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Dr. Gellner: You may think that an injury to your child's outer ear isn't a big deal, and you're probably right, but there are some times when it is a big deal. When should you worry about ear injuries? I'll tell you on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner, on The Scope.

Dr. Gellner: Most injuries to the outer ear are minor, like small bruises and scratches, and these are easily taken care of. But the large blood supply to the cartilage of the outer ear can lead to problems. If your child's ear is just scratched or scraped, then treat the injury just like any other skin scrape. Wash the injured area with soap and water, make sure the bleeding has stopped, and put over-the-counter antibiotic ointment on it until the injury's healed over.

But the one ear injury pediatricians get very concerned about is called cauliflower ear, and it's seen in boxers and wrestlers, and it happens when the ear cartilage is so badly damaged from a direct blow to the ear that there's a lot of swelling in the ear itself because of blood collecting under the skin. And that's a medical emergency, and your child will need to be seen in the emergency room right away to help reduce the swelling and make sure there's no other ear damage. Your child's ear could be permanently disfigured if action is not taken quickly.

And remember, while outer ear injuries are often minor, inner ear injuries can cause major problems.

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Interviewer: All right, it's time to play the game ER or Not, where you get to play along and decide whether something that happened is worth going to the emergency room or not.

Dr. Troy Madsen is an emergency room physician at University of Utah Health. All right, here is today's ER or Not. You've got your ear pierced. Now you believe that there might be an infection in the ear. ER or not?

Dr. Madsen: So when you think of an ear piercing, you might think, "Okay, this is a pretty minor thing." Maybe you got your ear pierced, maybe there's just a little bit of redness around it. And again, that would be a pretty minor thing and something you don't need to go to the ER for if it's just some local irritation or maybe just a small infection. You could probably go to an urgent care or go see your doctor. But there's so much else going on around the ear that can really cause problems.

So the ear is made of cartilage. If you get an infection that's spreading up beyond just the site of the piercing, where the full ear appears red and swollen or just even the lower half of it, then I would be a lot more concerned about an infection in the cartilage itself, and that would definitely be a reason to go to the ER.

Interviewer: So a cartilage infection is a lot worse than infections elsewhere. Why is that?

Dr. Madsen: It's just tougher to treat, you know? You figure cartilage doesn't have all of the blood going into it. You don't have all the vessels running into it so if you start antibiotics, it has a tougher time getting into that. So if you have an infection that's getting down into the cartilage of the ear, we may need to think about IV antibiotics, you know, something where we're admitting you to the hospital for that. And then behind the ear as well, the bones back there are notorious for getting infected and that can be a very serious thing as well.

So if someone comes into the ER and they've got ear pain and ear swelling, and then I push on the bones behind the ear, kind of at the base of the skull there, and they're really tender there, that can be a very serious thing too. And that, typically, requires IV antibiotics, sometimes even surgery.

Interviewer: So beyond the dangers of an infection, which infections aren't good, is there a danger to the actual ear itself if this goes untreated?

Dr. Madsen: Absolutely. Yes, I mean, you could have damage to the cartilage, you can have a breakdown of that cartilage, something that could cause long term issues, possibly deformity there.

Interviewer: So they're hearing loss?

Dr. Madsen: Absolutely. If you get enough swelling in there and enough long term issues, you could have some sort of, at least, hearing impairment or hearing issues. So, you know, it's kind of the thing again you hear about it, maybe an infection from an ear piercing sounds pretty minor but there's just so much going on around the ear. If that infection spreads, if it's deep or if it's into the bone absolutely come to the ER. Probably IV antibiotics, hospital admission for that.

Interviewer: So be sure you're going to a reputable place and don't let your friends do it, I guess is the lesson here, right?

Dr. Madsen: Yes. To me, too many memories as a kid of seeing kids in the boy's bathroom with a needle, stick it into the ear trying to piece their ear. You don't want to do that. This is not a home procedure.

updated: June 19, 2020
originally published: April 28, 2017

Dr. Gellner: Your child has yet another ear infection. How can you prevent ear infections and when is it time to see the specialist? Those are the big questions on today's Scope. I'm Dr. Cindy Gellner.

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Dr. Gellner: I get asked a lot about how ear infections can be prevented. Well, unfortunately, they can't entirely be prevented. Genetics plays a really big role here. If a sibling or parent had a lot of ear infections, there's a good chance it's going to run in the family. But don't despair. There are some tips to minimizing the possibly inevitable.

Protect your child from secondhand tobacco smoke. Kids shouldn't be around smokers anyways. It's really bad for their noses, lungs, ears, actually, every part of them. Passive smoking increases the frequency and the severity of ear infections. So that's one way you can minimize ear infections.

Another way is to reduce your child's exposure to colds during the first year of life. I know, yeah, right. I'm with you there. It's hard when there are older siblings in the home, or parents need to work and daycare is the only option. But most ear infections do start with a cold. In this case, you do the best you can. Most daycares do have separate infant rooms to keep the littlest ones away from the older, germier kids.

You can also breastfeed your baby during the first six to 12 months of life. Antibodies in breast milk reduce the rate of ear infections. For some women, this isn't always possible. But if you are able to get your baby any breastmilk, even the colostrum that comes in shortly after birth, you will give your baby an immune system boost.

Make sure you give your child all the recommended immunizations. The Haemophilus influenzae B, or HIB vaccine, and the pneumococcal 13, or Prevnar vaccine, will protect your child from the most common types of bacteria that cause ear infections.

If you are bottle-feeding your baby, avoid bottle propping. Hold your baby with the head of your baby higher than the stomach. Feeding your baby with them in the horizontal position can cause whatever you're feeding them to flow back up into the Eustachian tube, which is the tube that connects the back of the throat to the middle ear. And then that fluid goes back up into the middle ear. Allowing an infant to hold his or her own bottle can also cause the same problem.

Check to see if your infant has allergies. I know, not the kind you expect in the older kids with the runny nose, and the sneezing, and things like that. But your infant, if they always have a really runny nose, or really bad eczema, or a bloody bowel movement, a milk allergy may be the problem. Kids older than two are more likely to have seasonal allergies, so watch for those as well. Again, in those kids, the ear infections can be triggered by allergies.

Finally, check for snoring. If your toddler snores like an adult every night, or breathes through their mouth, never closing their mouth except to eat, they may have large adenoids. These are the glands that sit on top of the tonsils and behind the nose. Large adenoids can lead to ear infections by blocking those Eustachian tubes and not letting them drain.

If your child has back-to-back ear infections, more than six ear infections in a 12-month period, or you think their adenoids may be the issue, then it's time to get a referral to the ear, nose, and throat specialist. They will be able to tell you if your child does need ear tubes and they will be the ones to do the surgery.

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Dr. Gellner: One of the most common reasons a parent brings their children to the pediatrician is because they're concerned their child has an ear infection. I'll talk about the symptoms to watch for and what to do if your child does have one on today's Scope. I'm Doctor Cindy Gellner.

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Dr. Gellner: Parents come in all the time saying their child has been pulling on their ear and they know this means they have an ear infection. Well, not so fast. Kids pull on their ears for a lot of reasons, ear infections only being one of them. Other causes are teething, ear pressure from nose congestion or allergies, and because it just plain feels good, especially when kids are tired.

There are a lot of nerve endings in the ear and that's why it's such a popular place for massage therapists and acupuncturists to work on. So other than pulling, your child has no other symptoms. Ear infection? Maybe not. But say your child also has a fever, has had a cold for a while, isn't sleeping like they normally do and are just plain cranky, then it's time to get those ears checked out.

Despite what a lot of people think, going outside in the wind or cold without a hat on won't cause an ear infection. Ear infections happen behind the eardrum, not in front of it where the cold and the wind would hit. An ear infection is caused by bacteria and it's a common complication of a viral cold. Nasal congestion and mucus block off the tube that connects to the middle ear to the back of the throat. That's the Eustachian tube. And then the ears can't drain properly if that's blocked. This makes a pool of fluid, which is a great breeding ground for bacteria and, hence, an infection is born.

Sometimes, kids have what are called serous ear infections. That means there's fluid behind but it's not all gross, and this fluid usually goes away in a few months. This type of infection does not need antibiotics.

Kids between six months and two years are most likely to get ear infections, but they're actually pretty common until age eight when the internal anatomy of the ear starts to change and they aren't as prone to infections. Most kids will have at least one ear infection and over 25% of these children will have repeated ear infections. In a small percentage of children, the pressure in the middle ear fills with puss and that causes the eardrum to rupture and drain. It's usually just a small hole, which heals over the next three months.

Now, you find out your child does indeed have an infection, you need to be sure your child takes the antibiotics prescribed by the pediatrician and finish the entire course to make sure all the bacteria is treated. Tylenol and Motrin can also help with pain.

Some people talk about putting warm oil into the ear, but that's not a good idea. If the eardrum bursts, follow up in three weeks to make sure the infection is gone and the eardrum is healing. Ear infections seem like a rite of passage for some kids. I've had parents try looking in their child's ears with a flashlight to see if they have infections. Trust your child's ear exams to the experts. As pediatricians, we get really good at looking in ears and seeing if there truly is an infection or not.

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Dr. Gellner: Earwax seems to freak a lot of parents out. We'll deal with earwax facts today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kid Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: While some kids have more earwax than others, in general, the ear makes just as much wax as it needs. True some kids are little wax factories, but unless the wax causes pain or decreased hearing, leave it alone. So why do ears make wax? Yes, earwax really does have a function. It helps protect your child's eardrum and ear canal by providing a waterproof lining, helping to keep it dry when your child swims or bathes and preventing germs from causing infection. It also traps dust, dirt and other particles, keeping them from injuring or irritating the eardrum.

It's all the stuff earwax collects can give it unique color and smell. Say your child complains their ear hurts and you can actually see the wax. It's okay to use a wash cloth to clean it out, but do not, I repeat, do not use cotton swabs to clean out your child's ear. I've seen a lot of kids with ear canal and eardrum damage from those swabs going in too far or too fast. For some reason, kids are fascinated by putting things in any orifice, especially their ears. They'll want to use the swabs themselves to show that they're big and they can clean themselves.

That's why I tell my younger patients, "Do not put anything in your ears smaller than an elephant." And please do not do ear candling on your child. Placing a cone inserted into your child's ear and setting it on fire just isn't safe. If your child has any ear pain, hearing problems or an uncomfortable blocked feeling in the ear, take them in for their pediatrician to check out the earwax situation. We have ways of cleaning out the wax safety.

And if we find an infection, we can treat your child. If there is no infection and the wax was the only issue, they'll leave the office with squeaky-clean ear canals. If you have any concerns about your child's ears or hearing, be sure to call your child's pediatrician. We get really good at looking at ears.

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Swimmers get water in their ears a lot. But when fluid starts coming out of the ears, it's time to see the doctor.

If your child has swimmer's ear, you'll probably know it pretty quickly. He or she may have painful ear canals, their ear will hurt if it's moved up and down or if the tab on the outer ear that covers the ear canal is pushed in. If the child's ear feels really plugged up or you see discharge coming out of the ear. Now the discharge will be clear at first. But if it's not treated within 24 hours, it usually becomes yellow, and more like puss coming out of the ears. Clear drainage without ear pain is most likely water. That's not concerning for an infection.

Swimmer's ear occurs when your child's ears have been in the water for long periods of time and the water gets trapped in the ear canal. And the lining becomes damp, swollen, and prone to infection. Children are more likely to get swimmer's ear from swimming in a lake or a river compared to swimming in swimming pools or the sea. During the hottest weeks of summer, some lakes have really high levels of bacteria and narrow ear canals of children increase the risk of swimmer's ear.

Cotton swabs also contribute to the problem by causing wax build up. When you go to clean your clean your ears with a Q-tip, you're actually pushing the wax in further, and then you can get water trapped behind it. Swimmer's ear is easy to treat and the symptoms should be better within three days of starting treatment and cleared up within seven days.

Your child will need eardrops prescribed by your pediatrician that have both an antibiotic and a steroid in them. Be sure to run the eardrops into the ear canal with your child lying on his side so that air isn't trapped under the drops. Move the earlobe back and forth to help the eardrops pass down deep into the canal. And be sure to finish the eardrops as prescribed to make sure the infection is completely treated.

Generally, your child should not swim until the symptoms are gone. Continued swimming may cause a slower recovery, but it won't cause any serious problems. For mild swimmer's ear without puss coming out of the ear or serious ear pain, you can treat it at home. Use a mixture of one part water and one part white vinegar, and put 3 drops in the affected ear. After five minutes, remove the drops by turning the head to the side and rubbing the ear. Do this twice a day until the ear canal feels normal again.

So often parents ask, "How can I prevent swimmer's ear in my child?" First, limit how many hours a day your child spends in the water. The key to prevention is keeping the ear canals dry when your child is not swimming. After swimming, get all of the water out of the ear canals by turning the head to the side and pulling out the earlobe in different directions to help water run out. You can also put a towel into the ear and help soak up the water. Dry the opening to the ear canal very carefully so you don't injure the ear canal by going too far in.

If recurrent ear infections are a big problem, rinse your child's ear canals with three drops of rubbing alcohol each time he or she finishes swimming to help dry the ear canal and kill germs.

Another helpful home remedy is to use the solution of half water and half vinegar. The vinegar will restore the normal acid balance to the ear canal. Your child may also benefit from using earplugs or a swimming cap to keep the water out of the ear canal in the first place. Remember, rubbing alcohol is helpful for preventing swimmer's ear, but not for treating it because it stings the ear too much.