One of the most frequent reasons for a visit to the pediatrician continues to be ear infections (otitis). In fact, I think my otoscope (device used to look into the ear) is getting worn out!
Over the years there have been literally thousands of articles published on the diagnosis and treatment of ear infections. Parents continue to ask, “how do I know if my child has an ear infection?” and the answer to that question has yet to change, the only way to diagnose otitis is by looking in the ear and visualizing the ear drum.
There is not a symptom, or a combination of symptoms that will lead to the diagnosis of an ear infection without looking at the ear drum itself. So, babies that pull on their ears, or awaken at night, or children with a fever and cough, or even those who say their ears hurt, do not always have an ear infection.
There are many days that a 2-4 year old child will have said, “my ear hurts” and are therefore brought to my office. When I visualize their ear drum it looks perfectly normal, so ear pain (otalgia) does not always mean infection. The pain may be due to pressure behind the ear drum, or referred pain from a sore throat, or tooth, or even just a passing feeling in the ear after putting their finger in their ear canal. You have to look, and therefore the diagnosis may not be made over the phone (maybe one day there will be an App for visualizing the ear drum remotely?).
When the doctor looks down your child’s ear canal, they are looking for an ear drum that is either bulging, or red (if the child is not crying or does not have high fever as this may cause redness of the ear drum), or for fluid behind the ear drum (called an effusion). In most cases it is a combination of findings that one sees when looking at the ear drum. For a practicing pediatrician, visualizing an ear drum in a squirming, screaming, toddler who has waxy ears, is an art. Yes, ears can be full of wax and you don’t even realize it. (don’t use a Qtip it just makes it worse!)
Cleaning out a child’s ear is necessary and not always fun for the child or the doctor. One of the hardest skills to learn in early pediatric training is how to look at an ear drum. I remember it taking months and months of practice and instruction before really believing that I was getting better and better with the otoscope.
Many parents ask if they can look in their child’s ears at home with an otoscope that they bought on line? “Sure”, I reply, if you want to spend a year in the ER looking in thousands of ears!! Just like I am sure I could learn how to “tune up my car” if I went and worked in a garage for months, or tried to learn to speak a language by immersion, the skill of using an otoscope is based upon repetition and practice. (like most things in life I guess). Parents tell me that there are even some “swanky” otoscopes that purportedly talk to you and tell you if the ear is infected, but none of these devices are accurate, you have to rely on the old fashioned otoscope and know what you are looking for.
So, ear pain and ear infections are not synonymous and the “gold standard” of visualizing the ear drum is the only accurate way to diagnose an ear infection. Check out Friday’s Daily Dose: to treat or not to treat?
That’s your daily dose for today. We’ll chat again tomorrow.