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Tina
October 4th 03, 05:30 AM
Hello!

At my daughter's follow-up appointent today for a recent hospital stay
(asthma), I asked her pediatrician about her ear infections. My
daughter turned 2 in May, and has had about 10 ear infections. A
friend of mine has a daughter who's 3, who's had the same number of
ear infections, and her Dr. is recommending tubes to prevent hearing
loss. Her mother (the child's grandmother) actually does have some
hearing loss attributed to multiple ear infections as a child.

Right now, I'm no proponent of tubes, and I just wanted our
pediatrician's opinion as to the frequency of the infections (my 4
year old has never had one). The 2 year old seems to have an ear
infection every time someone looks in her ears (every well check,
pretty much), but she experiences no fever, and expresses no pain. We
don't like to give antibiotics without clear reason, so we usually
wait and see, and she's only had antibiotics three times. The
infections resolve within a few days of discovery most times.

So, after that background, the pediatrician said that the number of
ear infecitons is not unusual for a 2d child, and that because we only
treated three of them, she wasn't at risk for hearing loss. But if
we'd treated all of them, she would be very concerned.

I'm now more confused than before. Do antibiotics have something to
do with hearing loss? How does our 'watchful waiting' approach make
the infections less of an issue?

Any information will be appreciated,

Tina.

Bill Fischer
October 7th 03, 06:48 PM
Tina,

There is some controversy regarding PE Tubes. A recent article I read
indicated that PE tube placement, generally speaking, makes no
difference in the ultimate outcome year later.

If your child had ten bona fide middle ear infections (Otitis Media),
most pediatricians would at least send her for a consult with an ear,
nose and throat (ENT) specialist.

But the question here is: what type of infections did your child have?

Like your pediatrician, I tend to look at the child's chart to help me
assess the number of infections. Not all bouts of ear discomfort are due
to middle ear infections. Simple colds can sometimes cause ear
discomfort. Accumulation of fluid in the middle ear can cause ear
discomfort. Otitis Externa, or ear canal, infections can cause ferocious
discomfort. Objects placed in the ear can cause discomfort. Hard wax
in the ear can cause ear discomfort.

No pediatrician wants to send a child for surgery that may truly be
unwarranted. Remember, ear surgery and tube placement have risks.

Yes, a severe infection in the middle ear could cause permanent damage
to the bones and to the nerve that transmit the sounds. This is rare. I
have been a pediatrician for 30 years and have never seen a case of
that. Most kids who have frequent ear infections as infants and toddlers
reach adulthood with normal hearing.

But if, indeed, your child had five to seven documented bouts of Otitis
Media in a twelve-month period, I would consider referral to an ENT.

Bill Fischer

Tina wrote:
> Hello!
>
> At my daughter's follow-up appointent today for a recent hospital stay
> (asthma), I asked her pediatrician about her ear infections. My
> daughter turned 2 in May, and has had about 10 ear infections. A
> friend of mine has a daughter who's 3, who's had the same number of
> ear infections, and her Dr. is recommending tubes to prevent hearing
> loss. Her mother (the child's grandmother) actually does have some
> hearing loss attributed to multiple ear infections as a child.
>
> Right now, I'm no proponent of tubes, and I just wanted our
> pediatrician's opinion as to the frequency of the infections (my 4
> year old has never had one). The 2 year old seems to have an ear
> infection every time someone looks in her ears (every well check,
> pretty much), but she experiences no fever, and expresses no pain. We
> don't like to give antibiotics without clear reason, so we usually
> wait and see, and she's only had antibiotics three times. The
> infections resolve within a few days of discovery most times.
>
> So, after that background, the pediatrician said that the number of
> ear infecitons is not unusual for a 2d child, and that because we only
> treated three of them, she wasn't at risk for hearing loss. But if
> we'd treated all of them, she would be very concerned.
>
> I'm now more confused than before. Do antibiotics have something to
> do with hearing loss? How does our 'watchful waiting' approach make
> the infections less of an issue?
>
> Any information will be appreciated,
>
> Tina.

PF Riley
October 8th 03, 05:57 AM
On Tue, 07 Oct 2003 10:48:27 -0700, Bill Fischer
> wrote:
>
>There is some controversy regarding PE Tubes. A recent article I read
>indicated that PE tube placement, generally speaking, makes no
>difference in the ultimate outcome year later.

It's important to clarify what outcome you are talking about.
Frequency of ear infections? Presence of hearing loss? Speech
development? These are but a few of the many outcomes some attempt to
modify with PE tubes.

PF

Tina
October 9th 03, 06:36 AM
Bill Fischer > wrote in message >...
> Tina,
>
> There is some controversy regarding PE Tubes. A recent article I read
> indicated that PE tube placement, generally speaking, makes no
> difference in the ultimate outcome year later.
>
> If your child had ten bona fide middle ear infections (Otitis Media),
> most pediatricians would at least send her for a consult with an ear,
> nose and throat (ENT) specialist.
>

Yeah, this is why I asked her about it, because friends kids with the
same or fewer number of infections are being evaluated by ENTs.

I've been trying not to form an opinion about 'tubes', but from what
I've read, it doesn't seem to be the best option for a great number of
children.

> But the question here is: what type of infections did your child have?
>
> Like your pediatrician, I tend to look at the child's chart to help me
> assess the number of infections. Not all bouts of ear discomfort are due
> to middle ear infections. Simple colds can sometimes cause ear
> discomfort. Accumulation of fluid in the middle ear can cause ear
> discomfort. Otitis Externa, or ear canal, infections can cause ferocious
> discomfort. Objects placed in the ear can cause discomfort. Hard wax
> in the ear can cause ear discomfort.
>

She's had what the Dr. has called 'ear infections', on ten or twelve
occasions -- I was counting twelve, but I was later told that if both
ears are infected, it only counts as one infection. There's usually
no mention of fluid, sometimes redness, and twice 'bright red!' was
the description we got. We've also been told that there was pus
visible twice.

My daughter, however, has never complained of discomfort when she's
had an 'ear infection'! If she's being seen for something else, she
often has an 'ear infection', and she often does at a regular well
check. The Dr. seems to think that pain is a reason to treat, so if
she's not in pain, we don't treat it. When there's pus visible, we
treat it, though, or if it doesn't resolve on it's own given 5 or so
days.

> No pediatrician wants to send a child for surgery that may truly be
> unwarranted. Remember, ear surgery and tube placement have risks.
>

Oh, definitely. We were worried when she wasn't really talking at 12
months, but the Dr. said we'd give her some time, and if she wasn't
'caught up' by 18 months, we'd send her to an ear specialist, which
seemed reasonable, and her speech is now excellent, and she's ahead of
what's expected, and has been since around 18 months. So I don't
think any damage has been done yet, I just wondered why the Dr. didn't
think it was weird that she always has ear infections!

> Yes, a severe infection in the middle ear could cause permanent damage
> to the bones and to the nerve that transmit the sounds. This is rare. I
> have been a pediatrician for 30 years and have never seen a case of
> that. Most kids who have frequent ear infections as infants and toddlers
> reach adulthood with normal hearing.
>

Thank you for this information especially. That's good to know.

> But if, indeed, your child had five to seven documented bouts of Otitis
> Media in a twelve-month period, I would consider referral to an ENT.

I might ask for one, just to be careful, but I'm going to wait until
the next round of testing for her other issues is completed. This
might be another factor in my worrying -- she's overall what I would
call a healthy child, but she has some major ongoing medical issues
that don't seem related to one another, and every 'symptom' she has,
I'm always looking for a connection. Right now I'm trying to find out
if repeated ear infections go along with Cystic Fibrosis, because
she's about to be tested for that again; after 4 tests last year that
finally yielded a negative, they're not so sure she doesn't have a
mutated form of CF, due to breathing difficulties that aren't really
resolving with asthma treatment. And last year she was tested for CF
because she had malabsorbtion and FTT. She also is allergic to milk
and eggs. She also has (mild) VonWillebrand's disease.

So, when my friends kids are being checked out for the same thing
(repeated ear infections), and our Dr. isn't concerned, I wonder if
she's just sick of dealing with my family [you should see the size of
this kid's chart!], or she's just thinking 'this kid's so sick,
they'll figure it out from the
allergist/gastroenterologist/hematologist/pulmonologist soon enough, I
don't have to send them somewhere else to get more worried about
hearing loss when we have all these other issues....'

Thanks so much for your reply!

Tina.

>
> Bill Fischer

Bill Fischer
October 14th 03, 05:28 PM
Tina,

I am reassured to learn that your child's hearing is normal and speech
is advanced for age.

On the face of it, it appears that your child has ample specialty care
to keep up with her myriad of maladies.

From time to time, however, you may need to gently remind your
pediatrician about your concern regarding frequent otitis media and hearing.

These days, most pediatricians have short allotments of time with each
patient. Thick charts also make rapid scanning a demanding task.

Including ears, your child has concerns surrounding five different areas
of medicine. Each specialist wants to zero-in on problems regarding
his/her own specialty. And the pediatrician is often overwhelmed with
tying it all together, coordinating referrals, writing prescriptions,
and obtaining insurance authorization.

Again, inquire from time to time about your concerns regarding ears. Ask
at the beginning of the visit. Avoid voicing your concerns as your
pediatrician turns the doorknob to leave.

Bill Fischer

Tina wrote:
> So, when my friends kids are being checked out for the same thing
> (repeated ear infections), and our Dr. isn't concerned, I wonder if
> she's just sick of dealing with my family [you should see the size of
> this kid's chart!], or she's just thinking 'this kid's so sick,
> they'll figure it out from the
> allergist/gastroenterologist/hematologist/pulmonologist soon enough, I
> don't have to send them somewhere else to get more worried about
> hearing loss when we have all these other issues....'

Tina
October 15th 03, 04:37 AM
Bill Fischer > wrote in message >...


> These days, most pediatricians have short allotments of time with each
> patient. Thick charts also make rapid scanning a demanding task.
>
> Including ears, your child has concerns surrounding five different areas
> of medicine. Each specialist wants to zero-in on problems regarding
> his/her own specialty. And the pediatrician is often overwhelmed with
> tying it all together, coordinating referrals, writing prescriptions,
> and obtaining insurance authorization.
>

Thank you. Your post reminded me that the Pediatrician does have the
least support staff, too, it seems -- at GI, there are 2 Docs, 2 Nurse
Practitioners and a office manager; At Hematology, there are 6 Docs,
two Nurse Practitioners, 2 Office Managers and 2 Social Workers,
etc....

I guess she is likely overwhelmed, and really the ears would be the
least of her worries -- and it's better that way, really.

Thanks again for your thoughtful posts.

Tina.