Comments from Parents / Physicians:
Regarding Children age 5 to 15
Dear Dr. Hurst
I am just writing to give you a summary of our past experience
with our11 year old son. As a baby he had experience several bouts
of infection and fluid in the middle ear. The specialist finally
insetered tubes after a tonsil and< >adenoidectomy at 2years
old. Since then he has had 10 insertion of tubes sometimes in
one ear and< >sometimes in both. He does well while the
tubes are in place but they do tend to come out on their own and
he is ok for a while but then the hearing decreases and symptoms
show that he is again due for anotherrecheck. No one has ever
mentioned allergies to us as being the cause and the specialist
thought he would have outgrown the need for tubes before this.
His last comment when I asked how much longer we would
keep inserting these tubes was "until he stops needing them."
I am concerned about scar tissue and the permanent hearing loss
thatit could cause. We are very fortunate as Danny loves school
and does extremely well. I have alerted his teachers about this
every year and we usually can tell when things are starting to
heat up with ears. We make visits to the audiologists to keep
a check on the amount of hearing loss and usually it is no more
then 35% in one ear and that is usually the worst.
Can you tell me anything about the possible effects of
frequent isertion of these tubes and the scarring causing some
complications. In the last couple of years we had switched to
the "blue" tubes).... I think called gomets) so they
would stay in better because of the anchors on them, but I really
wonder if they do stay in better.Any comments you have would be
appriciated.
PEI
Canada
REPLY
DEAR PEI:
Your child has allergies and needs a full evaluation for inhalants
and food allergy before he has 10 sets of tubes!!
As for multiple tube insertions. There can be some scarring,
but the bigger danger - especially in the "Permanant tubes"
or large bore tubes/grommets is that they have a 30% or greater
chance of permanant perforation rate if left after 6 months. Better
the smalller tubes more frequently - they will buy you a year
to find his ALLERGIES.
As for your comment that he has "ONLY 35% HEARING LOSS"
is most frightening. We know that hearing loss in one ear for
3 months leads to speachand language delay. Fortunately your son
is brighter than the average and is getting by in the system -
but still not learning all that he is capable of learning. That
is why he needs the tubes back in!
Good luck
Dr. Hurst
To: MeEAR@earthlink.net
Dear Dr Hurst
My 14 year old son had chronic ear infections from birth
to 3 or 4 years (usually not going more than 60 days without one).
The continuous antibiotics didn't seem to slow it at all. Since
then, he's had a few sets of tubes, two adenoidectomies (the ENT
said they 'grew' back), a tonsillectomy, and an ear drum replaced
(result of years of scar tissue).
The infections became less frequent, but in the last 2
years, have begun again. Drainage is common now. Most recently,
he was on Medrol,Dura-Vent, Ceftin, eye drops, and Decadron. It
cleared up after 2 weeks or so, as if I had not treated it at
all. He already has a hearing loss and speech impediment resulting
from this problem, and I've noticed his speech deteriorating again.
I'm tired of years of antibiotics and assurances that he'll grow
out of it. Is is common for children to battle this for 14 years?
Please reply at my return e-mail address. Thank you.
K. G.
REPLY
DEAR Kay
Your son unfortunately has the typical history that occurs
rarely, but for him is a constant threat to his ears. He outgrew
his allergies and then redeveloped some. They must be aggressively
pursued, diagnosed with blood test and skin tests, and then treated
with allergy shots. He will get better. I have at least 5 patients
who had mastoid surgery and or perforated ear drums which drain
whenever their allergies are out of control. The good news is
that these ears will dry up with good allergy management - food
elimination or immunotherapy - as is appropriate. On occassion
he will need antibiotics or ear drops for an acute episode of
drainage.
Follow my recommendations on finding a good ENT-Allergist
to treat him.
Best of Luck,
David Hurst, M.D.
Dear Dr. Hurst,
I only hope that you can point us in the right direction
(rather than "solve" our problem).
History: 9 year old boy with chronic OME since 6-9 months
of age. The condition occurs multiple times in a year and progresses
until the tympanic membrane actually ruptures!
Treatment: All of the usual. Multiple antibiotics, multiple
frequencies (chronic low dose, more frequent, higher doses etc.)
Occasionally,. antibiotics would help, but more recently the course
would be the same (i.e. rupture despite antibiotics). Tubes were
placed twice. Finally, after many requests, he was referred to
an allergist. The allergist diagnosed multiple allergies (dust,
mold, animals etc.) based on a skin test and prescribed an inhaler.
This seemed to help for about 6 months but now the problem has
recurred.
Questions:
1) Both the primary physicians and the allergist have advised
us that the problem will continue and there is little else they
can do. Is this correct information?
2) Both the primary physicians and the allergist have informed
us that there is no need to be concerned about long term damage
to the ear or hearing loss with the chronicity or multiple ruptures.
Does this make sense?
3) Because the primary physician and the allergist feel
that no further treatment is either available or necessary, our
HMO has informed us that it will not cover any charges incurred
if we choose to seek another opinion. Even if we chose to pay
any charges ourselves, WHERE DO WE GO THAT CAN
HELP?????
Sincerely,
Diane S.
REPLY
Dear Scotts -
Thanks for the letter - you have gotten through the first
hurdle but have hit the usual brick wall of the dumb thinking
of the classic allergist who get the diagnosis right, but unless
you are dying will not use immunotherapy (shots). They seem to
want to push pills and inhalers and medicines, but not use what
they know works - Your son needs to be desensitized to what is
causing his allergy. At least your allergist is receptive, I suggest
they read the first article I published: Hurst, D.S. "Allergy
management of refractory otitis media." in Otolaryngol-Head
Neck Surgery. (1990) 102: 664-669. In that I proved that with
therapy 100% of children like your son will get better and stay
better and without it 100% will have recurrent disease.
I find that without shots about 25% of kids need a second
set of tubes. With shots that rate drops to 4%. So in answer to
your first question:You can do more - get him on shots. If that
means seeing an ENT allergist - than get a second opinion. Change
insurance companies if need be. You always have an open enrollment
period even if on an HMO. The cost of shots is less than repeat
tubes.
Long range problems - are his ears truely normal, no scarring
and no retraction. I doubt it. But even so, do they Guarantee
that this will not happen. Only stopping the infections will guarantee
this.
Best of Luck-
Dr. Hurst.
Note: Opinions contained in this web site are those of the author
alone and are not meant to be medical advice or perscribed treatment
for any particular individual.
David S. Hurst, M.D.
Allergy - Ear, Nose, Throat Surgery
R.R. 2 Box 4348
Farmington, Maine 04938