When my son was 1 week old, I noticed that he didn't startle when unexpected noise was made. Upon the recomendation of the peditrician we had his hearing checked. He failed 2 ABRs (mild to moderate), and an ottoacustic emissions test. We went to another facility for a second opinion where the audiologist discovered fluid in the baby's ears! This finding has been confirmed by an ENT doctor who put the baby on antibiotics. The first round was amoxicillin for 10 days and it didn't help. The doctor now has him on Augmentin for 14 days and he told us that if this doesn't work we have to have tubes put in the baby's ears. He is only 2 1/2 month old! I understand how important it is to get the fluid out of his ears, and nobody wants to know if he has normal hearing more than I do, but do you think he's a little young to go through this? One of my concerns is that he still wakes up in the night to nurse, and I don't know what to do about this if he is supposed to have nothing to eat or drink after midnight before surgery. What is the danger of nursing after midnight? Please give me your input. Thank you!
Reply: ------------------------------
In my opinion, it would be premature to consider tympanostomy tubes at this point for a 2 1/2 month old infant. The main indication for tympanostomy in an infant of this age would be as a treatment for sepsis due to uncontrolled middle ear infection that is failing to respond to empiric antibiotic treatment. It does not seem reasonable to proceed to tube insertion at this point in a 2 1/2 month old for the purpose of removing middle ear fluid thought to be the cause of hearing loss in the absence of obvious sepsis. A more appropriate recommendation would be to wait until the infant is over 6 months of age assuming there are no infectious complications that develop in the interim. Then if fluid persists (and has been continuously present) tympanostomy with tube insertion should be considered. Furthermore, unless the child is having fevers, pain or other symptoms which might suggest that the middle ear fluid is infected, there would be no indication to continue antibiotic therapy beyond the antibiotics that you have listed which have already been given. In other words, as long as the child is not ill because of the middle ear fluid, observation only would be recommended. I would suggest that you consider a second opinion from another ENT physician in your area if tubes are presently being recommended for your child considering the age of 2 1/2 months.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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