Ears, nose, and throat, oh, my!

November 1, 2017

From ear infections to croup to strep, I have found that the simplest diagnosis is often the best diagnosis.

1. In swimmer’s ear, the tympanic membrane is often distorted. Occam’s razor will tell you that a child is unlikely to have both otitis externa and otitis media (OM) at the same time, and, because treating OM in older children is optional anyway,1 according to current guidelines, one can do just fine with only a topical preparation.

2. Missing an early ear infection is not that big a deal. Either it will go away on its own, or it will worsen and then the picture will be clearer. One does not need to treat dubious unilateral ear infections in the otherwise well infant aged older than 6 months.1

3. I have found that ear tugging in an infant, in the absence of supportive findings such as fever, pain, or having a cold, is not a sign of an ear infection, and I do not bring happy ear-tuggers into the office to be seen. I call this the “Carol Burnett sign” (Carol Burnett tugs her left ear after a performance to tell her grandmother she loves her).

4. If a child in the family has conjunctivitis requiring antibiotic drops, I tell the family it will be okay to treat other children who come down with it that week, without an office visit, provided they are otherwise well (eg, there is not a concern for an associated ear infection).

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5. A child with croup does not have strep, nor does one with vesicles in the oropharynx. They do not need throat cultures.

6. If parents are interested in treating lop/protruding ears in their newborn, a useful site for home treatment is http://www.earbuddies.co.uk/. This should be done early for best results.

7. The nose cycles every 90 minutes, one side being open and the other closed, then alternating, so finding a nostril congested on one side does not necessarily mean there will be blockage later (eg, if trying to decide if there might be a sinus infection on that side).

8. Coughs can be treated with a teaspoon of buckwheat honey2 (and, presumably, other types) by mouth in children aged older than 1 year, and with vapor rub3 in children aged older than 2 years.


1. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e969. Erratum in: Pediatrics. 2014;133(2):346.

2. Cohen HA, Rozen J, Kristal H, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics. 2012;130(3):465-471.

3. Paul IM, Beiler JS, King TS, Clapp ER, Vallati J, Berlin CM Jr. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics. 2010;126(6):1092-1099.