|Colds, Sore Throats, Ear Aches & Germs

Phillip C Gioia, MD, PC

Pediatrics and Preventive Medicine

281 Grant Avenue Medical Center
Auburn, NY 13021
(315) 253-6257
email EVSX31A@prodigy.com

COLDS, SORE THROATS, EAR ACHES & GERMS

COLDS

Colds increase mucus secretions and congestion. This may lead to ear, sinus or lung infections. It is best to keep the mucus loose and draining. Infants may be given more water. Garlic helps helps to kill bacteria. Chicken soup helps to decrease congestion. It should be made from old chickens such as soup or stew chickens. Commercial chicken soups are generally effective. Runny noses with congestion are usually caused by viruses. At present, there are no medicines that control the cold viruses.

In the first few months of life, a bulb or nasal or ear syringe may be used to suction mucus out of the nose. Salt water nose drops (commercially available as Ayr or NaSal) may be used to break up the mucus. Use two drops of the solution up to 12 times per day.
Salt Water Nose Drops
1/8 teaspoon salt
2 ounces boiled, cooled water
Make fresh daily

A vaporizer or humidifier will also help to keep the mucus loose. These must be cleaned once a day and taken apart and cleaned with distilled vinegar once a week. These should not be used in warm humid weather because excess moisture promotes mold and dust growth. Humidity should be kept at 30 to 40%. Elevating the infant's head in an infant seat or car seat or elevating the head of the mattress also helps the to decrease nasal congestion.

In babies over 3 months of age, a mild decongestant may be used: Sudafed, Triaminic Expectorant (yellow), Robitussin PE, or Novafed. The dosage is: 1/4 teaspoon 3 times a day. For children over 6 months old, cough medicines may be used such as: Sudafed Cough Syrup or Robitussin DM. The dosage is: 1/4 teaspoon 3 times each day. DO NOT USE ANYTHING ELSE WHEN USING THESE COUGH PRODUCTS, EXCEPT ACETAMINOPHEN (Tylenol, Tempra, Panadol, Liquiprin, etc.). For children over 12 months of age, the dosage for the cold or cough medicines is 1/4 teaspoon 4 times each day is safe.

In children over 6 months of age, medicines with an antihistamine in them may be used such as orange Triaminic Syrup, Dimetapp, Sudafed Plus or Novahistine. The dosage is: 1/4 teaspoon 3 times per day. Antihistamines may make some people sleepy or spacey.

CALL THE DOCTOR :

SORE THROATS

Sore throats may be caused by strep (streptococcus pyrogenes), by other bacteria, or by viruses. One in 1000 children with untreated strep throat go on to have rheumatic fever about one month after the infection. Some strains of Strep not yet common here will cause Rheumatic Fever in 1 in 100 cases of untreated Strep. Rheumatic fever may be severe with permanent heart damage. Rheumatic fever may be prevented if a strep infection is treated within 5 days from its start. Because most sore throats are caused by viruses, throat cultures are often done to check for strep. If strep is found, then an antibiotic such as penicillin is prescribed. Strep is contagious, but is so common that it is nearly impossible to keep children away from it. About 10 percent of healthy school-aged children have strep in their throats. They only get sick from the strep when their resistance is lowered by physical or psychologic stress. Treating Strep in the first days of illness may lead to the Strep persisting and recurring. Strep in the throat of a healthy well child does not need to be treated. Throat cultures should be done on people who have a fever and a sore throat for more than 1 day.

In older children the symptoms of a sore throat may be treated by gargling with warm salt water: 1 teaspoon of salt in 8 ounces of water; or by using throat lozenges. If the children are too young to gargle or suck on lozenges without chewing them, warm clear liquids such as broth or bouillon, Chloroseptic Spray (1 spray every hour at most), Ora-jel, or Ambusol may be used. Do not use for at least an hour before throat cultures are done.

EAR ACHES

Middle Ear Infections

Because of the shape of the middle ear and the eustachian tubes, children tend to have more middle ear infections than adults. The eustachian tubes are passages to let air go between the middle ear and the back of the throat. When children have pain for more than 1 day or a fever for more than 1 day or much ear discharge, their ears should be checked. Some children with ear infections will have no pain or fever or discharge, but the ear infection may be seen on routine examinations, or a sudden hearing loss may be noted. It is important to treat ear infections in order to protect the child's hearing and to prevent infections of the skull and brain. Sixty percent of children will have an ear infection by 1 year of age and 80 percent by 2 years of age.

Middle ear infections are often preceeded by colds which congest and block the eustachian tubes. Bottle-fed infants who eat lying down may get formula in their eustachian tubes and then get middle ear infections. Sometimes ear aches may simply be caused by congestion of the eustachian tube. The tympanometer will check for eustachian tube function. When the ears pop, it is the eustachian tubes that open up. Decongestants such as sudafed or yellow triaminic may be used.

If the ear drums are red and swollen (this can only be seen using an otoscope), there is probably a bacterial infection in the middle ear. An antibiotic such as penicillin, ampicillin, amoxicillin or cefaclor may be prescribed. Erythromycin and a sulfonamide medicine are combined to make Pediazole and two sulfonamides together make Septra or Bactrim which are also good for ear infections. Occassionally, the swelling is severe and the ear drum breaks letting pus out of the middle ear. Medicines by mouth and/or ear drops will be used to help the ear drum heal. Auralgan or Tympagesic ear drops are sometimes used to relieve the ear pain. These drops work like novacaine by numbing the ear drum.

If the middle ear infections are very frequent or if fluid or mucus remains in the middle ear for more than four months, then the child should see an Ear, Nose, and Throat specialist to have tubes put in the ear drums to let out the extra fluid and/or to take out the adenoids which may block the eustachian tubes. The adenoids are like tonsils but are at the back of the nose. Children who snore frequently may have adenoid problems.

Outer Ear Infections

Sometimes water will get in the outer ear and bacteria will grow there and irritate the lining of the ear canal. The ear drum prevents these infections from going into the middle ear but still the pain may be severe. Often there is a white, waxy, smelly discharge. When there is ear discharge, the doctor may need to clean out extra wax to help clear up an infection and to examine the ear drum for a rupture. After the wax and pus are cleaned out, antibiotic/steroid ear drops are prescribed. If there is much swelling, oral amoxicillin may be prescribed also.

Swimmers, or babies who put their ears in bath water, or people with excessive ear wax frequently get outer ear infections. Swimmers may use 1/3 vinegar, 1/3 alcohol and 1/3 water in their ears before and after swimming to prevent infections. Babies should get only clean body temperature water in their ears. A bulb syringe (also called ear or nose syringe) may be used to squirt clean water into ears as long as the child has no fever or ear pain or ear discharge. Simply pouring body temperature 1/2 strength vinegar into wet ear canals and letting it drain out is a good way to prevent outer ear infections. Cold fluids in the ear may make the person dizzy and too warm fluids may burn.

When wax accumulates, 1/2 strength peroxide at body temperature (or Debrox) should be put in the ear canal and then the softened wax should be allowed to drain out. Only prescription ear drops should be put in the ears if there is ear discharge or ear pain. This prevents wax and germs from being washed into the middle ear through a ruptured ear drum. Avoid packing wax into the ear canal when using Q-tips or cotton swabs. Keep pouring the warm mixture of 1/2 peroxide and 1/2 water into the ear allowing it to drain out until the drainage becomes clear. Pulling the outer ear back and pushing in on the front of the ear helps to work the 1/2 strength peroxide into the ear canal.

GERMS IN THE NOSE AND THROAT

There are two major classes of germs or infectious agents. They are the bacteria and the viruses. Bacteria include streptococcus or strep., pneumococci, staphylococcus (or staph), hemophilus influenzae, moraxella catarrhalis, and neisseria meningitides. For all the bacteria of each species, there are also different types or strains. Some types of the same species may have resistance to some medicines and some do not. The viruses are best known as the cause of the common cold and of the flu, or influenza. Some names of viruses are rhinovirus, respiratory synctial virus and varicella or the chickenpox virus. Penicillin and the other antibacterial medicines are effective against some of the bacteria but do no good in combating viruses.

The bacteria listed above are often found in the nose and throat. They are usually not treated unless fever or pus in the nose, ears, or throat is present. The exact bacteria that is present helps to determine the kind of antibacterial medicine to use. If there is fluid in the lungs (pneumonia), antibacterial medicines are used in case there is bacteria in the lungs; though most often pneumonia in children is caused by viruses.

Antibacterial Medicines

In children over 8 years old penicillin is effective against 80% of bacteria causing ear and sinus infections. Despite its 20% failure rate, it is often used since it is safe and inexpensive. Cefaclor is 95% effective but 5 times as expensive. Amoxicillin is 90% effective but only 2 times as expensive as penicillin. Septra or Bactrim (trimethoprim-sulfamethoxazole) are a little less expensive than amoxicillin but like cefaclor they will kill bacteria that produce an enzyme that digests penicillin or amoxi- cillin, but will not kill Strep.

In younger children the bacteria that are resistent to penicillin are more common and treatment failures are more serious. Thus more cultures may be done to identify the type of bacteria and more expensive medicine may be used. Fortunately, smaller patients get smaller doses.

Cost of medicines will also depend on whether the generic type or only the brand name medicine is available. Some drug stores may not stock a generic medicine or some generic medicines are inferior to brand names, and then only the brand name medicine will be ordered. For newly patented medicines there is no generic equivalent [such as Ceftin (cefuroxime) and Augmentin (amoxicillin/ potassium clavulanate)] for 17 years by law.

Bacterial Resistance to Antibiotics: a Good Reason for vaccines.

Bacteria may become resistant to the drugs used to control them. When large number of bacteria are exposed to penicillin or sulfa medicine a few of them may remain. These bacteria that survive drug treatment then grow easily and replace the bacteria easily killed by the drugs. These resistant bacteria may then cause disease. The best way to avoid resistance to antibacterial drugs is by keeping off the drugs until necessary. Babies may get antibacterial drugs more often since they are unable to fight off bacteria as easily as older children. Older children should only receive antibacterial drugs when there is a definite bacterial infection or there is possibly a serious bacterial infection. If desired you may get your family flu vaccine and/or pneumococcal vaccine to help prevent infections.