesting. It's alwaysinteresting.
Well, thank you so much, is anyany other words of advice that I
didn't ask you that you want tooffer any parents listening?
(28:57):
Um, you know, I think I canthink of anything in particular.
I mean, I do always say toparents trust their instincts I
they really never run, you know,go wrong. If you think there's
something wrong with your child.
It's your paediatrician. Comesee us directly. If you really
feel like it's your nose issue.
I think parents intuition isreally something remarkable. But
(29:20):
otherwise, yeah, I mean, I thinkwe've kind of covered all our
bases today.
Thank you so much. Thank you.
Thank you for listening to thisweek's episode of Ask Dr.
Jessica. If you are enjoyingthis podcast, it would mean so
much to me. If you would take amoment to rate review and
subscribe to the podcast. Seeyou next week.
Hello and welcome to ask Dr. Jessica, the podcast
(00:03):
that discusses common paediatricquestions answered by experts.
So Summer is here and withsummer I get many questions
about the ears. Whether it beabout swimmers Ear, ear pain
from travel, or even ear wax. Onthis week's episode, I am joined
by a wonderful paediatric Ear,Nose and Throat specialist, Dr.
Ali Strucker. I'm excited foryou to hear her words of wisdom
(00:25):
on how to best protect yourchild's ears. Also, if you know
anyone who may benefit fromhearing this information, please
send it along. Your support iswhat helps this podcast grow.
Thank you for listening. Hi, andwelcome to another episode of
Ask Dr. Jessica I have awonderful guest today Dr. Ali
Stroker. She's an e and t andshe practices very close to
where I work. And I'm so happyto have her here. I have so many
(00:48):
patients that see her andthey're so thrilled with the
care that she offers. So how areyou Ali? Nice to have you here.
Thank you for having me on theshow. And I'm very excited to be
here.
Tell us about what you do.
You're a paediatric anti. Whatdoes that mean and who do you
treat?
So being a paediatric VNT meansI finished my full end residency
(01:09):
and then subsequently did afellowship to specialise in CARE
for Kids. So my whole practiceand my whole office is based
around kids from newborns, I'dsay till 18. But honestly, it
goes well on beyond that tillabout 25 years or so. Because
kids have different needs arenot just small adults as as you
know, as a paediatrician ortheir needs are very specific.
(01:32):
So we have extra training andtaking care of them. And also
just extra care given to thepatient and to the parents.
So I was thinking With summercoming up, there's a lot of
questions that come up aroundchildren and protecting their
ears, between going in the pooland being on vacation travelling
on aeroplanes. So I wanted toask you about how to protect our
(01:54):
kids ears. So the first thingthat comes up a lot is swimming.
Children tend to get aninfection called swimmers ear,
sometimes they get water intheir ears. Do you have any
general advice for parents onhow to protect their children
when they're swimming?
Um, yeah. So as we move into thesummer season, it's something
that I started to see a lot as akid start swimming every day a
(02:15):
few times a day. So yes, watertends to get trapped in the ear
and the outer ear canal. Andbecause your ear canal is dark
and warm, it's a perfect spotfor bacteria to grow. Especially
if kids have some ear wax intheir ears, it tends to sort of
give them like a food and thenyou have the kids aren't really
scratching at the year whichintroduces some bacteria, and
(02:36):
then you get swimmers ear. Soone of the best things I tell
parents as long as the child'seardrum is normal. So it's not a
child who has tubes or a hole intheir eardrum is you actually
can use either the over thecounter swimmers ear drops,
which are actually almost purealcohol and that dries the ear
out. Or you could actually makeup a mixture on your own of
half, rubbing alcohol and halfwhite vinegar and put a couple
(02:58):
drops in after the day ofswimming. And that'll dry the
ear and re acidify the ear canalprevent the swimmers ear.
Honestly, I usually recommendthat to kids who are getting a
lot of swimmers ear because noteverybody gets it. But if you
have a child who's getting it atleast once a summer, that might
be something you want to do sothat your child doesn't have to
have a summer of pain.
So just to clarify, you wouldtake over the counter swimmers
(03:21):
ear drops or you'd make aformulation from home. And then
you would put a couple drops ineach ear right after swimming
and for how long would the childhave to stay on their side with
the drops in. Um,so I typically say just do it at
the end of the day because rightmost kids are in the pool and
wonderful out of the pool sothat every time they come out,
that would be a lot but at theend of the day when you're done,
you're packing up to go home oryou're gonna go inside from
(03:42):
swimming pool in your backyard,I would have them kind of lay on
their side or lay across yourlap, pull back on their ear, but
about four or five drops in, rubit around and then tip their
head over and let it drain out.
They don't need to stay therevery long actually want it to
sort of wash the ear canal anddrain out to help dry it out.
And that should be all you haveto do.
(04:03):
And what about hydrogen peroxidethat's a popular one that people
use is that as helpful as well.
Hydrogen peroxide is good forbuilding with excess earwax. So
if you're if your child tends tohave a lot of earwax, it is
something you can use it issomething probably be used
pretty regularly because it justsoftens the earwax. If you have
a big mound of earwax and yousoften it guess what it just
(04:23):
slips into the ear canal. But ifyou if you notice your child
tends to be about a year Mexiaonce a week it can put a little
hydrogen peroxide and use it tohelp the earwax come out. Again
I would caution you make sureyour child doesn't have your
tubes or a hole near thembecause otherwise those things
will burnthat's a good cautionary
reminder. Now what about signslooking for an outer ear
infection or swimmers ear whatwhat signs tip you off that
(04:45):
child may may have swimmers earyeah so um your outer ear
infections and swimmers you'revery different than say them
from middle ear infections. Sothe way that we can kind of tell
a lot of times just by talkingto some before I even touch them
is onset so to Typically they'vebeen swimming a lot or in the
water, the lake, the ocean, someof that. And then it's really a
lot more pain on the outside ofthe year. So when you have an
(05:06):
outer ear infection, likeswimmers ear, the ear canal
itself swells, and thentherefore the outer part of the
child's ear gets very tender aswell because it's all connected.
So kind of tell us what you meanby gently pulling on their outer
ear. And if that hurts, that'susually a sign that there's an
outer ear infection, middle earsactually hurt more internally,
(05:26):
so the child might complain inthe back of the head or deep
inside that separates the twoof those. Okay, and then just to
distinguish a clarify middle earinfection, what typically causes
a middle ear infection.
So middle ear infections tend tooccur typically after the
child's had some sort of cold,so you get a cold, you get
swelling in the nose and nasalcavity, the Eustachian tube,
(05:49):
which was what drains yourinternally on the other side of
the eardrum, that part thatEustachian tube gets blocked,
fluid backs up into the middleear space. And that's the middle
ear infections. That's the oneswe see a lot of during the
winter, some of the summer aswell. But when we get to all the
kids are getting all theseviruses that are bombarding us,
that's when we usually see themgetting ear infections.
That's a great explanation. Ilike to distinguish the two
(06:11):
because I think it's confusingfor parents, especially because
with with middle ear infections,we prescribe antibiotics. And
for swimmers ear, we don'tprescribe oral antibiotics.
And that's a very good point. Somiddle ear infections must be
treated with an oral antibioticbecause between the outside of
your ear canal and your middleear space, you have your
(06:33):
eardrum, so anything you put onthe outside is not going to get
in there to treat that middleear infection. middle ear
infections hold middle earswollen eardrum swelling, you
got it, you gotta go internallyand treat that with oral
antibiotics. outer ear infectionis very different. You actually
only want to treat with dropsand 99% of the time because the
drops when I locally treat theinfection, and usually actually
(06:55):
oral antibiotics don't work verywell. So it's only really severe
cases where the infection isactually starting to spread we
get some called cellulitis wherethe whole ear canal and outer
ear is infected. That's the onlytime we used to do oral
antibiotics because most thetime the drops are gonna work
great.
Okay, yeah. So so and just tobring that up, you said drops
what what typical drops canparents expect as treatment for
(07:16):
swimmers ear infection.
So this is definitely somethingif you think your child has or
your need to go see yourpaediatrician or if it's really
severe and come see us. So weusually use typically we use
something called superdex.
There's a couple of variationsof that, which is ciprofloxacin,
antibiotic and a steroid. Thesteroid is actually very
integral because it helps bringdown the swelling and gets the
antibiotic to work. And there'sthey have a couple other
(07:39):
steroids as well asCiprofloxacin with trying to
sing along. It's all the samething. We're basically an oral
ciprofloxacin, which is reallygood for the ear canal and to
treat the ear canal infectionand the steroid to bring down
the swelling.
It's great. And so can childrenexpect to feel better pretty
quickly after taking the the eardrops a superdex?
(08:01):
Yeah, I would say typicallywithin 24 to 48 hours they
should feel relief. So as soonas as soon as you get into see
your paediatrician then youstart the drops, they usually
within about a day or so startto have some relief as that
swelling comes down. The reasonwhy it's painful, you have a
swollen ear canal in his bonyspace. Now, the reason I said is
if it's really severe, sometimesthe paediatricians will send
(08:21):
children to us because a lot iswe actually have to clean out
the ear. If there's a lot ofdebris filling the ear canal,
that's where I come in, I have amicroscope and suction to clean
out that stuff. And then reallysevere cases, the ear canal will
swell shut. And we have to putwhat's called a Wiccans a little
cotton piece goes down in theear canal helps open that you're
gonna also get the drops justlike a candle that helps the
(08:43):
drops to get down to the deepestpart of the ear canal. Wow.
Got some good tricks. Okay. Nowa couple common questions that
parents asked me with regard toswimmers ear. The first one is
sometimes parents have troublegetting the drops in their
children's ears, the childrenare either in pain, they don't
want to sit still, do you haveany advice to put in ear drops?
Yeah, it can be challenging,because part of that is
(09:05):
evolution before you have toactually pull back on the ear
itself to try and get the canalto open up. And if it doesn't,
then that's when you know thecanal drops won't get down to
the deepest part of the canal.
So gently, you've gently pullback and then do have to rub a
little on the fret. Now a lot oftimes what I'll do with a older
child, let's say maybe five orsix years old is ask them to rub
it for you. So to have themeither take their hand or then
(09:27):
and show them and they can rubit around. That rubbing that
kind of pumping machine gets thedrops to go further down in the
ear canal.
That's a great tip. That's agreat tip.
And now it's not perfect, it'sstill it's still be
uncomfortable. And they can usethings like Motrin and Tylenol
for that first 24 hours whilethey're still having a lot of
pain.
I've also heard that you can puta cotton ball in the ear canal
(09:48):
and put the drops onto thecotton ball so that the child
feels a little more comfortableas the as the moisture gets into
the ear canal.
You really gotta make sureenough, enough drop As you're
getting down there, so I mean,you could sort of leave the
cotton ball there afterwards, wereally got to make sure you're
kind of saturating it. And andthe other thing is, if you're
their parents are really havingtrouble as those drops are not
(10:10):
going down, they're pooling thatmight be cut time to come see me
to clean out the ear and maybemaybe even need to work. If it's
a really blocked, it doessometimes happen. It's not and
you're able to get those drops,and you kind of slowly the other
thing that we sometimes dorecommend is warming the drops
up a little bit, put in yourpocket, and sometimes that feels
(10:32):
better. And it's not so cold tothe bodies a lot warmer,
especially that ear canal isgoing to be hot with the
infection. That might feel alittle bit better for them as
well.
Yes, or I'll say like rub, rubthe drops in your hands. Warm it
up that way. Okay, that's a goodtip in the pocket. I like it.
And I appreciate you saying thatabout the cotton ball. Because
you're right. You have to becareful that you're getting
enough medication into the earcanal.
(10:52):
Yeah. And otherwise, you'llyou'll end up saturate the
cotton ball drops. Soabsolutely, yes, yes. Miss the
treatment. Okay, another commonquestion I get about swimmers
ear. Now, a lot of these kidsare avid swimmers and parents
want to know, when is it safefor them to get back into the
pool.
So you need at least probablydepending on the severity, the
(11:12):
infection, at least probablygood five days on the drops,
trying to keep the ear dry, thatyou're still draining a lot. The
drops are struggling to get in,you're going to try and have to
keep that air dry once the dropsare going in pretty easily. And
Charles no longer having a lotof pain, you could probably
start to resume swimming again.
Okay. Okay, so on average, you'dsay about five days,
yeah, I get depending on theseverity, most employees need to
(11:35):
follow up either paediatricianor with us and make sure that
things are getting better, andlooking good and that you can
resume swimming.
There's nothing worse than whenyou tell a kid they can't go
swimming, and they're about togo on vacation, or that they
can't get their head under thewater they look at you like give
them the worst news.
It is heartbreaking. And that'sone thing too, if you you also
find your child gets a lot ofear infections, a lot of times
(11:56):
I'll have patients come to seeme in June before swim season
starts, let me clean out the theear canal, let me get that ear
wax out. So because a lot oftimes again, that your wax traps
the water in there. So thosekind of kids, it might be
beneficial to have a good earcleaning at the beginning of
summer, hopefully decreasing thefrequency of swimmers ear.
Okay, so this is really helpful.
I mean, while we're on the topicof ear wax, maybe we can talk
(12:19):
about this a little bit more,because I do get mixed messages
on on earwax and when to when toleave it alone when it might be
harmful for kids. So can we talkabout ear wax? What what is your
general feeling on ear wax? Andwhen does it need to be taken
care of.
So your wax is normal. It'sactually the ear canal is
(12:41):
protective mechanism. It's likethe oil on our skin. Some people
make a lot. Some people don'tmake very much at all again,
just like oily skin and dryskin. So it's in general ear wax
is not a problem. And I tellparents, you can clean the ear
the outside part of the ear andjust at the opening of the ear
canal does every parentespecially the Moms always want
their kids to be totally clean,right? No one wants to see the
(13:04):
wax on their kids. But don't besticking the Q tips down into
the ear canal on. And the reasonfor that is most of the time
people want to pushing the waxin deeper and scratching the ear
canal and then setting them upfor an ear infection, outer ear
infection. So clean the outsidepart. If your child is one who
has a lot of earwax inpaediatrician will clean in
their office, if it's reallybad, they'll send them to us
(13:26):
we're happy to clean ears. Itdoesn't it doesn't usually have
to be removed except for thefact that two things one it
makes it hard for us to seeright you have to see the
eardrum you know if this childhas an ear infection, we need to
clean the ear for that. And theother part is if the ear is very
full of wax, yes, sometimes thatsets them up for things like
swimmers ear because that wax isgoing to trap the water and and
it's frustrating. If you everhad a lot of ear wax, get some
(13:48):
water and you can't hear becauseit swells. So if your child has
truly excessive earwax, thenwe're happy to see them and
clean their ears. I havepatients who come once a year
some patients come every sixmonths or so every three months
if they really have a lot. Soare there are there ways to
remove wax from home?
Yeah, so if your child has, youknow, tend to have a lot of
(14:10):
earwax, you can use things likedebe rocks, which is an over the
counter drop. It's actually amixture of hydrogen, hydrogen
peroxide, and some oils,basically to soften the earwax.
The same caveat I mentionedbefore, you have to use those
pretty regularly. If you have alot of wax and you put that in
it softens it and most of time,it just loops down onto the
eardrum and then the ear canalis full. So I tell people if you
(14:33):
want to use it once a week,remember maybe every Sunday bath
put put that in before the kidsbath. And that will keep the ear
wax softer and coming easiercome out. Some kids also just
have very small ear canals andthey're more likely to have wax
get trapped. And again, that'sthe kind of patients we see
we're using our microscope andable to clean the ear canal and
visualise what we're doing whilewe're doing it.
(14:54):
So just to sort of clarify andhow deep rocks works, parents
put the drops in once a week andthen that your wax will soften
and sort of fizzle out and drainon its own.
Yes, exactly. So same sort ofmechanism of applying the drops,
you put it in at the start ofthe bath, kind of rub it around,
and it'll start to loosen it up,you might not see a big chunk
come out. But again, this issort of maintenance, you would
(15:15):
do this all the time, and it'lljust soften the wax. And if you
see stuff come out, then yes,cleaning the outside with either
a Q tip or a cotton ball.
Okay. And when a patient comesto see you for earwax removal,
what can they expect? How do youactually remove the earwax.
So we unfortunately have amicroscope in the office and a
little exam bed, we lay the kiddown, we actually decorate our
(15:37):
ceiling with stickers, we givethe kids something to look at
while they're lying on theirback. And then using the
microscope and which allows meto use both of my hands, I can
gently touch the ear, outer earand usable either a curate,
which is like a little tinyscoop, a little spoon or a
suction to basically remove thewax that way,
it's great that you can seethe visualisation using a
(15:59):
microscope, which really givesme both eyes but looking at it's
a lot easier than trying to doit with just an otoscope. So, or
ever.
Do you ever ear flush,I don't ever flush the years, I
actually kind of hate it. Ithink it's uncomfortable for the
patient. It's usually like thisrush of water in the air, they
don't like it. And the otherthing is I've seen kids get
(16:19):
either traumatised from doingit, but also trauma to the ear
canal. So sometimes you can getactually get an ear infection
from all that water or the orthe syringe irritating the ear
canal. So I like to just do itdirectly visualising what I'm
doing, using the scoop, we'reusing a section depending on the
quality of the wax, and usuallycan get almost every kid get it
all at one time, sometimesreally severe cases, I'll have
(16:40):
parents do some deep rocks for aweek or two and then come back
to the last little bit. Butthat's pretty rare that that
happens.
That's great to soften it aheadof time. Yeah. And then come
see, you know, I agree you'reflushing we you know, we do have
an ear flushing. We do have earflushing equipment here in the
office. And it works. Butparents, but a lot of times kids
don't like how it feels theyfeel a little dizzy afterwards.
(17:03):
So I'm glad that you have a moreexact method.
And it's you know, it'ssomething relatively simple for
us to do. And we're happy to doit, we're happy to have that
service for people to come in.
It's safe and it's clean. Andkids usually do very well with
it, get their lollipop on theirway out and are happy
just to clarify a myth. A lot ofpeople like to use the ear wax
(17:26):
candles to get wax out. Doesthat actually work? No, you're
right, that is a myth. Sobasically, when you use that,
like people say, Oh, I see stuffcoming on the paper. Well, it's
the wax and maybe the front ofthe candle, excuse me that and
then maybe a little bit of waxfrom the inside, but you're not
really getting it out and therisk of burn injuries and just
(17:48):
it's ineffective so thatpatients a candle in their ear
canal still full of wax.
So what is it exactly? They puta candle in the ear?
It's like a little cup basicallypaper and then yeah, there's
like a little candle it sits inthere and candle wax melts down
and warms that year. And thetheoretical thought is it pulls
the wax out of the ear canal.
I've never seen it work and theidea of putting fire that close
(18:12):
to a child's ears is petrifyingto me so
well, thank you for clarifyingthem. And I there's a lot of
people that swear it's helpingand I think just visually they
see what they think is wax andit's not. Right. Right. Okay,
thank you so much for that. Allright. So so so I guess the big
take home message is if you havea lot of earwax, I would
(18:33):
definitely go see your end. Yes.
Or you can try debe rocks firstand then see your end. Okay, now
question about travel. I get alot of questions about how to
protect ears, from pressure thatresults from aeroplane rides
from the ascent in the descentor from you know, from cars. If
someone's travelling up into themountains. Do you have any
(18:53):
advice for parents on how theycan protect their children's
ears from being uncomfortable?
Definitely. So children ingeneral have poor Eustachian
tube function. As we get oldereustachian tubes work a lot
better. It's why everyone who'sbeen on a plane and there's a
crying baby. And most of that isactually the change in pressures
(19:13):
is bothering their ears. Andthey can't clear their ears like
we can popping our ears andswallowing. So what I usually
recommend with little ones isbreastfeeding or bottle feeding,
especially in the descent. Sowhen we rise up in a plane when
you go that your pressureoutside is lower than it was
when you were down on theground. So the pressure in your
(19:34):
middle ear actually drains out.
It's not it's not terriblyuncomfortable as we come down
versus you go from low pressureto high pressure and that's
usually when the eardrum willnow get sucked in on that low
pressure. And that's when theyreally will cry. So most
important is trying to get thelittle infants on the breast or
the bottle for the descentbecause they're too young to
(19:55):
really understand your oldertoddlers and preschoolers Have a
little juice boxes, get them inthe airport, you can travel the
volume of liquid, but pick up alittle juice box, have them set
from Australia same thing thatswallowing really helps I tell
people, as soon as it plays,there's a good answer to have
them start taking sips all theway down until the plane lands.
Obviously older kids, you can dothe chewing gum and second
(20:18):
lollipops and those sorts ofthings. Again, the swallowing is
really what opens the Eustachiantube up. If your child has a
little bit of a cold whileyou're flying, you can use a
little nasal spray likesomething called Neo synephrine
was like aspirin. They have amild version. So again, it only
use that in the case of a childwho's actually sick. That'll
(20:39):
help decongest the nose to helpthat Eustachian tube as well.
Okay, and that child, you wouldspray in the nose. Yeah. For the
scent.
Yeah, so Exactly. So it's a longflight right before you said, if
you're doing a short flight,let's say from here to San
Francisco, or someone that youcould probably do it at the
start because that thosemedications lasts for a few
hours.
That's really helpful. Yeah. I'mjust thinking I remember many
(21:03):
plane flights where my ears feltso uncomfortable as a kid.
Yeah. And the boys were adultstoo. So if you're flying and
you're having too bad allergies,or a little bit of a cold when
you're flying, then yeah, youcan use a little bit like a
little spray bath. And that'lljust help unblock the the nose
and unblock the Eustachian tubefor the descend. But the real
key that I do every time I flyis I get a bottle of water in
the airport. And as soon as Ifeel the plane going out, I just
(21:25):
keep drinking because even evenas an adult that pressure is not
very comfortable.
So continued sips. Okay, you gotit. That's good. Yeah, and I
know sometimes patients will askme about taking medications like
Benadryl or I guess painrelievers can be helpful,
potentially. But yeah, you canuse some pain relievers. You can
use things like Benadryl or, butthey're really the thing is
(21:46):
like, would it have to be like aSudafed type of medication. And
we don't really love using thosein kids, or even in adults, for
that matter. So unless a childwas really sick, which hopefully
you won't be flying, anyhow,it's not really going to be very
helpful. If there are somethingcalled your planes that I know
some people use, it's basicallylike a little earplugs you put
in your ear, and some peoplehave really bad Eustachian tube
(22:09):
function just discovered thatthat actually helps a little
bit. It basically helps modulatethat change in pressure. So
there's not as much pull on theeardrum, probably not as you
can't use it on a baby ortoddler. But again, that the
older child who's 70 years oldand beyond who's still really
struggling with the pressure,you can you can purchase those.
(22:30):
Another question that comes up alot. Children will have ear
infections and parents areconcerned about the flight Do
you usually tell parents thatthey can't fly or can fly when
they have an ear infection?
So if your child has an earinfection, I recommend not
flying and I've actually hadthis happen with my own
daughter. Because when you havea middle ear infection so like
(22:50):
we're talking about this isdifferent than the outers,
people will come to me and theirtoes. Swimmers ear, can we fly?
Yes, you're gonna fly withswimmers ear, because that's the
outer ear, we're not worriedabout the eardrum in the middle
of your space. But if it's amillion infections or your child
had a cold, they got congested,boom, fluid got up in the middle
ear, it got infected. Whathappens is that Eustachian tube
gets blocked by the infection,your eardrum is now bulging,
(23:13):
almost like imagine a bigpimples, we have all this plus
in the middle ear that you'redoing bulges out. If you go up
in the plane that all thosepressure changes we talked about
happen, a couple of things canhappen be your gym can actually
rupture, the pressure gets sointense that your general pop
will elbow that sounds awful, isactually the best of all case
scenarios because the infectionwas venturing out into the ear
(23:34):
canal. But the bad scenarios arethat pus under pressure that
middle ear space can actuallybreak through the other way. So
you can actually injure youryour inner ear. And that
shouldn't can cause permanenthearing loss. It can also travel
upwards into the bone and rightabove your ear is your brain. So
we we see this every once in awhile kids will have infection
or up underneath the brain inthe sinuses, the little blood
(23:56):
vessels that drain the ear upthere. And they're they're life
threatening there. These arethings where kids have to get
hospitalised they have to getdrained. So if your child has a
new ear infection,unfortunately, no no air travel
until the infection resolves nowOkay, that's
good to hear. Don't want that.
Yeah, no, definitely get go seeyour paediatrician get on
antibiotics right away. Now,after a few days, when the
(24:21):
infection is now clear that pusis no longer under pressure, we
look we see we might still see alittle bit of fluid in the ear.
But we don't no longer see pusor red eardrum than it actually
is okay to fly your child mightbe more uncomfortable because of
the pressure there. But thatrisk I was describing where the
infection could spread orrupture the eardrum or damaged
the inner ear. That risk is nowgone.
(24:41):
So it sounds like it might be agood time to see your
paediatrician if you're not surebecause if it's slightly red or
there's not pus behind theeardrum, it sounds like it's
okay to fly. But if there'ssignificant fluid pass, don't
want to goback as well. But when patients
I sometimes end up coming to seeus with an active ear infection
three The antibiotics, you know,if you have a flight coming up,
(25:01):
or let me see you back beforethen, you know to make sure it's
resolved before you get on theplane.
Okay, no very helpful advice.
Now, speaking of keeping the earsafe, sometimes I'll have
patients very typically are moremore typically than then you
might expect or not you expectDr. Striker, but for people
listening, where kids like toput objects in their nose in
(25:23):
their ears. When children putthings in their ears, is that a
reason to see an end right away?
Or are there ways that parentscan try at home to remove things
from the ears? What's youradvice?
Um, so yes, it is actually quitecommon. We see this a lot. And
actually, my husband who's notmedical at all was shocked once
(25:44):
we were together, how frequentlyI got this phone call about
something in the ear orsomething in the nose. He never
realised that this was a thing.
But after being with me for ashort while he realised Yes,
this happens quite a bit, I seeat least a couple times a month.
Why kids do it. We don't knowthe whole there, right? It's
fun. It's interesting. Like,let's let's explore our bodies.
Most of the time, it's not anemergency. So what I would, what
(26:05):
I recommend is, wait, call usfirst thing in the morning, my
staff knows right away, we'llfind you a slot that same day
we'll get you in to removewhether it's from the ear or
from the nose, because most ofthe it's not going to go
anywhere, it's usually stuck. Ifyou go rush off to the ER,
unfortunately, you're gonna endup by sitting around obviously,
right? There's a lot of stuffgoing on in the ers right now.
(26:26):
It's not super high priority.
And the other thing is theydon't have the same equipment.
So again, I have my microscopefor the ear. For the nose, I
have multiple different devicesto be able to take whatever the
object is, usually it's a beador a piece of food. You get all
those things out. The onlycaveat the only time where I
tell people you really do needto go right away to seek medical
(26:49):
attention whether from erpaediatrician or something that
day is if it's a battery. Sothose small coin batteries,
they're a huge danger anywherethey go. But even in an ear
canal Orna knows that acidinside the battery can leak out
and it can damage the ear canalskin or can damage the nose, the
septum, the cartilage in there.
So if you think your child mayhave put a small coin battery,
(27:09):
that little disk batteries rightaway, see your paediatrician
come call us same day. But foryour child who maybe put a bead
in their in their nose. And it'sSaturday afternoon, you can
wait. Call us Monday morning andwe can get you in and get it
out.
That's great advice. So if it'sif there's a battery in the ear
(27:29):
and the nose, that's anemergency where you want to see
an EMT or go to the emergencyroom, but otherwise, it can wait
until your office is open. Yes.
Sounds like no, I have to tellyou there's so many times I've
been surprised where I'll do aroutine, you know, physical
examination, I'll look in theair and lo and behold, there's a
there's a Lego, or there'ssomething shiny or there's some
playdough so I'm definitely I'msurprised at how often things
(27:51):
are put in the ears or nose, butit is I mean, I will never
forget when I was in training upat all of you Medical Centre,
and there was we got this urgentconsult. There was a child that
they thought had a tumour in theear they actually even had done
an MRI and all the stuff and itwas very you know, small tumour
(28:11):
looking at your canal on I gotmy microscope and looked. I said
I got this and slid out and whatit was was a top of a little
pencil eraser, but no one hedidn't say anything. They had
gone for routine physical, thepink fleshy thing look like a
tumour, right, this wholeprocess of happen. The moms in
tears thinking her child's up,you know, I'm gonna give her
death, you know, like a cancerdiagnosis for a child. And then
I said, Well, here's, here'syour little eraser. And
(28:34):
obviously, there's no tears ofjoy at that point. But, you
know, it's funny that it is verycommon to put stuff in their
ears and nose.
That's why we love kids. Right?
Always interesting. It's alwaysinteresting.
Well, thank you so much, is anyany other words of advice that I
didn't ask you that you want tooffer any parents listening?
(28:57):
Um, you know, I think I canthink of anything in particular.
I mean, I do always say toparents trust their instincts I
they really never run, you know,go wrong. If you think there's
something wrong with your child.
It's your paediatrician. Comesee us directly. If you really
feel like it's your nose issue.
I think parents intuition isreally something remarkable. But
(29:20):
otherwise, yeah, I mean, I thinkwe've kind of covered all our
bases today.
Thank you so much. Thank you.
Thank you for listening to thisweek's episode of Ask Dr.
Jessica. If you are enjoyingthis podcast, it would mean so
much to me. If you would take amoment to rate review and
subscribe to the podcast. Seeyou next week.
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