Lets start from the begining. My daughter was 3 months old and had her first
ear infection and by the time she was 7 monthe old she had been on
antibiotics for almost the full 4 months. I finally on my own took her to a
ent. He sent us for a hearing test in which she failed . The doctor
scheduled her for PE tube palcement. The surgery went fine and for about 6
weeks she done good then after that she was on constant antibiotics. Her
ears began to drain and drained all the time. I took her back to the ent
that had done her surgery and he said this was normal and put her on
antibiotics. We went throught this medication and the ears continued to run
and drain. It was to the point that her little head would actually stick to
her pillow it was so bad. For 3 months we went through this being on and off
antibiotics and nothing seeming to help. One night she start screaming and
nothing we done comforted her when i noticed her ear was bleeding. I called
the doctor and he was not concerned he told me that she would not bleed to
death and call in the morning. Instead of calling him I decided that it was
time to find a new doctor in which i did.
I took my child to a new ent and he looked at her ears and said how long has
she been in this shape. He then took her to an exam room where he suctioned
her ears out and got lots of infection out. It took us about 3 months to get
her straight. There was a couple of occasions were she would have an
infection but it took nothing to clear her up. Her tubes stayed in for 2 and
half years then they were surgically removed. She had no problems for
several months. During the summer we did have one infection and we related
it to her swimming so much. Now scince Januaray she has had 4 infection with
her ear absessing one time. We went to the ent and he wants to wait and see
if she has anymore. Im afraid of what may end up happening. He did mention
taking the adenoids out and placeing tubs again kinda leaving it up to me.
My question is what should I do. I feel sorry for my daughter for the fact
that she has to have all this pain and stay on antibiotics seems like all
the time. Would taking the adeniods out and putting tubs back in help?
Reply: ---------------------
Whether or not tubes and/or adenoidectomy is advisable depends upon a number of factors including the exact nature of the problem, the presence of environmental risk factors and whether they can be controlled, the efficacy of medical treatment, amongst others.
There are in general two basic types of ear problems in children. One is the child with recurrent acute otitis media which is usually defined as recurrent acute ear infections which can in each instance be successfully treated to resolution only to have a recurrence shortly after medical therapy has ended. The other basic type is the child with persistent fluid behind the ear drums that fails to resolve after several months which is known as chronic otitis media with effusion.
In the first type, recurrent acute otitis media, the role of tubes and/or adenoidectomy has not yet been clearly defined. When a child has 3 or more acute infections in a 4-6 month period with clearance of symptoms and findings between episodes, the child is considered to have recurrent acute otitis media. Management of this condition first consists of identification of potential risk factors such as allergy, immune disorders, exposure to second hand cigarette smoke, and day-care. If possible, risk factors should be eliminated or controlled. For most physicians, the next step is consideration of preventative courses of antibiotics such as a daily dose of amoxicillin or gantrisin given over several weeks, typically during the usual seasons of high frequency such as winter months. However, with the increasing prevalence of drug resistant bacteria in society, the use of such prophylactic regimens is becoming increasingly controversial. Ultimately, if a child continues to have frequent episodes of acute otitis media despite prophylaxis, tube insertion is usually considered.
In the second type, chronic otitis media with effusion, antibiotic therapy is less effective. A child is diagnosed with this condition when fluid is present behind the ear drums without signs of acute infection and fails to clear after 3 or more months. It is important to note that fluid typically develops behind the ear drum after acute ear infections and may take several weeks to clear. However, such fluid usually does not require any treatment and antibiotics are generally not warranted if the child does not have a fever and is not in constant pain. If the fluid fails to clear after 3 or more months, tubes are generally considered because of concerns regarding hearing loss, speech development, or future complications of chronic ear disease such as cholesteatoma, scarring inside the middle ear, etc.
Adenoidectomy has been found in a number of recent studies to be beneficial in the child over 4 years of age who has chronic ear disease. These studies have also shown that the benefit derived from adenoidectomy in these children is independent of the size of the adenoids. Tonsillectomy on the other hand has never been conclusively shown to provide benefit for chronic ear disease. Most otolaryngologists will also consider adenoidectomy in a child older than 2 years of age who has chronic ear disease recur after a previous set of tubes has extruded.
Finally, it is important to realize that while tube insertion +/- adenoidectomy is generally highly successful in the managment of the child with chronic ear disease according to the criteria mentioned above, ear infections can nevertheless still occur in a child who has undergone the procedure.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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