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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.
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. 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. 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. Commonly, it may be misconstrued because of the teething that’s often associated with that timing.
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. 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. 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. 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. 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. 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. 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. 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.
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. The next thing that we look at is when you are aware that there is a fever with an earache.
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.
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. 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.
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. 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?
A simple temporal thermometer, excellent to be able to quickly evaluate the child’s temperature. 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. The chewable Congaplex is potentially a means of helping to eradicate the antibiotic resistance staph infection with its co-infection of strep. 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.
First, let’s clarify that when talking about “ear infections”, there are 3 kinds of ear infections depending on where the problem is anatomically.
I always explain to families that once a child is prescribed an antibiotic, even though the child may finish eating 7-10 days of the medication, about 80% of children need up to 4 weeks for the middle ear fluid to completely go away, while another 10% may need up to 8 weeks to clear the fluid completely.
For straight forward acute ear infections diagnosed by otoscopy, benefits of tubes should be considered if child has had at least 3 episodes in 6 months or 4 episodes in 12 months.
Tubes are also indicated if there is severe complications from an acute ear infection such as “mastoiditis” and even extension of infection into the head like subdural abscess or epidural abcess. With all due respect to the many walk-in and urgent care clinics in our communities, if most diagnoses are made by individuals that the family never sees again, nor have a relationship with, this scenario is less optimal then most diagnoses being made by the child’s primary care provider and same office where parents do have a relationship with the provider. Often, parents will tell me that the person said the ear drum looks “red”, and there was no mention of  presence of fluid or not.  I ask families to always respectfully push for specific information about presence of fluid, since research also shows subjective description of “redness” of the ear drum is not an accurate way of diagnosing true acute otitis media. Just because a child has a 3 infections in the past 6 months, if on the day we visit the ears look great, hearing is perfect, speech is normal, and especially if it’s spring and warmer months are approaching, I will often explain everything but reassure parents and ask them to wait. Any child who has clinical speech delay should have a full hearing test when they come into an ENT’s office, and the physician should fully explain the results of the test.  If hearing is considered normal on the test, then I send them for formal speech evaluation. Often I meet preschool or school-aged children who may even have “never” had an ear infection, but “fails” a school hearing screen and comes to see me. When she is not in the clinic, operating room, or conducting research, you will find her in the kitchen preparing food with love along with her daughter Claire. Ear infections are one of the most common health problems for children, with most kids experiencing at least one by their third birthday. When these infections are left untreated, complications can include hearing loss, speech problems and more severe infections that can spread to bone and brain, causing meningitis. A newly released study by scientists at the David Geffen School of Medicine at UCLA and Harvard Medical School has observed that racial and ethnic disparities among children with frequent ear infections can significantly influence access to health care resources. The findings, reported in the November 2010 issue of the journal OtolaryngologyHead and Neck Surgery, show that compared with white children, African American and Hispanic children are at increased odds of not being able to afford prescription medications, not having medical insurance and not being able to see a specialist.
The study also shows that African American and Hispanic children are more likely than white children to visit the emergency room for an ear infection. Parents of children under the age of 18 were asked various questions, including whether their child had three or more ear infections over the prior 12 months. The study observed that each year, 4.6 million children reportedly had "frequent" ear infections defined as more than three infections over a 12-month period. The next stage of the research is to follow the racial and ethnic groups prospectively and to monitor whether changes stemming from health care reform influence disparities in these groups over time. Did you know?Ear infections are one of the most common health problems for children, with most kids experiencing at least one by their third birthday.
Ear infections are among the most common illnesses in childhood and are frequently found in children with influenza, even if there is no flu symptom per se.
Seventy five percent of children suffer from at least one episode of ear infection before they reach the age of three. Pain and a fever of 100°F (37.7°C), or above, are the symptoms commonly associated with ear infections. Temporary hearing loss may occur because fluid build-up makes it difficult for the eardrum and the small bones of the middle ear to move freely, which, in turn, prevents sound vibrations travelling from the outer ear to the inner ear.
In approximately 80 percent of cases ear infections don't normally need antibiotic treatment and resolve spontaneously within a few days.
Antihistamines, especially if the child suffers from a respiratory allergy, as this may increase the production of fluid. In the small number of cases in which the infection does not resolve spontaneously, antibiotic treatment (usually with amoxicillin or Ceftin) may be tried. The journal Pediatrics reports the results of a study by scientists at the University of Texas showing that, in children aged six months to four years, who received the vaccine for pneumonia, PCV7, the incidents of middle ear infections due to the bacterium Streptococcus pneumoniae was reduced by 34 percent. A newborn infant will respond more quickly to sound even than before their eyes begin to track. 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. If there’s pressure in that ear, the child will often respond adversely or directly to that. Commonly, though, what we see is that the pressure has built up in there, and it’s not able to equalize.
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.
If you notice a child that has a severe ear infection, they may even be tipping or feel off-balance. As you look into the back of the throat, you’ll see what we call the pharynx, or the uvula, hanging down. What’s very interesting is, again, you view that tympanic membrane from the observation of looking into the canal.
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.


As those tonsil tissues and that retropharyngeal space is opened, it will make almost a kissing or a clicking sound. 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. Congaplex has a great benefit in the adult who’s had this history of chronic ear infections to eliminate that type of an infection.
Now, we have an antibiotic resistant staff, and it’s companion becomes the strep infection. Then, commonly, what ends up happening is the tonsils are removed because of the kissing tonsil presentation and the recurrent strep throat. 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.
When we look again for the child who’s in distress, we want to check their temperature. Keeping your child’s temperature, remember, below 104 is really a healthy temperature. 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. Parents, when you’re looking at your child, make sure that your child is able to hear, respond to the source of the sound.
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? 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. 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. The most common kind which may cause infants and toddlers fevers, screaming at night, poor sleep, decreased appetite and lead to many doctor’s visits is what we refer to as otitis media or middle ear infection. Acute means it is associated with symptoms such as fever and pain, while chronic is used to describe the condition when fluid in the middle ear is present for more than 4 weeks, likely up to even over 3 months! When a baby, toddler, or even an older child comes for an opinion about whether ear tubes are necessary, here is what I ask and whey I ask these questions. Again, one can only count them as separate if there is documentation that ears were normal and clear in between episodes.
Often moms tell me they know it’s an ear infection if their child pulls on their ears.  I ALWAYS inform families that research shows that ear pulling is not sensitive, instead, fever and actual otoscopy is the most sensitive way to diagnose an ear infection.
Let’s face it, accountability is really not a mandate, nor even relevant, if the person seeing you and your child may never see you again. I never suggest that we providers should act as robots and every human health care decision should be as simple or black and white as some statements or a guideline. I will not just recommend ear tubes because I do not run my practice like a “business”.  Yes, we all work and ultimately, healthcare is a business. If your child was born with normal hearing, there is no good reason to live for months with decreased hearing which can impact speech development.
Thank goodness moms are often more strict on definition of speech delay than our speech language pathologists! Sounds simple but believe me, this is the part that I believe we need to mandate improvement on as a society, otherwise no amount of research evidence and clinical practice guidelines will make an impact, because every day, decision are being made by a human being in some practice setting, and if you can’t trust the diagnosis, there is no point in discussion which treatment is the best. Julie Wei is a pediatric ear, nose, and throat specialist and the author of A Healthier Wei.
If you sit next to her on the plane, she will likely share with you information about how to minimize choking hazards in young children, and many other tips for improving your child's health. Julie Wei or A Healthier Wei, LLC and do not reflect the opinions of Nemours Children’s Health System.
So, fluid from the middle ear can still drain into the nose to be eliminated, despite the swelling. However, if your child is too young to talk, you may also need to look for other clues, as well.
Surgery, whereby new drainage tubes (grommets) are inserted in the child’s ears under general anaesthesia (myringotomy), may be required with recurrent infections that don’t respond to antibiotic treatment.
Research shows that infants who drink their bottle lying down have an increased risk of developing ear infections. The incidents of middle ear infections from all causes were also reduced, although by a modest six to eight percent.
It’s difficult, at times, to ascertain is this really an earache or an ear infection. Because there’s often a fever linked to ear infections or earaches, the child may, then, have that irritation. Also associated with that inner ear is the ear canals that have to do with our sense of equilibrium or balance. That type of an inner ear congestion is linked as we go beyond that canal to what we call the eustachian tube. The tonsils here, in the back of the throat, are a reflection of what’s happening in the body. 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. When we look at staff infections that are old and antibiotic resistant, their number one pal becomes the strep infections. The biggest thing that I see consistently is when we have tonsils and adenoids removed is we develop lower and upper GI distress.
What are the things that we’re feeding them in order to assist their well-being into life and into adulthood?
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.
For those parents, who even in themselves, know that in past, they’ve had a long standing infection, we recommend Congaplex for the adult. Thanks for taking the time to listen to this and share this information with you, and your family, and your friends. The EndHEADLINES FROM THE YEAR: 2059 Ozone created by electric cars now killing millions in the seventh largest country in the world, Mexifornia, (formerly California)White minorities still trying to have English recognized as Mexifornia's third language. Even though there is a wealth of research, and efforts by specialists and pediatricians from the American Academy of Pediatrics focused on developing “Clinical Practice Guidelines” to try and standardize what is considered the best for patients, I know that families who come through my office do not know such details nor may not understand how research data and studies translates into actual treatment plans.
As we are finally approaching swimming season, I tell parents the simple trick of how to tell if your child has a “middle” or “outer” ear infection (also known as swimmer’s ear). As a parents, what you need the health care professional to be clear with you about is whether on the day of the visit, your child has “fluid” in the middle ear or not, as well as whether it’s pus like fluid or not “pus’ or acutely infected fluid.
Indications for tubes are many, and includes for both recurrent acute, chronic, and complications from acute ear infections. Yet, it is precisely accountability that must be a key part of the medical and surgical treatment decision making. However, before we go making exceptions, we have the responsibility of making sure that those exceptions are truly exceptions. However, each and every patient encounter and decisions made that day in the office with the parents should never be a business transaction, and I sleep soundly at night because I never suggest surgery I truly believe the benefits highly outweigh the risk, and we have exhausted all nonsurgical options. This part is not as simple as looking at “flat” lines on tympanograms, because once again, an ENT should consider the entire picture and I have always prided myself is never making surgical decisions based on a “test” alone. Meaning that often a child will be considered to have speech within normal range despite mom’s perception. While tests like tympanometry can suggest whether there is fluid behind the ear drum, it is not accurate enough to tell us whether your child has an acute ear infection or chronic, since both have “fluid” in the middle ear space.
This is not just for all doctors of medicine, chiropractic medicine, osteopathic medicine, but all physician assistants, nurse practitioners, and anyone who is licensed to treat the human condition and has the power to write a prescription. Children, on the other hand, have narrower Eustachian tubes, which are level to the nasal passages. If fluid build-up persists for months, the eardrum and the bones in the middle ear may become damaged, which may lead to permanent hearing loss. This involves the careful monitoring of the child’s symptoms, without using any medication, to see whether or not the infection clears up on its own. 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. When the light shines into the ear, there will be a cone of light that’s directed forward in the ear. We start to grade it as a one, a two, a three, or a four, breaking that canal up into four regions.


That phlegm can build up, if you will, or that mucus will build up into that eustachian tube, causing then the glue ear.
A sustained temperature above 106 for greater than four hours is really a concern, but up to 104 is safe.
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. By definition, a child does not have an ear infection if there is no fluid behind the ear drum!
The system is complex and human factors involved in making this diagnosis in essence make it impossible to be a perfect science.
Sometime these children are bothered by loud noises, this can reflect having middle ear fluid and mild conductive hearing loss. Finally, by giving families information, education you the consumers of medicine as a commodity, can we empower everyone to minimize over-utilization of our resources, and reclaim health for your hopefully not but likely at times misdiagnosed and over-medicated children.
Wei is a passionate advocate for improving children's health through better diet and dietary habits.
Thus, when the tubes swell, the fluid cannot drain efficiently and builds up behind the eardrum. 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.
In other words, you’ll see what looks like a little triangle, or a cone, that points forward in that canal.
Tylenol’s, according to pediatricians now and acknowledge by the pediatricians, Acetaminophen as the Tylenol chemical formula impairs liver functions. I say this without judgment, but only because day in and day out I have had the opportunity to see such a variation in practice by primary care providers and even other ENT doctors in how they treat issues related to a child’s ear. My opinion must be based on research and evidence, otherwise it’s not good enough for my patients and not good enough for me. Again, otoscopy by a health care professional as well as hearing test can most accurately help decide on the presence and extent of the problem. As fluid fills the middle ear, it can become infected itself and result in an ear infection. Let me share with you what I share with families during any visit for consideration of ear tubes.
If there is truly an ear infection, then the fluid really does not magically clear up within 24-48 hours! It takes days, and antibiotics does not make middle ear fluid “drain” or clear out faster.  The most recent large scale research studies with control groups, comparing oral antibiotics to placebo, to examine whether there is benefit in using oral antibiotics to treat ear infections, shows that there is certainly higher likelihood of decreasing symptoms sooner when a child is given antibiotics.
However, this is always weighed against the increased likelihood of side effects such as rash and diarrhea associated with eating antibiotics.
Postal Service raises price of first class stamp to $17.89 and reduces mail delivery to Wednesday only. Global cooling blamed for citrus crop failure for third consecutive year in Mexifornia and Floruba.
WITNESS: Getting laid ____________________________________________ ATTORNEY: She had three children, right? Important Women's Health Issue:* Do you have feelings of inadequacy?* Do you suffer from shyness?* Do you sometimes wish you were more assertive?* Do you suffer exhaustion from the day to day grind? If you answered yes to any of these questions, ask your doctor or pharmacist about Margaritas. Margaritas are the safe, natural way to feel better and more confident about yourself and your actions. Margaritas can help ease you out of your shyness and let you tell the world that you're ready and willing to do just about anything. You will notice the benefits of Margaritas almost immediately and with a regimen of regular doses you can overcome any obstacles that prevent you from living the life you want to live.
Shyness and awkwardness will be a thing of the past and you will discover many talents you never knew you had. The next time you are washing your hands and complain because the water temperature isn't just how you like it, think about how things used to be. Here are some facts about the 1500s: Most people got married in June because they took their yearly bath in May, and they still smelled pretty good by June.
The man of the house had the privilege of the nice clean water, then all the other sons and men, then the women and finally the children. Hence the saying, "Don't throw the baby out with the Bath water!" Houses had thatched roofs-thick straw-piled high with no wood underneath . It was the only place for animals to get warm, so all the cats and other small animals (mice, bugs) lived in the roof. Hence the saying "It's raining cats and dogs." There was nothing to stop things from falling into the house. This posed a real problem in the bedroom where bugs and other droppings could mess up your nice clean bed.
Hence the saying, "Dirt poor." The wealthy had slate floors that would get slippery in the winter when wet, so they spread thresh (straw) on floor to help keep their footing. As the winter wore on, they added more thresh until, when you opened the door, it would all start slipping outside. They would eat the stew for dinner, leaving leftovers in the pot to get cold overnight and then start over the next day. Hence the rhyme: Peas porridge hot, peas porridge cold, peas porridge in the pot nine days old.
It was a sign of wealth that a man could, "bring home the bacon." They would cut off a little to share with guests and would all sit around and chew the fat. Food with high acid content caused some of the lead to leach onto the food, causing lead poisoning death. This happened most often with tomatoes, so for the next 400 years or so, tomatoes were considered poisonous.
Workers got the burnt bottom of the loaf, the family got the middle, and guests got the top, or the upper crust.
They were laid out on the kitchen table for a couple of days and the family would gather around and eat and drink and wait and see if they would wake up. So they would dig up coffins and would take the bones to a bone-house, and reuse the grave. When reopening these coffins, 1 out of 25 coffins were found to have scratch marks on the inside and they realized they had been burying people alive. So they would tie a string on the wrist of the corpse, lead it through the coffin and up through the ground and tie it to a bell. I thought I saw an eye doctor on an Alaskan island, but it turned outto be an optical Aleutian .3.
A rubber band pistol was confiscated from algebra class, because itwas a weapon of math disruption.5. It's important to have a woman, who helps at home, who cooks from time to time, cleans up and has a job.
It's very, very important that these four women do not know each otherNew Tests For Long Term Care During a visit to my doctor, I asked him, "How do you determine whetheror not an older person should be put in an old age home?" Well," he said, "We fill up a bathtub, then we offer a teaspoon, a teacup and a bucket to the person to empty the bathtub." Oh, I understand," I said.
Bartenders Ever since I was a child I've always had a fear of someone under my bed at night.
I was so happy to have saved all that money that I went and bought me a new pickup!' 'Is that so!' With a bit of an attitude he said, 'and how, may I ask, did a bartender cure you?' 'He told me to cut the legs off the bed! Here's how the scam works: Two seriously good-looking 20-21 year-old girls come over to your car as you are packing your shopping into the trunk. They both start wiping your windshield with a rag and Windex, with their breasts almost falling out of their skimpy T-shirts. When you thank them and offer them a tip, they say 'No' and instead ask you for a ride to McDonald's. Then one of them climbs over into the front seat and starts crawling all over you, while the other one steals your wallet.
I had my wallet stolen March 4th, 9th, 10th, twice on the 15th, 17th, 20th,24th & 29th. Writer Samuel Clemens took the term for his pen name after a stint as an apprentice river pilot.



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