Comments from Parents / Physicians:
Dear Dr. Hurst,
My daughter is 13 months old and has suffered from OME
since the age of 4 months. She has had an average of 2 ear infections
per month. My pediatrician has spoken to me about tubes on several
occasions, but now she does not respond to the same medication
twice in a row. For example, she was on Zithromax for 5 days and
then we waited 5 days and started it again as a preventive. During
the 2nd administration of it she developed a severe infection
in the right ear. She is now finishing up the Vantin and seems
to be clear. The pediatrician has recommended an ENT (whom is
not an allergist) to do the surgery and I am having trouble finding
an ENT-Allergist in my area. (Pompano Beach, FL - near FT. Lauderdale/Boca
Raton) I am skeptical of tubes because I do not feel it is a solution
to the problem, only to the symptom. Is 13 months young to have
tubes placed?
Thanks again and Happy New Year.
Barbara
REPLY:
There are basically 2 types of ear infections: Your daughter
shows the first type - that is recurrent infections, one right
after another, which usually clear in 1-2 weeks. These are the
children who are most easily cured by tympanostomy (hole in the
ear drum) tubes. If your daughter not only has recurrent infections,
but also does not clear easily, than she may ALSO have allergies.
At her age foods are the most common culprit. I would suspect
her MILK first. So switch her to soy milk or better - stop all
dairy, including cheese if she is old enough to have a decent
diet. Otherwise, put in the tubes, trust your physician and wait
until she is 18 months or older to try the milk elimination diet.
Good Luck
Dr. Hurst
What about TUBES ??
To: <MeEAR@earthlink.net>
Subject: Your theory on Allergy as cause of OMB with effusion
Date: Thur, 19 Sep 1996
I was hoping that I could get some
input from you on this problem.....
My five year old daughter has been diagnosed with OM with effusion
in both ears. A hearing test today confirmed significant hearing
loss in both ears. Otherwise she is healthy and fine. However,
this diagnosis was discovered after I consulted an ENT doctor
because of a persistent nasal congestion that several doses of
antibiotics (prescribed by a pediatrician) would not clear it
up. He gave her a nasal spray that he said only works for allergies.
So I am pretty sure that she has allergies. (There is also a history
of allergies on her father's side.) Anyway, the ENT and audiologist
recommend tubes. I am really not happy about that and have been
searching the Internet for alternative treatment, but besides
your page everyone recommends tubes more or less. I really don't
know what to do. She has just started Kindergarten and I don't
want her to be disadvantaged because of her hearing. However,
I am really concerned about the traumatic experience of surgery.
I am very open to suggestions at this point. Maybe you can find
the time to answer me. I would really appreciate it. Thanks a
lot.
Mrs. I.G., Middletown, NY
REPLY:
Thanks for taking the time to try an E-mail letter to me.
I understand your anxiety at having your daughter have surgery
to
place tubes in her ears - but you should go ahead.
There are 2 reasons to put the tubes in: FIRST, you want her hearing
back to normal as soon as possible so there is no FURTHER speech
and language delay, and so she gets all that you and your husband
are trying to teach her at home. SECOND, the fluid contains various
mediators and enzymes which in themselves perpetuate the inflammation
that causes the fluid to form and to remain. So until it is removed,
it may not clear for several months - or the underlying allergy
will repeatedly get your daughter's ears to make more mediators
which will cause the fluid to re-form this winter, should it happen
to clear briefly anyway.
Getting the tubes in buys you a year (until they fall out) to
find the UNDERLYING CAUSE so you can get that under control and
not have to put in a second set of tubes - as happens 15 to 30%
of the time!!
So good luck.
As I mentioned on the TREATMENT PAGE: ask your Pediatrician to
at least draw a RAST or better yet, a THABEST (Molecular Medicine)
and see for himself if allergies are present. Or better yet, see
an ENT who also does allergy - a member of AAOA (AAOA@AOL.com)
in your area.
Good luck.
Dr. Hurst
Dear Dr. Hurst:
I have a four and a half month old daughter who has had
a chronic ear infection since practically birth. She has had a
total of five different antibiotics and is currently taking Vantin.
My pediatrician stated that if that doesn't work, he wants to
consider putting tubes in. He feels that she is pretty young and
would prefer to wait until she is a year old but since the ears
are not clearing, he feels he does not have a choice. She was
born only two weeks premature (8 lbs at birth) but with respiratory
distress syndrome and spent 11 days in the NICU, five of them
on a respirator. She received intravenous antibiotics during that
time.
Re:My questions are: Did her time in the NICU cause or contribute
to her ear problems? Is she really too young for tubes? (I sincerely
hope not... I would like her to feel better and her screaming
is making me crazy) Is it possible that she has a food allergy?
She got breastmilk for approximately three weeks and then Nutramigen
formula and is now on Lacto-Free formula.
Sincerely,
B.J.
REPLY:
Dear B.J.
It is doubtful the NICU had any effect - and certainly not
her prematurity. Infants with this much ear disease usually are
allergic to the milk and your peds is right to try the Nutramigen.
Did that help? If not, then probably tubes by age 7-10 mos is
reasonable.
Dr. Hurst
Dear Dr. Hurst
I have an one year daughter who has had an ear infection
in both ears since August. They seem to clear up but as soon as
she goes off the medicine they reoccur. Prior to August I breast-feed
my daughter. It seems as soon as I stop breast feeding her they
occurred. My daughter has been on Amoxicillian, Zithromax, Suprax,
Cedax, Lorabid, Augmentum, Gantrisin (spelling could be wrong)
and now they have her on Cefzil. We went to see an ear, nose and
throat specialist and he stated that she as a slight hearing loss.
He would like to see her again in April to see if she has regain
any hearing loss. When she gets these infections, she usually
has a runny nose, and the past couple of months she has been getting
teeth (could that be part of the reason). For your information,
I just put her in day care in December - so she had ear infections
prior to day care. Also, I am not exactly sure what to do next
- tubes? I look forward to your response. Thank you for your time.
Denise
REPLY:
Dear Denise
Your story is classic for allergic otitis due to the milk
you started to feed your daughter.
Six different antibiotics later and no better!!!
Unfortunately, tubes will help the best, but be prepared for
draining ears if you do not find which milk bothered her.
Dr. Hurst
MORE QUESTIONS ON TUBES:::::
Regarding Stephen:
Our two year old son, has been experiencing chronic ear
infections since
December 1995, when he was 13 months old. He started day
care that same month and got his first cold (which was the beginning
of our problems). Since then, he has had numerous colds and a
faucet as a nose. The middle ear has had fluids ever since (on
both sides).
We have already taken him to see an ENT Specialist which
recommended the tubes, however, we would prefer not to have to
put him through that operation (having to put him under). Therefore,
we asked what else could be done, unfortunately, the only alternative
was limited to monitoring his hearing and to assure ourselves
that he does not experience any loss of hearing.
At his first hearing examination (just yesterday), the
examiner informed us that his inner ear seems to be working well,
however, his hearing decreased below the normal level when the
middle ear was not bypassed. The examiner indicated that she would
like to re-examine him when his ear is not infected, unfortunately,
that situation may not occur for a while.
When we whisper, he does not hear us. This is true irrespective
of where we are.
Thank you in advance for your assistance in this troubling
time.
Regards
REPLY:
The first consideration is to return hearing to your child.
To do that the fluid must be removed. It has been proven that
hearing loss for just 3 months on one side alone will result in
decreased IQ scores in both reading and math skills in
children under 7 years old. Language is most critical in its development
at age 2 to 4.
The fluid must be removed to 1) restore hearing and 2) the
fluid itself contains various enzymes that irritate the area and
produce more fluid. That means tubes.
The only risk of tubes is that when the tubes fall out sometimes
the hole does not close and leaves a perforation.(1% in small
tubes and up to 30% if the large "permanent" type are
used.) Also there is the inconvenience of using ear plugs when
swimming so as not to let water get in and cause and infection.
Many parents are understandably afraid of anesthesia - which
is safer than taking an airplane ride.
Dr. Hurst
Dear Dr. Hurst:
Our 10 month old has had chronic ear infections and constant
drainage. She is always gagging herself (as if she's trying to
scratch her throat).
After multiple antibiotics and tubes, she is worse. Now
her ears are draining a green/yellow/brown fluid which the doctor
said was pseudomonas bacteria which oral antibiotics can't kill.
He prescribed chibroxin drops. What is your advise?
Thank you so much.
I love your WEB SITE!!!!!
REPLY:
Dear Bobby & Char:
Your child definitely needed to have the tubes placed, but
the child who has continual drainage after having tubes in ALWAYS
has allergies. Just as they would make her nose run, so they make
her ears run!!
At her age the most likely culprit is a food.- Try eliminating
all dairy products for a week, then challenge her. You cannot
see what her ears do, but can see what her runny nose does. Milk
allergies account for 1/3 of the cases of draining ears. If not
that, then she needs a full blood evaluation - RAST - for other
foods and dust, etc.
DR. HURST
dear sir,
I have a 22 month daughter who had tubes put in sept 1997.
she was 11 months old. I work at a hospital and I'm a paramedic
and lab tech. she kept getting constant ear infections. she goes
to the hospital's private day care on site of the hospital, getting
colds and everything else was to be expected. and I look at it,
she either gets now or she'll get everything when she starts school.
nothing serious but a few bad colds and RSV and the darn ear infections
and constant antibiotics....finally I was asked about tubes....and
the DR said if she was to get one more, each she did 3 days after
finishing her antibiotic. so, tubes were ordered and placed in
by a ENT. knowing everybody in the hospital helped and coming
from a medical background, I knew his was a final solution. one
week after the tubes placed in, an immediate difference......she
has been only placed on 2 antibiotics since (once for strep).
I'm deaf in one ear due to an early childhood injury, so being
partly disabled, I didn't want this for our child.
After the surgery, we gave the normal care, which I've enforced
strictly. tonight, after giving her bath, I looked in her ear
for drainage, only excepting to find maybe yellow wax, but to
my surprise......the turquoise blue colored tube almost out! she
had been fusing all afternoon, but I blamed it on her age and
it being close to 95 degrees outside. I called a friend in the
ER and she told be that if it doesn't fall out in a few days or
she developed a high temp to call my pedi. dr.. if you can see
what time I'm writing to you, you can see I'm worried and concerned.
we live in a small community, and the hospital I work for has
started their own insurance company, which is why I think my pedi
DR waited so long....know one told me that this was only a temp.
fix. she responded so well to the tubes....my DR never tested
for allergies. I want the little critter put back in there.....she
suffered she much and being a mother, I don't want her to suffer
anymore. she doesn't talk as well as the other children in her
class at day care, but she's catching up beautifully. I don't
want her to be delayed again...please give suggestions on what
to look for. how can I get my DR to ok for more tubes.....will
the infections show up quickly now that we are entering flu/holiday
season? help!!! now what? no milk restrictions placed and no changes
in post nasal drip. it was like a miracle once the tubes were
placed in. hardly any colds and if so....only a day or 2...pretty
normal. she doesn't get that milk......1 4-6 oz. in am. maybe
she'll take some at luch, but mostly she wants juice..so I give
it to her. and sometimes she'll want milk while my husband or
myself read to her....rarely though. that's it. or is that a lot?
please responded. I don't want to act crazy to my pedi DR, but
I'm scared for my daughter too.
Dear Dr. Hurst
I have a Two 1/2 year old daughter, she is constantly telling
me her ears hurt. At one point when she was about 16 months old,
She had so many ear infections that at 19 months they inserted
the tubes in both ears and she was a total different kid. The
whining stopped, she talked better,She even ate better.
Dear Dr.David Hurst
Our 4yr old daughter is about to go for a second set of
tubes (Nov 28,96).The last set were put in in April '96. we are
concerned because she has been having reoccurring 'ear infections'
since about the age of six months. Our doctor, at the time simply
prescribed antibiotic after antibiotic, and told us to put oil
(cooking or baby oil) in her ear when she complained. After about
18 infections we finally got fed up and changed doctors. This
doctor immediately sent her to see a specialist, who then performed
the tube insertions in both ears. She has since had several reoccurring
infections and they have been giving her antibiotics again. What
is your feeling on this??? Should we be worried ???
It is now six months (approx) after the first set of tubes,
were put in.Our last visit to the specialist (Nov 21, 96) sent
him into a panic...he was so shocked that the ears were infected
to the degree they are, he immediately booked an appointment for
the surgery. We are frustrated,distraught, confused,and pretty
angry because of the incompetent way the doctors seeing to our
daughter have handled her case.
Can you please advise us on what to do. I know that this
is quite a request, but after reviewing the information on your
web page, we are more informed than we have ever been. We would
like to send her for the allergy testing you recommend, do you
know of any specialist who can help us out in the (Hamilton Ontario
and or surrounding areas, Canada).
Yours sincerely,
Karl & Melanie
REPLY:
THE CHILD WITH CONSTANT DRAINING TUBES ALMOST ALWAYS HAS FOOD
ALLERGIES.
DO NOT WORRY - It was correct to put in the tubes but THE
FACT THAT THEY ARE STEADILY DRAINING IS A SIGN OF ALLERGY AND
ALMOST ALWAYS IT IS TO A FOOD. FIRST TRY TO ELIMINATE ALL HER
DAIRY PRODUCTS - NO MILK, CHEESE, ICE CREAME OR YOGART FOR 2 WEEKS
(Water is wonderful - no one is allergic to it). THEN, AFTER 10
DAYS - LOAD HER UP !! SEE IF THE DRAINAGE - AND RUNNY NOSE STOP.
PROBABLY 30% OF KIDS LIKE YOURS ARE ALLERGIC TO DAIRY PRODUCTS.
OTHERWISE GET HELP FROM AN ENT ALLERGIST.
BEWARE: BEFORE YOUR DAUGHTER HAS FURTHER SURGERY ON HER EARS
- GET ANOTHER OPINION. CALL THE CANADIAN SOCIETY OF OTOLARYNGOLOGY
OR THE AMERICAN ACADEMY OF OTOLARYNGOLOGIC ALLERGY (AAOA) TO GET
HELP.
Dear Dr. Hurst,
I'm writing because my 9-month old son has been on five
different
antibiotics consecutively for the last three months. The
" infection " was discovered during a well-baby exam
at 6 months. My son seems oblivious to the infection and has had
no symptoms or fever. Your articles are making me suspicious that
he is suffering from an inflammation due to allergies rather than
a bacterial infection. My doctor has advised me that if no progress
is >made by his next ear re-check ( January 7 ) he will be
referring us to an
ear specialist. To me that automatically means tubes. While
I don't like the fact that he has been on antibiotics for so long,
especially when they aren't doing anything except building tolerances
and causing antibiotic side effects, I am also very hesitant to
jump right into tubes for a 9-month old What is your opinion on
insertion of tubes? I have heard that it may cause more problems
than it helps (ie. hearing loss, profuse drainage, re-insertion
of tubes ). Also, would you recommend allergy testing at this
point even though he shows none of the other symptoms you have
listed on your " Straight talk for Parents on Ear Disease
" page?
Thank you very much should you take the time to respond.
REPLY
Dear Mr. Stoner:
Your son of 9 months has all the classic signs of allergic
otitis in that he has fluid but no signs of fever, discomfort
or "infection".
With the fluid is probable hearing loss. Placement of tubes
is essential usually to return hearing and to get the inflammatory
mediators out of the ear which perpetuate the problem.
Having no other signs of allergy such as eczema, diaper rash,
runny nose or continual upper respiratory infections means he
is 1) lucky and 2) harder to diagnose. I would then try to change
his milk to whatever else he is NOT currently drinking.
Your ENT should explain the other risks of tubes - which are
minimal compared to the benefit they will bring your son.
Dr. Hurst
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
inserted 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 another recheck. 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
that it 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 insertion 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 grommets) 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
appreciated.
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 "Permanent tubes"
or large bore tubes/grommets is that they have a 30% or greater
chance of permanent perforation rate if left after 6 months. Better
the smaller 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 speach and 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:
DEAR Dr. Hurst:
I am writing in twe hope that you can respond to this message.
My son now 3 had constant fluid drainage and ear infections
from the age of 8 months for approx 2 years without any relief.
After doses of antibiotics he had tubes inserted. They dislodged
within 2 weeks only to have a second large set put in plus adenoidectomy.
The adenoids did not seem enlarged at the time of surgery. Prior
to the 2nd set of tubes I took my son off all dairy products for
20 days to no relief. He has never been tested for allergies.
He was hospitalized for 2 weeks on intravenous drugs to stop the
drainage as the surgeon suspected the ear trouble may have caused
meningitis.Thankfully this was not the case. The drugs still did
not clear up the ears.
Eventually his ears have cleared up. A new surgeon we went
to took out the large tubes. My 10 month old son has just had
his first ear infection with fluid in his ears. His first course
of antibiotics have not cleared it up.
The thing is that I have not learned much through my first
experience with my son. I don't know what I have done right or
wrong. Will the ears eventually clear up without antibiotics?
If the infection is viral why are we constantly perscribed antibiotics?
We have no history of allergies in our family. My eldest son had
mild eczema and my youngest has a few small eczema patches in
his neck and body.
Thank you in advance for your time,
Miriam
REPLY:
Dear Mir and Joe
First, you have not done anything wrong. Your son is just
a more severe case of the classic problem of allergic otitis that
I have been talking about. Have your physician get a blood test
- especiallly for foods from the lab I talk about. He will need
some food and then later, some mold inhalant testing. When the
ears do drain, usually Cortisporin drops will stop things. The
Pseudomonal is just an opportunisic infection - not the cause.
Once they stop the allergen, then the ears will dry d luck,
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