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Reading and writing and ear infections? What back-to-school means for common ear, nose and throat conditions

August 12, 2021

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Dr. Kathleen Billings, a pediatric otolaryngologist and surgeon, looks into the ear of Pepper, age one

Lurie Children’s pediatric otolaryngology physicians treat more children for ear, nose and throat-related conditions than any other hospital in Illinois.

Read more below about common ear, nose and throat conditions children may encounter this fall and winter, including ear infections, sore throats and tonsillitis.

Lurie Children’s pediatric otolaryngology specialists, Drs. Kathleen Billings, Douglas Johnston and Saied Ghadersohi, weigh in on common questions parents may have as some children return to school in-person.

What are some of the conditions you may expect to see as many children return to school full-time in person?

Kathleen R. Billings, MD, FACS, FAAP: Typically, during the fall and winter seasons there are increases in the number of viral upper respiratory tract infections, or URIs. During the pandemic, there was a notable decrease in these infections, likely related to a combination of virtual learning, mask wearing, increased enforcement of hand hygiene (handwashing) and social distancing practices. With easing of some of these restrictions, one might expect an increase in upper respiratory tract infections this fall and winter. This may in turn increase the rate of episodes of acute otitis media (ear infections), sinus infections and tonsillitis infections, which often relate to underlying upper respiratory infections. It is unclear if the rates of these infections will return to pre-COVID levels, as hand hygiene and masking may continue to be part of the norm for school-aged children for the time being.

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Dr. Johnston

Douglas R. Johnston, MD: In general, we would expect to see an increase in the number of upper respiratory infections as children return to school in-person, although not to the same levels we saw before the pandemic. The upper respiratory infections often start as a cold but end up as otitis media (middle ear infections), tonsillitis, sinusitis or infected lymph nodes in the neck. With repeated or prolonged ear, tonsil, sinus or lymph node infections, our specialists are ready to help diagnose and manage these children.

How can these conditions be avoided, if at all?

Dr. Billings: Upper respiratory infections spread through direct contact with sick individuals. For example, when someone with an upper respiratory infection coughs, they can spread the virus to those around them, particularly if they are not covering their mouth. This leads to spread of infections in classrooms and daycare settings, where young children are not as apt to cover their mouths or wash their hands regularly. Wearing masks, hand hygiene and keeping sick children home from school or daycare are all ways spread of infections can be reduced.

Dr. Johnston: Masking, hand washing and social distancing in some manner will likely be a part of school protocols for the foreseeable future, so infections in the head and neck will be certainly reduced. As the COVID-19 infection numbers decrease and restrictions and mask recommendations ease, these infections will rise, but they are largely manageable through conventional methods without a significant long-term impact on quality of life. At that point, we need to remember that a runny nose, cough or congestion is likely due to previously common viruses and bacteria and shouldn’t be feared.

How concerned should parents be about their children’s exposure to ear, nose and throat conditions when they return to school in person?

Dr. Billings: By educating young children on the importance of hand hygiene, covering the mouth when coughing (into the elbow, for example), and keeping a sick child home from school or daycare, infections may be prevented. Despite this, one might expect a typical rise in URIs and URI associated condition like ear and sinus infections in the fall/winter season. Parents should consult their primary care providers if they feel their children are suffering from any infectious conditions. If appropriate, a referral to ENT specialist might follow. For example, if children have multiple bouts of acute otitis media (ear infections) in a short time span, they may be candidates for ear tube placement.

How can Lurie Children’s ear, nose and throat experts help parents with prevalent issues like recurrent sore throats, ear infections, tonsillitis, ear fluid, etc.?

Dr. Billings: The pediatric ENT specialists at Lurie Children’s are experts in treating children with chronic or recurrent infection conditions like ear infections, sinus infections, and tonsillitis infections. If the primary provider feels like the infectious condition has been frequent enough, they may suggest a referral to an ENT specialist to discuss surgical options (i.e., ear tube placement, removing tonsils and adenoids). Children with persistent fluid in their ears may also be referred to an ENT specialist for consideration for hearing testing by the audiology team and possibly ear tube placement. Simple and complex ENT conditions alike are treated by the specialists at Lurie Children’s and satellite locations.

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Dr. Ghadersohi

Saied Ghadersohi, MD: For most conditions, we will look to understand the severity of the symptoms, and what exactly may be causing them. We also help parents understand all the treatment options, including both medical and surgical measures, when appropriate. For example, for ear infections, if they are diagnosed by a pediatrician and have occurred three times in the last six months, or four times in the last year, then the Lurie Children’s team will evaluate a child to determine if they are a good candidate for ear tube (tympanostomy tube) surgery.

Can common ear, nose and throat conditions have long-term affects?

Dr. Ghadersohi: Sometimes. Though largely issues like recurrent sore throats and ear infections affect quality of life in the short-term, causing missed work or activities.

If recurrent sore throats they are caused by recurrent tonsillitis, they can be problematic as patients may require repeated courses of antibiotics that could lead to allergies, drug resistance or gastrointestinal effects. Recurrent ear infections can result in hearing loss, speech delay and development of chronic ear disease. Still, in many cases, our care team can prevent these complications, or at least make them manageable for your family.

How are these conditions usually treated?

Dr. Ghadersohi: It will usually depend on what is causing the issue, and how severe it is. For example, with recurrent sore throats, if they are caused by recurrent tonsillitis and meet certain documented criteria (seven sore throats in one year, five per year for two years, or three per year for three years) or have other criteria, they may be a candidate for tonsillectomy or surgical removal of the tonsils.

For ear infections, antibiotic drops directly to the site of an ear infection, or by mouth are often effective. Sometimes ear tube placement is needed.

For breathing issues during sleep, if the issues are severe and include snoring, apneas or pauses in breathing, the child may be a candidate for tonsillectomy. In less severe cases, use of nasal steroids, or other medications, can help treat symptoms.

Each case will be different, and the care team will determine the best course of treatment.

If my child needs surgery for one of these conditions, what will that be like?

Dr. Ghadersohi: Lurie Children’s pediatric otolaryngology team will help guide you through every step from the initial clinic visit including any additional workup that is needed. Then, if a surgery recommendation is made, our scheduling team will coordinate a date for surgery and help you get your child ready for surgery.

Both ear tube surgery (tympanostomy tube placement) or tonsillectomy with or without adenoidectomy (removal of the tonsils and adenoids) are quick procedures, about 10-15 minutes and 30-45 minutes respectively. You child will be completely asleep for both procedures. The surgical team and nurses will carefully go over the surgical findings and post-surgical care instructions. We will be available by phone call day or night to answer any post-surgical concerns and the team will arrange for follow up in the clinic for your child after surgery if needed.

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Dr. Billings talks with patient Ezra, age one, and his mom, Allison

Why is Lurie Children’s the best place for pediatric ENT care?

Dr. Johnston: Pediatric ear, nose and throat and head and neck specialists at Lurie Children’s understand that prolonged and recurrent head and neck infections can have a big impact on quality of life for children and entire families since they affect communication, sleep and general comfort. Through referral from a pediatrician, or self-referral, our specialists are available in person or via telemedicine to expertly examine and diagnose children and review the benefits and risks of the available treatment options. Patients can even schedule appointments, whether first time or follow-up, via the Lurie Children’s MyChart portal.

Dr. Ghadersohi: The two most important reasons for me and why I bring my own kids to Lurie Children’s for care are: 1) Care of children requires a team that is dedicated to pediatric care from doctors and nurses to child life specialists and ancillary staff that enjoy caring for children. Lurie Children’s has this! 2) As the premier pediatric hospital in the area, Lurie Children’s has the widest array of specialists that one can trust to be well-trained experts in their field.

Learn more about our ENT services