i have a 2 y/o that is getting repeated ear infections with ear tubes. she is hearing impaired and wears hearing aides regularly. she has had 4 sets of ear tubes since birth.she also was born with cleft lip and palette which has been repaired.she is on bactrim every day due to another medical condition.we keep using tobramycin when we notice drainage. she averages 2 ear infections a month. can anything more be done to help treat or prevent these infections? she relies on her hearing or what little she has and is trying to communicate but when she gets an infection her hearing decreases. please reply.
Reply: --------------------------
This is a difficult problem not only obviously for you and your child, but for the physician trying to help her. The basic underlying problem is most likely eustachian tube dysfunction that is directly related to the cleft palate. Even when the palate is repaired, the eustachian tube does not function in the normal fashion. For many individuals born with cleft palates, this can mean chronic ear problems well into adulthood. Tympanostomy tubes at least can prevent more serious complications from the ear infections even if they do not by themselves prevent or reduce the frequency of ear infections.
In your child's case, I would avoid getting any water in the ears. (Usually I do not advise that children with tympanostomy tubes wear ear plugs for bathing or surface swimming in chlorinated pools, but in your child's case I would avoid getting any moisture in the ears). I would also assess the immune status although it is likely that if a significant immune disorder were present, there would be more than just recurrent ear infections - eg there would likely be recurring upper respiratory infections in general such as bronchitis, sinusitis, etc. An allergy evaluation should be considered at this point as well. Other possible risk factors such as second hand cigarette smoke exposure or enrollment in day care should be evaluated. Finally I would evaluate possible dietary factors such as sensitivity to dairy products etc.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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