Ear Infections, Tubes & Tonsils

Listen in as Dr. Melissa St. Germain, one of the pediatricians here at Children’s Physicians at Children’s Nebraska, discusses what parents need to know about ear and tonsil infections and ear tubes.

Topic Breakdown

1:40 – How to tell if your child has an ear infection
3:28 – Fighting recurrent ear infections
5:38 – Frequent nosebleeds and what to do if your child’s nose is bleeding
8:06 – When your child snores
10:08 – Tonsils and ear, nose, and throat problems
11:00 – The frequency of ear infections with age and ear tubes
12:25 – Ear infections and antibiotics


Gina: You know, when my son Grant was younger, he had chronic ear infections. And as a parent, that’s just really hard to watch. You know, the crying and the tugging of the ear. I guess, let’s face it — nothing is too small or too large when it comes to our kids and the health of our kids. That’s what we’re going to explore today, and so much more.

I’m Gina Melton with the Just Kids Health podcast, from Children’s Hospital & Medical Center. Join me as I talk with the region’s pediatric experts about everything related to children’s health — from medical issues to mental health — all to keep your child healthy, safe, and strong. So important. So just sit back and listen, or multitask like the super parent you are.

Now today, I’d like to welcome pediatrician, Dr. Melissa St. Germain, to discuss ear, nose, and throat issues in children. But first, I noticed, this is really neat — the doctors at Children’s are amazing, and you actually volunteered at the hospital when you were a teenager, right?

Dr. St. Germain: I did, yes. I was born and raised in Omaha and grew up here, and got to experience the loveliness of Children’s physicians and doctors.

As I was growing up, I had asthma and spent some time in the emergency department. But as a teenager, I was able to volunteer at Children’s Hospital — in the old building, back then — but I made the crib cards for the NICU babies. I got to put their names on it and use my creativity to put some cute little flourishes on those cards. So that really spiked my interest in helping kids.

Gina: How neat, that’s really cool.

How to tell if your child has an ear infection

Gina: As far as ear infections, how can you tell if your child has an ear infection? Especially a baby or a toddler who Can’t tell you, right?

Dr. St. Germain: Yeah. Ear infections are so common. Up to 65% of kids have had an ear infection by the time they turn a year old, and up to 90% of kids have had an ear infection by the time they turn seven. So they’re really common in those first few years of life.

They tend to follow after a cold. So kids get colds, runny noses, viral respiratory infections, really frequently in those first couple of years of life. And if you think about the anatomy of the ear — the middle ear space that has the bones that conduct hearing also has air in it. It’s connected to your nose through your eustachian tube. Any time your nose gets really stuffy, that can close off that eustachian tube, and then fluid can collect in that middle ear space. It’s hard for it to get out.

And a little kid who’s got a tiny little nose and tiny little eustachian tubes — so when that fluid collects in that middle ear space, it can grow bacteria. That’s what we call an ear infection. A lot of times, they have a cold first, right? They develop the runny nose, the snotty nose, the fever, the irritability. And then in a lot of colds, that goes away within 10 to 14 days. That’s how we usually expect a cold to last.

But in kids who develop an ear infection — it might be during that second week — then all of a sudden, they get fussier again. Or they start tugging on their ears or poking in their ears. Or they were sleeping better but now they’re not sleeping at all. And those are signs of a secondary bacterial infection, like an ear infection.

Gina: I always knew when my son Grant would have one when he’d start tugging on his ear and then he’d get really, really fussy when he was normally just this really, you know, even-tempered child. So I can see what you’re saying now.

Fighting recurrent ear infections

How can I stop those — how can parents stop those recurring ear infections? I’m sure that’s a question a lot of people want to know. How do we do that?

Dr. St. Germain: Yeah, absolutely. When our kids — especially if they’re in a daycare center or around a lot of other kids in that first couple of years of life — we expect that they might get 7 to 10 colds per year. And if each cold lasts two weeks, that’s a lot of weeks that they’re suffering with some of those respiratory symptoms like the runny nose and things like that.

So anything we can do that keeps the nose cleared out will help promote drainage from the ears and keep that fluid from collecting. If your kid’s got a really stuffy nose, and they’re not able to blow their nose yet because they’re only a year old and they don’t know how to do that, help them get rid of the mucus that’s in there. So either using nasal saline to flush things out or using a bulb suction. Or they make the NoseFrida and those other kinds of devices that help you suction out your baby’s nose. That really can help prevent ear infections.

The other things that help — breastfeeding for at least 6 months reduces the risk of ear infections by 25%. Really, just cleaning out the nose and making sure that there’s not fluid collecting in the middle of the ear.

Gina: That’s important. Is that a sign of something more serious than an ear infection? Is that something to be concerned about?

Dr. St. Germain: Not usually. Because the majority of kids get one — at least one, and some kids get a lot more that one — most of the time, it’s just the fact that they’re small and that they’re getting a lot of colds.

And again, those kids who are around a lot of other kids are going to get more colds, so they’re more likely to get more ear infections. Children who stay home for the whole first year of life are going to get fewer colds and fewer ear infections. But eventually, they get exposed to those cold viruses. So sometimes the kids who have been home for their first five years, are sick half of kindergarten because they haven’t been exposed to any of those viruses yet. But really just, again, helping keep that nose clear is the best thing you can do to help those ears clear.

Gina: And just hoping they will wash their hands when they’re at school.

Dr. St. Germain: That too, yup. Just teaching them to keep things out of their mouths. That helps, also.

Gina: Thank goodness for teachers who encourage that at school. I think that’s wonderful.

Frequent nosebleeds and what to do if your child’s nose is bleeding

Gina: Children with nosebleeds and frequent nosebleeds — my son’s doing wrestling, so that’s a whole different thing, because I see a lot of nosebleeds there. But the nosebleeds where their nose is dry — is that a sign of something more serious? How can we help with that?

Dr. St. Germain: Winter in Nebraska — usually, our relative humidity is about zero. So we see a lot of the dry air, and the dry nose kind of comes along with that.

Generally, kids who are getting recurrent bloody noses, it’s dry air and it’s digging for gold. Kids like to get fingers up there, and those blood vessels are easily traumatized. So if you’ve got your finger up there a lot, you’re more likely to get bloody noses, too. Really encouraging them to keep their fingers out of there. Masks have helped with that, too. It’s a lot harder to get fingers in your nose if you’ve got a mask covering it.

But again, a little saline really helps if it’s the really dry air. Squirting nasal saline up into the nasal cavities helps. Running a humidifier in the child’s room at night if they tend to bloody noses can help, too.

And then when you get a bloody nose, it’s really tempting to hold it for a second and then see if it stops, right? Every time you take the tissue away to see if it stopped, you can open those blood vessels back up again. So really, if you’ve got a bloody nose, you want to try to hold pressure for at least five minutes before you take that tissue away. Usually, that is long enough to form a blood clot and stop it from bleeding.

The bloody noses that last longer than 20 minutes are ones we worry more about. Those are ones you probably want to call your doctor. Or, if they’re getting them really frequently, and you’ve done the saline sprays, and you’ve done the keeping their fingers out, and they’re not getting better, that’s a time to call your doctor, too.

Gina: Now, do you lean back when you do that? Or is that not a good thing to do?

Dr. St. Germain: Just kind of a little bit forward, I would say. If you lean way back, all that blood goes down the back of the throat, and that can irritate your stomach. Some kids will throw up if they’ve got a lot of blood down there. A little bit of leaning, a little bit forward, usually works better.

When your child snores

Gina: Now, I know we expect parents to snore. Like husbands, just snore. But kids can actually snore, too. Is it common for a child to snore at night?

Dr. St. Germain: When kids are sick, when they’ve got respiratory infections, colds, things like that, you’re more likely to hear snoring. Because that’ll swell all the tissues in the back of the nose and the back of the throat.

You’ve got parts of your immune system in both of those areas. In the back of your throat, you’ve got your tonsils. Most people know what those look like. And those tend to swell if they’re fighting off an infection. In the back of your nose, you’ve got adenoids, which are similar — kind of in the same line as tonsils, but higher up. Those do the same thing. They swell if you’ve got an infection, if they’re trying to fight something off. So that’s okay, if kids are snoring when they’re sick and it goes away when they get better. That’s normal.

If you’ve got a child who snores loudly all the time, every night, that’s probably something that needs a visit to their pediatrician or to their doctor. Especially if they’re having any symptoms of apnea, where you hear pauses in their breathing and then [makes snorting noises], kind of like they’re trying to catch their breath. That’s not normal in a child. So if you’re hearing that, that’s something that needs to be evaluated.

Gina: I didn’t even know kids could have sleep apnea. That’s interesting.

Dr. St. Germain: They can. And one of the causes is recurrent tonsil infections, adenoid infections. Another cause is obesity. Just like in adults — the more extra weight we’re carrying around our neck area, the more likely that the windpipe is kind of collapsed down when we sleep. That’s another thing that causes that sleep apnea.

Gina: Interesting. So it’s important to call your pediatrician at Children’s when you see something like that happening.

Dr. St. Germain: And sometimes, if we’re not sure, they’ll recommend what’s called a “sleep study,” where we actually monitor the child all through the night and monitor their oxygen levels, making sure they’re getting adequate oxygen as they sleep. That can help us determine sometimes if the sleep apnea is severe enough to warrant some kind of intervention.

Tonsils and ear, nose, and throat problems

Gina: Now, can tonsils be the cause of a child’s ENT problems in general?

Dr. St. Germain: They can, yes. When kids are really small and they’re fighting off lots of infections — normal respiratory infections, viruses that they get exposed to — those tonsils work harder, because they are part of the immune system. So they swell up more frequently. As kids get older, they swell up less frequently. So a lot of times, we’ll see them look fairly big in younger kids, and then smaller as the kids get older.

And so, kids who are getting lots of tonsil infections — sometimes, that’s like seven in a year, or five a year for a couple of years — those are kids that might need their tonsils out. But a lot of kids — if they’re having three or four infections a year, but we can get them cleared up with antibiotics and they don’t have symptoms in between, their tonsils might be just fine and are going to shrink down as they [the child] get bigger.

The frequency of ear infections with age and ear tubes

Gina: Is there a certain age that kids get more ear infections? Like, does it start to taper off as they get older?

Dr. St. Germain: Yes, ear infections are more common in kids under the age of 2 because they’re exposed to so many respiratory viruses that their immune system has never seen before.

And because of their anatomy. That nose is smaller. The eustachian tubes are smaller. Their ears are smaller. And so as they grow, they tend to get fewer infections, fewer colds, and fewer ear infections.

Most of the time, if kids make it to age 2 without needing to get ear tubes, then they’re probably not going to need them. Ear tubes are what ENTs will put in for kids who have recurrent ear infections. So for most kids that have more than about 4 to 6 ear infections over a 6-month period of time, then we’ll have them go see the ear, nose, and throat specialist, and they’ll talk about putting tubes in.

Tubes go into the tympanic membrane, which is the eardrum. And they’re a little collar button tube that’s designed to stay in there and allow fluid to drain out instead of collecting and creating infection. They fall out on their own after 6 to 12 months. As the tympanic membrane grows, the tube stays the same size, and it eventually falls out on its own. Those can be a really good way to prevent those recurrent infections in kids in that younger age group.

Gina: I heard that’s kind of a game-changer.

Dr. St. Germain: For a lot of kids, it is, yes.

Ear infections and antibiotics

Gina: I’m sure parents are wondering — when kids get ear infections, are antibiotics always necessary for those?

Dr. St. Germain: Not always. Now, the little kids — especially under 6 months, the kids who Can’t tell you when they’re feeling better, the kids who are at a little bit higher risk of severe infection — need antibiotics for most of their bacterial ear infections.

But kids who are older who don’t have severe symptoms, who are able to tolerate the pain, who don’t have fevers — sometimes, those kids don’t need antibiotics. And if you look at the data, up to 60% of ear infections will clear on their own, without antibiotics. So those older kids and the ones who don’t have fevers can usually get away without them. The kids that need antibiotics usually end up on a 7 to 10 day course of those.

Gina: That’s good information to have.

Thank you so much, thanks for coming in today. I know parents are going to be really interested in this. Because I feel like — including my son, Grant — a lot of people are dealing with kids who have ear infections and just need the information. So thank you so much.

Dr. St. Germain: Thank you.

Gina: And thank you so much for listening to the Just Kids Health podcast. Please remember to rate, review, and subscribe. And for more information on how we can help your child, visit childrensnebraska.org and follow us on social media.


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