As we get into the winter months there’s a chance your child will come home with a cold or the flu, and with those can come earaches and sore throats. Dr. J. Robert “Bobby” Silver, an ear, nose, and throat doctor with Charlotte Eye Ear Nose and Throat Associates, P.A., joins us this month to talk about preventing, identifying, and treating those sore throats and earaches.
Winter is a big time of year for colds and the flu. Why do we get them now versus other times of the year?
Colds and the flu are caused by viruses. Nobody knows for sure why winter is worse but there is speculation that perhaps viruses survive and replicate better in the colder, less-humid winter. Others feel that maybe our immune systems do not work as well in the cold, and still others argue that exposure to viruses is higher in the winter because people tend to congregate inside to avoid the cold. All of these make some sense, but the bottom line is that we don’t know for certain why colds and the flu are worse in winter.
What causes sore throats when you have a cold? When you have the flu?
The sore throat that comes along with a cold or the flu is typically caused by drainage down the back of the throat from the sinuses. It can also come from inflammation in the throat caused directly by the infection.
What causes earaches when you have a cold? When you have the flu?
Colds and the flu cause inflammation in the back of the nose and throat. Inflammation can cause pain. Due to the way the nerves are structured in the throat, sometimes pain that actually occurs in your throat can feel like it’s coming from your ears. This is called referred pain.
The inflammation can also block the Eustachian tube in the back of the nose. When this is blocked, no air can get to the space behind the eardrum (the middle ear) and a vacuum is created. This vacuum can cause pain by pulling on the eardrum and, if the vacuum is strong enough, it can draw fluid into the middle ear from the surrounding tissues and potentially cause an ear infection. The vacuum and the fluid in the middle ear keep the eardrum from moving well, which is why our ears feel “stopped up” when we have a cold or the flu.
What are common symptoms of an earache or sore throat?
Pain, your ears feel stopped up and you can’t hear well, and difficulty swallowing due to pain.
What is the best way for a child to avoid getting a cold or the flu?
The viruses that cause colds and the flu are generally spread by the coughs and sneezes of those who are sick already. People usually get the virus when they touch an object that has recently been touched by a person who has a cold or the flu. The viruses can live on objects such as door handles, hand rails, computer keyboards, etc., for several hours. Therefore, the best defense against getting the virus is to wash your hands often.
Children should be taught to wash their hands frequently. A fun way to encourage kids to wash their hands is to have them sing the Happy Birthday song twice while washing their hands. This is generally long enough to thoroughly cleanse dangerous germs from the hands. Hand sanitizers are also helpful, especially after visiting public places like the grocery store. It is also good to teach children to refrain from touching their mouth, nose, and eyes with their hands.
In addition, a healthy diet, consistent exercise, and adequate sleep keep the immune system strong to help fight off potential infection.
Does taking vitamins help prevent you from getting sick? What about immune boosters like Emergen-C or Airborne? Should children take immune boosters?
I cannot speak to specific products, but in general, anything that strengthens the immune system will help decrease the chances of getting sick. There is little to suggest that vitamins, Echinacea, zinc, etc., prevent colds. On the other hand, there is some evidence to suggest that vitamins, Echinacea, and zinc may lessen the severity and length of a cold. However, these products are not without risks. For example, some are concerned that zinc nasal sprays may lead to a loss of smell. In taking these products, one must weigh potential risks with uncertain benefit. Ultimately, the best way to prevent a cold or the flu is to avoid the virus in the first place (hand-washing, etc.) and to keep the immune system strong with a healthy diet, plenty of exercise, and adequate rest.
If a child does get a cold or the flu, what is the best way to treat a cold or earache? Is medicine necessary or are home remedies sufficient? What are some good home remedies?
Colds and the flu are caused by viruses, and viruses do not respond to antibiotics. Therefore, getting amoxicillin or a Z-Pak will not help and, in fact, could create other problems for the patient. There is even some concern that over-the-counter cough and cold medicines could be risky and they are therefore not recommended for children under the age of four. Viruses generally just have to run their course.
In the meantime, Tylenol or Motrin can be helpful to reduce fever and pain. Avoid aspirin with children due to the risk of developing a rare, but serious, condition called Reye’s syndrome. Honey can help with the cough and sore throat in children, but should not be given to infants. Saline spray or drops can help clear nasal mucous. Give plenty of fluids to prevent dehydration and thin the mucous. A humidifier may help as well.
If a child does start showing signs of a sore throat, earache, or other symptom of a cold or flu, how long are they contagious for? Should they be kept away from their sisters and brothers?
People can be contagious from one to two days before they start showing symptoms up until a week (and in some cases even longer) after symptoms start. During this time, it is best to reduce contact with others to a minimum and take precautions with additional hand-washing and vigilant cleaning. Teach kids who are sick to cough or sneeze into their elbow to prevent getting the virus onto their hands.
At what point does it become important to see a doctor if a child has a sore throat or earache?
If a child does not get better after several days, it is best to consult a doctor. Also, if there is a high fever, vomiting, severe headache, chills and shakes, deep hacking cough, wheezing, shortness of breath, or extreme fatigue, the child should be seen. In short, if you are concerned, call or see the doctor.
Can an earache or sore throat from a cold or the flu develop into something worse, like strep throat or an ear infection? How can you tell if they are developing into something worse?
Bacterial infections, such as sinusitis or ear infections, can occur as a result of a cold or the flu. The inflammation caused by the virus can block sinus drainage and potentially cause sinusitis. In the same way, inflammation can block the Eustachian tube leading to the middle ear and cause an ear infection. In these cases, antibiotics may be helpful even though the antibiotics will not treat the underlying virus.
Sometimes a sore throat can be caused by strep, which is a bacterium. Strep throat does not generally develop as a result of a cold or the flu. It usually occurs independently. Strep throat, since it is not caused by a virus, will often be treated with an antibiotic. Through examination and testing, your doctor can tell whether or not a sore throat is coming from bacteria or a virus and whether or not an antibiotic is indicated.
Along the same lines, how can you tell if a child doesn’t actually have a cold or the flu, and that an earache or sore throat is actually the sign of something worse?
Persistence of symptoms with no improvement for more than 3-5 days is usually a sign that something other than a virus is the cause of the illness. High fever, vomiting, a severe headache, chills and shakes, a deep hacking cough, wheezing, shortness of breath, or extreme fatigue are also signs of more serious conditions. Again, if in doubt or you are concerned, call or see the doctor.
How can you tell if a child actually have a cold- or flu-related earache or sore throat, and they aren’t just sore from running around shouting all day, playing loud music, etc.?
Generally speaking, if children are sick they will act sick. You can usually tell if they feel poorly. If they are playful, interactive, laughing, and yelling, they are probably not ill.
Is there anything else important for people to know about cold or flu-related sore throats and earaches in children?
Colds are common. Most run their course without any problems. Supportive care and common sense about infecting others is generally all that is needed. The flu can be more serious, but again usually resolves without complication. However, if at any time you are concerned about your child’s condition do not hesitate to contact his or her doctor.
Dr. Silver is a comprehensive otolaryngologist who attended Davidson College for his undergraduate degree and the University of North Carolina School of Medicine for his medical degree. He completed his internship and residency at the Medical College of Georgia. He practices in our Matthews office.