Saturday, October 12, 2019

Ear Infections

Ear infections can be a cause of ear pain.  Otitis media is the term used for middle ear infection.  Common in childhood, otitis media occurs infrequently in adults.  Many children have recurrent ear infections that often occur after a cold or upper respiratory infection. Inflammation of the Eustachian tube prevents normal fluid drainage from the middle ear, which serves as a growth media for bacteria.  Secondhand tobacco smoke may predispose a child to middle ear infections.  Frequently eaten foods or allergies can alter the tissue resistance of the ear, setting up conditions for an infection.  Milk is a prime suspect.  Wheat, egg, peanut, soy, and corn can cause fluid behind the eardrum, which predisposes the child to ear infections.

Eustachian tube dysfunction plays a role in ear infections.  The Eustachian tube drains both fluid and mucus from the middle ear into the nose.  The Eustachian tube in children is short, straight, and may not drain well, resulting in mucus accumulation in the middle ear.  If the mucus becomes thick and glue-like, the condition is known as glue ear. Fluid behind the eardrum without infection can be very painful, but the pain may come and go.  Hearing loss, delayed development of speech and language skills, and problems with gross motor skills and balance may result.

Because typical symptoms overlap other conditions, a physician should be consulted, particularly in the case of recurrent ear infections.

Wednesday, September 25, 2019


Although they can occur at any time of the day, most parents have had the experience of a child crying in the night from the pain of an earache.  There are many things that can cause earache (otalgia), and it may not be associated with ear disease.  Conditions such as an impacted tooth, sinus problems, inflamed tonsils, teething pain, TMJ, and infections in the nose and throat may play a role.

Ear pain may originate from the external, middle, or inner ear, but it is not always possible to tell the location of the pain.  External ear pain can be caused by trauma, swimmer's ear, or foreign bodies in the external ear.  Dental disease can cause ear pain as can other diseases.  Ear pain may also be a side effect of contagious illnesses such as colds, coughs, or eye problems like conjunctivitis.  When babies discover their ears they may pull at them until they hurt, causing mothers to fear their baby may have an ear infection. 

Friday, September 13, 2019


Acetaminophen (term used in the United States, Canada, and Japan), APAP, or paracetamol (term used elsewhere) is a widely used OTC pain reliever and fever reducer.  A mild analgesic commonly used for the relief of headaches and other minor aches and pains, it is also a major ingredient in numerous cold and flu remedies.  While it is used to treat inflammatory pain, it is not classified as an NSAID because its anti-inflammatory action is quite weak.  Tylenol (OTC name) is acetaminophen and because it does not reduce inflammation it is not very helpful for people with arthritis or aching joints to use. 

It is imperative that acetaminophen be taken in recommended doses.  It is generally safe for use at these recommended doses, but even small overdoses can have serious health consequences.  It may be more toxic in overdose than other OTC painkillers, but may be less toxic when used chronically at recommended doses.  Acetaminophen is metabolized by the liver and side effects are multiplied if consumed with alcoholic drinks or when fasting. 

Overdoses can cause potentially fatal liver damage.  Severe kidney damage is also a possibility.  Symptoms of overdose begin several hours after ingestion and include nausea, vomiting, and pain as acute liver failure starts.  If an overdose is suspected  taking activated charcoal given within one hour of acetaminophen ingestion may treat the overdose.  Acetylcysteine should be given the acetaminophen levels are high.  Treatment within 10 hours of ingestion reduces the risk to the liver.

Friday, August 9, 2019


Painkillers or analgesics are used to achieve analgesia or relief from pain.  These drugs act in various ways on the peripheral and central nervous systems.  The type of pain determines the analgesic choice.  There are several classes of analgesic drugs.  Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are both nonprescription and prescription. COX-2 inhibitors are prescription drugs derived from NSAIDs.  Another important class of analgesics is opioids, which are narcotics and require a written prescription and include morphine, codeine, oxycodone, hydrocodone.  There can also be pain relief benefit from classes of drugs that are not normally classed as analgesics, such as tricyclic antidepressants and anticonvulsants.

Most people take something when they have pain of any kind. There are analgesics or pain killers that are over-the-counter (OTC).  There is some confusion about dosage on these agents.  Patients tend to think that because these drugs are OTC that they are totally safe in all amounts, but they are not.  The most common OTC NSAIDs are aspirin, ibuprofen (Advil, Motrin, and others), and naproxen sodium (Aleve).  Many times physicians are not contacted for a painkiller and pain control until and unless the patient receives no relief from OTC medications. "Letting the pain get ahead," or allowing it to be untreated can make it more difficult to bring under control.  Being absolutely pain free may not be a realistic goal, but pain can usually be regulated so it does not interfere with daily life.

Friday, July 26, 2019


Pain is the most common reason physicians are consulted in the United States, the main reason for visiting the emergency department, and is present in 30% of family practice visits.  Pain is physical suffering or distress caused by injury or illness.  Ability to experience pain is essential for protection from injury and recognition of the presence of injury.  It can also protect the affected part of the body while it heals and help avoid harmful situations in the future.

For many medical conditions pain is a major symptom, and it can significantly interfere with quality of life and ability to function.  Acute pain resolves quickly, but chronic pain lasts a long time. There are many differences in the times assigned to the definitions of these types of pain and when pain is considered to be chronic.

Acute pain is managed with medications.  Chronic pain is more difficult and the efforts of a pain management team may be required.  Living with chronic pain can be devastating and can destroy people's lives.  It is not just an inconvenience and must be treated safely.
Treating pain is a crucial step in recovery from many conditions.

Tuesday, July 2, 2019


Most people think of sunscreen use only during the summer months.  However, successful sunscreen use is to apply a lot of sunscreen liberally, repeatedly, and often to the body when exposed to the sun’s rays regardless of the time off the year.  Sunscreens are best applied 15 to 30 minutes before sun exposure to allow the active ingredients to dissolve into skin layers.  Epidemiologic data indicates that a history of five episodes of sunburn per decade increases risk for melanoma (a type of skin cancer) by threefold.

There is much confusion regarding the SPF (sun protective factor) values.  SPF is primarily an indication of UVB protection as this type of radiation causes more skin redness than UVA radiation.  Damaging effects from UVB occur mostly in the summer as sunburn, but damage resulting in skin aging and skin cancer can occur throughout the year from UVA as well as UVB.
SPF of 15 blocks 93% of UVB radiation.  SPF of 30 blocks 97% and an SPF of 50 blocks 98% of UVB radiation.  Sunscreens can no longer be labeled witn an SPF greater than 50 and are now labeled as SPF50+.  A “broad spectrum” sunscreen with protection from UVB and UVA is the most helpful and is recommended.

Use a “broad spectrum” product with SPF of 15 or 30. Apply to all exposed body parts.  The amounts used should be 4 tablespoons/12 teaspoons, a shot glass full, or an amount to fill a child’s cupped hand.  Sunscreen should be reapplied every 2 hours while outside and more when swimming.  A large bottle of sunscreen will not last a whole family during the summer months.  If it does, not enough is being applied.  Sunscreen is available as liquid creams, sprays, gels, and sticks.  Sprays are easy and convenient, but may cause too little sunscreen to be applied.  Spray an adequate amount into hands and then apply.  Gels may be good for the male chest or the scalp.

Sunday, June 9, 2019


Sunburn is a concern during the summer months.  The radiation from the sun causing sunburn is UVB (ultra violet B).  UVA1 and UVA2  age the skin.  The burning question, both literally and figuratively, is which type of sunscreen is best.  The most commonly used sunscreens are “chemical absorbers,” which the FDA prefers to refer to as organic because they contain carbon compounds.  Broad spectrum sunscreens are meant to protect against a range of radiation wavelengths.  The chemical absorbers absorb the active UV rays and release their energy in harmless ways.  The FDA recommends using sunscreen with an SPF (sun protection factor) of at least 15. 

Zinc oxide and titanium oxide are physical blockers.  They do not decompose through sun exposure and theoretically will remain on the skin longer.  When UV rays hit skin coated in physical blockers, they are reflected and cannot penetrate the skin.  A concern is whether blocking the sun’s rays can result in vitamin D deficiency.

A sunscreen of some type should be put on the skin before going out in the sun.  It should be reapplied every two hours as long as you are out in the sun.  No sunscreen of any type should be used on babies younger than 6 months, and they should be kept out of the sun.  People with broken skin or rashes should talk to a physician before applying sunscreen to the affected parts of the body.