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Kids, Upper Respiratory Viruses, And Ear Infections

According to a new study published this month, more than 20 percent of young children with colds or other upper respiratory viruses will develop middle ear infections.

This finding isn’t that surprising. Eear symptoms along with a viral upper respiratory infection (URI) are common, including ear fullness and difficulty popping the ear. Although adults tend to be able to keep their ears clear by swallowing, chewing gum, yawning, or ear popping, most kids don’t know what to do when their ears feel full.

Whether in adults or kids, when the ears don’t ventilate or clear properly it can lead to ear problems including fluid buildup and middel ear infection. Why does this occur?

With a viral URI the lining of the nose swells, leading to symptoms of runny nose, nasal congestion, and sometimes nasal obstruction. This swelling doesn’t just occur in the nose, but also in the eustachian tube, which connects the back of the nose to the middle ear. When the ear “pops,” the eustachian tube opens to allow pressure and fluid to drain from the ear into the back of the nose. This is why yawning, swallowing, or noseblowing can cause an ear to pop normally.

When the lining in the eustachian tube swells up, the tube becomes blocked and prevents the ear from popping, leading to symptoms of ear pressure and fullness, fluid buildup, clogging, and often ear infections.

Read more about eustachian tube dysfunction here.


Clinical Spectrum of Acute Otitis Media Complicating Upper Respiratory Tract Viral Infection.” Pediatric Infectious Disease Journal. February 2011, volume 30, issue 2, pp 95-99.

*This blog post was originally published at Fauquier ENT Blog*

The Eyes Have It

I was coming to the end of my ER shift and realized that a fairly large list of patients still waiting to be seen. I scanned the chief complaints listed on our white triage board to see if there was a straight forward case that I could handle quickly before I went home. Since it was early in the morning, we had the typical extremes of patients – those who were badly injured (drunk driving is more common in the wee hours) and those who were really weird.

ER nurses are amazingly adept at capturing the seriousness of a complaint with their choice of words. Reading between the lines is a bit of an art form – and part of the natural communication in a busy ED. I understood the art fairly well, though this night I missed a big clue. Here were some of the chief complaints that I could choose from:

1. Crushing substernal chest pain x1hour

2. Butt twitching x3 months

3. Head vs. light post

4. Ear pain x2 days

First of all I made sure that a colleague was with patient #1, which left me a choice between patient #2 – clearly weird and doubtful that I’d be able to resolve his problems any time soon, patient #3 – probably going to take a lot of sutures and more time than is left in my shift, and patient #4 – a fairly innocuous-seeming issue, probably otitis media.

Needless to say, I chose patient #4… though I hadn’t recognized the subtle distinction between “ear pain” and “ear ache.” I was about to figure this out the hard way.

As I drew back the curtain to patient #4’s room, I saw a tall, thin man sitting bolt upright in the chair next to the stretcher. He was polite and respectful – but there was something odd about him. A few minutes into our interview about his ear pain, I finally put my finger on it. The guy never blinked.

After several more minutes of what could only be described as fairly straight forward answers to medical history questions – and a fully negative review of systems – I had this sneaking feeling that Patient #4’s pain wasn’t otitis media.

“I’d like to ask you a question that might seem kind of strange…” I said, peering intently at his face.

“Ok,” said the young man.

“Have you ever thought that your pain is related to a transistor radio of some sort in your ear?”

His eyes grew as large as saucers.

“Yes! How did you know?!”

And there it was – a young man with schizophrenia, experiencing his first psychotic break. It took me a few hours to get him a full work up and a discharge plan to the inpatient psych unit… and I was very late getting home from this shift. So much for a straight forward case…

I wonder what would have happened if I’d chosen patient #2?

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