John Dahl, M.D., otolaryngologist at Riley Hospital for Children at Indiana University Health, debunks common myths & misconceptions surrounding pediatric ENT concerns.
Ear, nose and throat (ENT) issues are some of the most common reasons that kids visit the doctor. ENT concerns are also the basis of some of the most common misconceptions. To set the record straight, we asked John Dahl, M.D., otolaryngologist at Riley Hospital for Children at Indiana University Health, to debunk these myths.
Myth: You should clear out your child’s earwax
Fact: There is little reason to worry about wax in your child’s ears. “In kids, it rarely feels uncomfortable, and you’d need almost the entire ear canal obstructed with wax to have noticeable hearing loss,” says Dr. Dahl. If your child is bothered by excessive earwax, ask your ENT how to use mineral oil drops to lessen the wax buildup. But whatever you do, skip the Q-tips. “We discourage Q-tip use,” he adds. “The ear is a self-cleaning structure and it’s designed to clean itself from the inside out. By putting Q-tips in the ear canal, you push the wax back toward the inside, which defeats the purpose of the ear’s cleaning mechanism.”
Myth: Big tonsils need to be extracted
Fact: “A lot of patients are sent to us because they have large tonsils but big tonsils in their own right don’t indicate a problem,” says Dr. Dahl, who notes that research shows no correlation between the size of tonsils and the incidence of obstructive sleep apnea, for instance. “For parents who suspect their child has obstructive sleep apnea, the decision to remove tonsils and adenoids to open up the airway and improve nighttime breathing is based on the child’s symptoms, not on tonsil size,” he says. The same applies to strep throat infections: Big tonsils don’t automatically mean a child will be prone to strep. “We consider removing tonsils to reduce the incidence of strep when a child has had seven strep infections in one year, five strep infections per year for two consecutive years, or three strep infections per year for three consecutive years,” explains Dr. Dahl. Note that a child can still get strep even after a tonsillectomy, but surgery should lower the likelihood of infection.
Myth: You can’t damage your vocal cords by talking too much
Fact: Yes, you can. “The most common cause of hoarseness is vocal cord nodules, which form in response to voice trauma, such as talking too much or screaming loudly and often,” says Dr. Dahl. It actually happens fairly frequently, he says. Fortunately the remedy is simple: voice rest.
Myth: Recurrent ear infections mean your child needs ear tubes
Fact: “Many people think that if you have a certain number of ear infections, the child needs ear tubes, but that’s not always the case,” says Dr. Dahl. The current guideline is that ENT doctors should consider ear tube surgery primarily in cases where the child has had chronic otitis media with effusion (an ongoing middle ear infection with fluid behind the eardrum that causes conductive hearing loss) for three months or longer. In those cases, ear tubes inserted into the eardrum may relieve the buildup of fluid and equalize pressure in the ear, thereby preventing hearing loss. “For kids with recurrent otitis media (ear infections) without fluid buildup, the need for ear tubes is more difficult to assess,” he adds. “Ear tube surgery can be considered in those instances when there are three ear infections in six months or four infections in a year with one of those being in the past six months—but if the child doesn’t have fluid buildup at the time of ENT evaluation, we generally don’t recommend ear tubes unless there is concern for an underlying hearing loss, speech delay, or developmental delay.”
-- By Rachel Rabkin Peachman
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