COMMON ENT PROBLEMS
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An upper respiratory illness, more typically called a “cold”, usually lasts 7-10 days in children. The worst symptoms are noted on days 3 to 5 of illness. Symptoms can include cough, nasal congestion, nasal drainage, sore throat, and fever. Medications are only given to help symptoms, as colds commonly resolve on their own.
Children under 3 months of age with a fever greater than 100.4 degrees Fahrenheit (rectally) should be evaluated immediately by their doctor. Children older than 3 months of age, with a fever between 101-104 may be monitored at home if they are having good urine output and drinking well. For more information on adequate fluid intake visit our page on oral rehydration. If the fever lasts longer than 5 days or gets higher than 104 in this age group you should seek a full medical evaluation.
Typically the cough from a cold is wet or productive. This cough should not cause difficulty breathing or cause inability to drink. For children greater than 1 year of age, use 1 spoonful of honey every 2 hours as needed to gain control of coughing. Under 1 year of age, there is no known, safe cough suppressant. This cough is usually worse on days 3-5 of the cold and begins to improve by days 7-10 of the illness. If you have not noticed improvement by day 14 of the illness, please discuss this with your healthcare provider.
Under 6 months of age, congestion can cause the inability to drink fluids and even cause difficulty breathing. If your child is having difficulty breathing or drinking, we recommend seeking medical attention. For congestion that is causing discomfort, you can use nasal saline. Also for children under 6 months of age, you can follow up nasal saline with suctioning of the nose with a nosefrida or bulb suction. Nasal congestion is typically worse from days 3-5 of illness and improves by days 7-10 of illness. For older children, greater than 12 years of age, an over-the-counter nasal decongestant or nasal sinus rinse might be recommended by your healthcare provider.
This can be managed by taking either tylenol or ibuprofen. Under 3 months of age, tylenol should only be given if recommended by your healthcare provider. Ibuprofen should never be given under 6 months of age. If your child’s sore throat causes an inability to drink the appropriate amount of fluids, you should seek medical attention. Sore throats are usually worse on days 3-5 of illness and start to improve quickly thereafter.
Allergic Runny Nose (Rhinitis)
Treating allergic rhinitis depends on the specific cause or diagnosis. If there is a specific trigger that can be avoided, this may be the most appropriate treatment. For example, in people with a cat allergy, avoidance of direct contact with cats is the most effective strategy to decrease symptoms.
When avoidance is not reasonable, medications can be used to control symptoms. Depending on the specific cause of the allergic symptoms, some of the medications that may be used include:
Intranasal saline spray or rinse
Antihistamines (oral or intranasal)
Corticosteroids (usually applied as an intranasal spray)
These require consistent daily use for up to 1 week before they become effective
Ipratropium bromide intranasal spray
Allergy shots may be an option and should be discussed with your primary care physician.
For severe runny nose or nasal obstruction/congestion that does not respond to medications, your ENT specialist may consider additional office procedures or surgery appropriate to your situation.
Children over 2 years of age can be infected with streptococcal bacteria, what many call a “Strep Throat”. Children with strep throat can exhibit the following symptoms: fever of 101 degrees Fahrenheit or greater, a sore throat, headache, stomachache, and tender swollen glands in the front of the neck. Typically there is no cough associated with strep throat.
Pain is controlled using scheduled ibuprofen, and the infection is typically treated with a penicillin antibiotic. Your doctor may choose to do a strep test, which takes 5 minutes and is very reliable in deciphering between strep or a viral infection.
If your child has been diagnosed with strep, they are contagious to other children that are 2 years or older until 12 hours after their first dose of antibiotics. Please call us if your child has been exposed and develops these symptoms within 5 days of the exposure. Generally, children are able to return to school once the fever has resolved and they are drinking well.
Tonsillectomies have been proven useful in preventing strep infections if the child has had 7 strep infections in 1 year, 5 infections in 2 consecutive years, or 3 infections in 3 consecutive years.
Lump on the Head or Neck
Lumps on a child’s head or neck are common and can cause a lot of concern and anxiety for parents. Children under the age of 4 are most common to get these lumps due to their frequent viral illnesses. Most lumps are caused by the body’s lymph nodes responding against infection. In general, a normal node feels like a pea under the skin, the node is round, and you can move it around under the skin. A normal lymph node does not hurt to touch and there is no redness or swelling surrounding it. Conversely, if you have a lump that is larger than an almond and you notice that it is not movable or tender, you should bring your child in for a full evaluation. Normal lumps or nodes, as above, typically resolve over 3-6 months and require no treatment or medication.
Ear infections occur at any age, but are most commonly found in the first 3 years of life. They are caused by a virus that results in congestion of the nose and ears. When the ears are unable to drain fluid appropriately, that stagnant fluid grows a bacterial infection within the ear. While colds and viruses can’t be treated by antibiotics, a bacterial infection of the ear can be treated with antibiotics to decrease complication. Typically, children with an ear infection will exhibit moderate to severe pain of the ear and a fever of 101 degrees fahrenheit or greater. It is unlikely that a child with mild or absent ear pain or a low grade or absent fever will have an ear infection. Typically, the first sign of an ear infection is moderate ear pain and fever and not drainage, however if you do see drainage please seek medical attention. Your doctor may choose to forego treatment of an ear infection in instances where it is only in one ear, has mild or absent pain, or the child does not have a fever. In these instances, ear infections are managed without an antibiotic and treated with scheduled ibuprofen or tylenol. Ear tubes are considered for ear infections when there have been 3 infections in a 6 month period or 6 infections in a year. Ear tubes decrease the chance of your child developing future ear infections, hearing problems, speech problems, and antibiotic resistant infections.
Nosebleeds can happen at any age and while they can be provoke anxiety, they are very safe. To stop a bloody nose, raise your head above the level of your heart, pinch your nose for ten minutes and apply ice packs to your neck and forehead. Call your doctor if the nosebleed doesn’t stop in fifteen minutes. If you have frequent nosebleeds, moisturize your nose nightly with saline nasal spray or saline gel (available at most drugstores) and get NasalCease to use as packing. Follow the label directions. If these preventive measures don’t stop your nosebleeds, see your doctor to be sure you don’t have high blood pressure, a blood clotting problem, or a growth in the nose.
Sometimes if nosebleeds continue to happen despite regular moisturization, an ENT doctor may recommend cauterization of the vessel causing the nose to bleed. Speak with your ENT or Primary Care Physician to see if this is an option.
Swimmer’s ear usually appears in children older than age 5 who regularly get their ears submerged in a pond or pool. The child typically appears with ear pain that is one sided, swelling, drainage, or redness, pain upon tugging the outer ear also may be noticed. It is typically treated with antibiotic-steroid ear drops to kill the infection and decrease pain. It is recommended that your child abstain from ear submersion in water for 5 days to decrease the chance of treatment failure. For prevention of swimmer’s ear, you can use special ear drops after swimming to decrease the chance of infection. These drops can be made at home with a 50:50 mixture of white vinegar and rubbing alcohol or they can be purchased at a store. Two to four drops of the preventative mixture in both ears after swimming should be sufficient to prevent infection.