Parents and schools tend to have a strong reaction to finding out a child has head lice. I hear “burn down the house” often given as a recommendation for dealing with lice. Head lice aren’t a health hazard or a sign of dirtiness or poor hygiene. They are, though, one of the most common causes of school absenteeism. Despite not causing any actual medical problems, those little bugs cause a great deal of anxiety among parents and schools. Grab a drink, y’all, because there is a lot to talk about.
Ear infections happen when infected fluid builds up in the space behind the ear drum (or tympanic membrane), called the middle ear. Fluid in the middle ear usually drains out the eustachian tubes, which connect the middle ear to the back of the nose. These tubes are soft tubes (like a sock with the toes cut off) rather than a hard tube (like a straw). Eustachian tubes open and let fluid drain from the middle ear when you move your jaw around talking or chewing, when you yawn, or when you hold your nose blow to “pop” your ears. If there is swelling or mucus around the opening of the eustachian tubes, like from allergies or a cold, the fluid can’t drain and will build up in the inner ear. If you have ever had a cold and felt like your ears were “stuffy” or your hearing was muffled, this is probably what was going on. Kids tend to get more fluid behind their ears than adults, because kids’ eustachian tubes are more horizontal. As people get older, their eustachian tubes get more vertical, which makes it easier for the fluid to drain.
A study was recently published in the Journal of the American Medical Association (JAMA) looking at unnecessary antibiotic prescription practices in different medical settings: doctors’ offices, emergency rooms, urgent care centers, and retail based clinics (clinics inside of stores like Walmart or CVS). Antibiotics are used to treat bacterial infections. The study found that nearly half (46%) of people seeking treatment in urgent care centers for viral illnesses like colds, flu, bronchitis/bronhiolitis, ear infections without pus behind the ear drum, and viral pneumonia and for things like asthma and allergies were prescribed antibiotics. That is nearly 3 times the rate of inappropriate prescription in medical offices (17%) and twice as high as emergency departments. Retail clinics actually had the lowest rate of inappropriate antibiotic prescriptions at 14%.