Ear tubes for a 10 month old girl?

[Jeffrey]

We didn't have to have ear tubes for either of our kids, but my understanding is that they're not terribly controversial at this point -- if they're truly indicated. It does seem odd to recommend them so quickly, after a single infection. I have several friends/relatives who found that tubes were the only way to prevent the multiple ear infections they were struggling with. One good friend's son was about 2 when he had them, and his slight language delay was erased in the matter of a few weeks. It was startling to realize (later) how much the infections were affecting his hearing, and therefore his language development.

There seems to be controversy over whether tubes should be used in regards to language development:

http://content.nejm.org/cgi/content/full/356/3/248

I haven't paid much attention to this issue since it's not our current concern. My quick review (of this and other studies) lead me to the conclusion the need for tubes (under certain conditions) is controversial.

That said, my youngest did have several ear infections, just never one on top of another. We considered tubes, but it never got quite to that point. (I should note that my husband is a pediatrician, if that matters.)

The fact your husband is a pediatrician matters to me. At what point would have your husband been in favor of tubes for your youngest? What do you think your husband would do if he were in our situation?

Definitely, the second opinion (or third) sounds warranted, and there's no reason to rush out for tubes, if antibiotics work to beat the infection.

The immediate problem is the original antibiotics did not beat the infection.

If you feel that daycare is the problem, perhaps your wife and you could work together to stay home? Is there some reason it would be solely up to her (don't mean to pry, and feel free to ignore it, but your statement seemed a bit extreme and surprised me)?

My comment was strictly based on economics. My wife's income is her fun money. My income pays all of our bills and creates financial security for all of us.
I would LOVE to stay home with our baby girl! The cost to our family would be significant.

[Lid]

There seems to be controversy over whether tubes should be used in regards to language development:

http://content.nejm.org/cgi/content/full/356/3/248

That makes sense -- I remember seeing that study, but I hear what you're saying, that language development isn't your immediate concern. I think this link might help you, if you haven't seen it yet. It's the AAP policy statement on ear infections, basically (from 2004). It's long and detailed (but I think you'll enjoy diving in!) -- sections 4 and 9 are probably the most relevant to you, but I didn't look closely to see which parts apply to children under age 2.

The fact your husband is a pediatrician matters to me. At what point would have your husband been in favor of tubes for your youngest?

If I remember correctly (and I may not -- the glorious fact that eventually, most things pass), if he'd had 4 ear infections within 6 months, we were going to seriously consider it. He ended up tapering off with the infections soon after, and we got lucky.

The immediate problem is the original antibiotics did not beat the infection.

I'm so sorry, I read too quickly before and missed that. My husband has practiced in three different places, and one of the main regional differences (even though all are in the South) seems to be the antibiotics of choice for ear infections. There are a variety of options, and it's a bit unusual, I think, to do two rounds of the same antibiotic instead of trying another one. I'd ask about that, definitely, before you go much further. There may be a reason, but it's not been a common approach in any of the places we've lived.

My comment was strictly based on economics. My wife's income is her fun money. My income pays all of our bills and creates financial security for all of us.
I would LOVE to stay home with our baby girl! The cost to our family would be significant.

Ah, gotcha. That does complicate the matter, and I can relate. Someday we hope to be able to do dual part-time jobs and manage that way...

Good luck with this.

[greybeard]

One option that I highly recommend is noninvasive and has great efficacy--take your daughter to a Dr. of Osteopathy who specializes in cranial sacral work. The angle of the ear canals can be sufficiently altered by this work to solve the drainage issue and surgery avoided. My son had similar issues albeit less severe and at an older age than your daughter and Harold made it "all better" in a few visits. Cranial sacral treatments are completely delightful for the patient, and many people take their newborns to their osteopaths immediately after birth and regularly thereafter.

[Jeffrey]

I think this link might help you, if you haven't seen it yet. It's the AAP policy statement on ear infections, basically (from 2004). It's long and detailed (but I think you'll enjoy diving in!) -- sections 4 and 9 are probably the most relevant to you, but I didn't look closely to see which parts apply to children under age 2.

Thank you very much! I'll definitely look over the policy statement, when time avails.

If I remember correctly (and I may not -- the glorious fact that eventually, most things pass), if he'd had 4 ear infections within 6 months, we were going to seriously consider it.

That seems much more logical to me than the first ear infection.

My husband has practiced in three different places, and one of the main regional differences (even though all are in the South) seems to be the antibiotics of choice for ear infections. There are a variety of options, and it's a bit unusual, I think, to do two rounds of the same antibiotic instead of trying another one. I'd ask about that, definitely, before you go much further. There may be a reason, but it's not been a common approach in any of the places we've lived.

Thank you very much for the antibiotics information. It's in harmony with my suspicion and supports what I've already done.

It seemed logical to me (not that I know anything about medicine) that different types of antibiotics would have different success rates with a specific bacteria. After the first round, I requested a different type but our doctor wanted to use Augmentin a second time because she felt it had made some progress during the first round. Today, I strongly requested (while staying polite) a different type of antibiotic and we were prescribed Vantin. I/we want to give Vantin a chance before moving forward with any other alternative.

[Jeffrey]

One option that I highly recommend is noninvasive and has great efficacy--take your daughter to a Dr. of Osteopathy who specializes in cranial sacral work. The angle of the ear canals can be sufficiently altered by this work to solve the drainage issue and surgery avoided. My son had similar issues albeit less severe and at an older age than your daughter and Harold made it "all better" in a few visits. Cranial sacral treatments are completely delightful for the patient, and many people take their newborns to their osteopaths immediately after birth and regularly thereafter.

Thank you very much for an alternative approach! That's a concept I would definitely entertain and my wife would definitely not.

I have a ruptured disc in my lower back and surgery was recommended. Instead, I've utilized the McKenzie method with sufficient success. OTOH, my brother has had back surgery twice with minimal hesitation. My brother now plays golf. I wouldn't even consider doing such.

[bjornolf]

My wife was a little older when she got a tube in one ear. It was removed many years ago, but her hearing is MUCH worse in the ear that had the tube. Like, if I'm listening to the TV and she has her good ear up, she can't fall asleep. If she turns the other ear up, a freight train could go through and she'd snore right through it. She's not DEAF in that ear, but her hearing definitely isn't good on that side.

I had ear infections for years, but despite the doctor's advice, my mother had read some horrible reports about them and refused them. Turned out I was eating foods I was allergic too, which was cause me to get toncilitis, which cause swelling in my ear canals. When we figured that out and I stopped eating those foods, my infections stopped. Maybe you should get your daughter tested for food allergies?

Also, is it possible that someone in the daycare is smoking? Even smoke on clothing can have adverse affects like this.

I'd look into alternative treatment and maybe get a second opinion from another ENT before taking the rather drastic step of getting tubes put in.

[greybeard]

Thank you very much for an alternative approach! That's a concept I would definitely entertain and my wife would definitely not.

I have a ruptured disc in my lower back and surgery was recommended. Instead, I've utilized the McKenzie method with sufficient success. OTOH, my brother has had back surgery twice with minimal hesitation. My brother now plays golf. I wouldn't even consider doing such.

Not either or, and changing the declination of the ear canals in an infant is a piece of cake for a skilled practitioner. You have a lifetime to load your kid up with antibiotics. If ear aches become a problem, a visit to an osteopath might change that. Less ear aches, less antibiotics. Your wife is against this. Must be related to mine.

Never heard of the McKenzie method; I'm a Feldenkrais man myself. If you are interested in discovering how to learn to use your body differently to avoid difficulties that the ruptured disc might present, my guy Moshe and his body of work are nothing to sneeze at, and the lessons the work comprises are fun and interesting. Learning to become aware of what we do that is habitual is a developed skill, and then developing options, real choice about such matters, is actually quite rewarding in my experience.

You might keep in mind the following: the muscles of the belly, which flex your torso, work easiest, most effectively and comfortably, when the muscles of the back, which are erector muscles, are most devoid of constriction, that is, when they are relaxed. Most concepts around protecting the back involve straightening the spine and holding firm with the erector muscles and constricting your rib cage. Doing that makes movement, getting up or turning, imponderably more difficult, and creates overload in the erector muscles to boot, which will end up aching at the end of the day due to such overwork. Learning how to reduce the residual tension in your back muscles (no not by stretching), to soften your ribs and allow your sternum to sink, will improve the ease on your back in getting in and out of chairs and up from lying down. It will also help free up your pelvis which will permit you to ambulate, either walking or crawling after your kid, with much greater ease and strain on your back.

Yeah I know, not what your orthopod told you. What do they know about how the body moves most effectively? Do they study that? Where?

[arydolphin]

Jeffrey,
I finished my pediatric residency last June, and am now working in a Pediatric ER. You've already gotten a bunch of good information from others in this thread. I'll just add a few quick things, and if you have other questions, just PM me and we can go from there. In short, a surgery for ear tubes is one of the most common surgeries that an ENT doctor can do, and one of the shortest as well. However, in my experience, that type of surgery is done on kids with recurrent ear infections, not one persistent infection. Also, while Augmentin is a pretty good drug for ear infections, my first choice if a kid was not responding to Augmentin would be to switch antibiotics after a full course of the antibiotic, not just add on more days of the same antibiotic. For what it's worth, my first-line choice for ear infections in Amoxicillin, and Augmentin is a combination medication that contains Amoxicillin; if a kid doesn't respond to Amox, I usually step up to Augmentin. The particular organism that was causing the infection may have not responded well to Augmentin for some reason.

One other thing: did your child start to have fevers again after completing the course of Augmentin? A child of that age will have some fluid behind their tympanic membranes whenever they have a cold (aka upper respiratory infection, or URI), but that fluid doesn't necessarily mean that they have an ear infection. The fluid can build up due to nasal congestion that is part of a URI, which can lead to an ear infection after the URI starts. Of course, it's hard to specifically talk about your child when I can't see her, but I ask about the fever to try to figure out whether it's a new infection, or whether she has continued to have nasal congestion from the previous infection.

Anyways, there's no problem in going back to your pediatrician and saying that the ENT recommended surgery, but that you're not comfortable with that. You could also ask about another ENT group to see your daughter as well. Feel free to PM me with other questions if you have them, and have a great night.

[Jeffrey]

Maybe you should get your daughter tested for food allergies?

Also, is it possible that someone in the daycare is smoking? Even smoke on clothing can have adverse affects like this.

I'd look into alternative treatment and maybe get a second opinion from another ENT before taking the rather drastic step of getting tubes put in.

Thank you very much! I appreciate your insight and advice. We will not be making a rushed decision, since we have the benefit of time. I will definitely give more thought to the food allergy and daycare smoking possibilities you kindly mentioned.

[Jeffrey]

Not either or, and changing the declination of the ear canals in an infant is a piece of cake for a skilled practitioner. You have a lifetime to load your kid up with antibiotics. If ear aches become a problem, a visit to an osteopath might change that. Less ear aches, less antibiotics. Your wife is against this. Must be related to mine.

Yes, she is, and they could be.

Never heard of the McKenzie method; I'm a Feldenkrais man myself. If you are interested in discovering how to learn to use your body differently to avoid difficulties that the ruptured disc might present, my guy Moshe and his body of work are nothing to sneeze at, and the lessons the work comprises are fun and interesting. Learning to become aware of what we do that is habitual is a developed skill, and then developing options, real choice about such matters, is actually quite rewarding in my experience.

Thank you very much for an alternative approach. After resolving my more important concern (my girl's ear infection issue), I'd love to discuss this further with you. We could start another thread (hopefully next week) or exchange PM's (whichever you'd prefer).

Until then, here's a McKenzie link:

http://www.mckenziemdt.org/robin.cfm

[Jeffrey]

Jeffrey,
I finished my pediatric residency last June, and am now working in a Pediatric ER.

Mere thanks cannot fully display how much I appreciate your help and assistance with our precious little one! Nevertheless, thank you very much!

I'll just add a few quick things, and if you have other questions, just PM me and we can go from there.

Thank you very much for the very kind offer! I will gratefully send you a PM or proceed with this thread (your choice).

However, in my experience, that type of surgery is done on kids with recurrent ear infections, not one persistent infection. Also, while Augmentin is a pretty good drug for ear infections, my first choice if a kid was not responding to Augmentin would be to switch antibiotics after a full course of the antibiotic, not just add on more days of the same antibiotic.

Thank you for confirming both of my suspicions. Neither (ear tubes for first infection and not changing antibiotics after the first round was unsuccessful) seemed logical to me, but I'm ignorant on the subject.

For what it's worth, my first-line choice for ear infections in Amoxicillin, and Augmentin is a combination medication that contains Amoxicillin; if a kid doesn't respond to Amox, I usually step up to Augmentin. The particular organism that was causing the infection may have not responded well to Augmentin for some reason.

We started Vantin last night. What are your views on Vantin for this purpose?

One other thing: did your child start to have fevers again after completing the course of Augmentin? A child of that age will have some fluid behind their tympanic membranes whenever they have a cold (aka upper respiratory infection, or URI), but that fluid doesn't necessarily mean that they have an ear infection. The fluid can build up due to nasal congestion that is part of a URI, which can lead to an ear infection after the URI starts. Of course, it's hard to specifically talk about your child when I can't see her, but I ask about the fever to try to figure out whether it's a new infection, or whether she has continued to have nasal congestion from the previous infection.

I'll call my wife and get her recall on this, since all of the doctor visits are starting to blend together in my mind. I want to make sure my recall is correct.

Feel free to PM me with other questions if you have them, and have a great night.

Thanks again for your kindness and generosity! All the best to you & yours!

[allenmurray]

I have a ruptured disc in my lower back and surgery was recommended. Instead, I've utilized the McKenzie method with sufficient success. OTOH, my brother has had back surgery twice with minimal hesitation. My brother now plays golf. I wouldn't even consider doing such.

After struggling with my back for a number of years, my GP referred me to a orthopedist. Because of her conservative approach (which I appreciate) she sent me to a back doctor who is not a surgeon and who specializes in non-surgical approaches to back problems. He looked at my MRI, did a thorough exam, took me through some exercises and posture positions in his office, and then said, (I'm not sure it will make it through the filters) "I can dick around with this if you want, but if you want it fixed you'll need surgery." Having the surgery reccomended by someone who specializes in non-surgical approaches made me feel far better about the surgery. As I was coming out of the anethsesia I could tell it was "fixed". Two months later (after working hard with my PT) I could barely remember the pain I had lived with for six years.

Don't discount surgery. But having it reccomended by someone who tries to avoid surgery will make you feel a lot better about going into it.

[Jeffrey]

One other thing: did your child start to have fevers again after completing the course of Augmentin? A child of that age will have some fluid behind their tympanic membranes whenever they have a cold (aka upper respiratory infection, or URI), but that fluid doesn't necessarily mean that they have an ear infection. The fluid can build up due to nasal congestion that is part of a URI, which can lead to an ear infection after the URI starts. Of course, it's hard to specifically talk about your child when I can't see her, but I ask about the fever to try to figure out whether it's a new infection, or whether she has continued to have nasal congestion from the previous infection.

My wife's recall is the same as mine. The second round of Augmentin ended on May 1st. On the evening of May 5th, our baby started running a slight fever (around 101 degrees) and we took her back to her doctor on the morning of May 6th. Our pediatrician said her ears looked the same as they had during the two previous visits and thus sent us to an ENT. It was at this visit (May 6th) when I questioned whether her ears looked the same as they had during the two previous visits (during the second office visit, our pediatrician said one side had improved which was her justification for prescribing the same antibiotic a second time). Our pediatrician said, "I think I made a mistake before when I said one side had improved. I think they've looked the same each time and I just got the two sides confused before". That's when I strongly requested a different antibiotic.

Thanks again for the help... we need it!

[Jeffrey]

After struggling with my back for a number of years, my GP referred me to a orthopedist. Because of her conservative approach (which I appreciate) she sent me to a back doctor who is not a surgeon and who specializes in non-surgical approaches to back problems. He looked at my MRI, did a thorough exam, took me through some exercises and posture positions in his office, and then said, (I'm not sure it will make it through the filters) "I can dick around with this if you want, but if you want it fixed you'll need surgery." Having the surgery reccomended by someone who specializes in non-surgical approaches made me feel far better about the surgery. As I was coming out of the anethsesia I could tell it was "fixed". Two months later (after working hard with my PT) I could barely remember the pain I had lived with for six years.

Don't discount surgery. But having it reccomended by someone who tries to avoid surgery will make you feel a lot better about going into it.

Thank you very much for the detailed account of your experiences! I'll heed your appreciated advice.

[moonpie23]

After struggling with my back for a number of years, my GP referred me to a orthopedist. Because of her conservative approach (which I appreciate) she sent me to a back doctor who is not a surgeon and who specializes in non-surgical approaches to back problems. He looked at my MRI, did a thorough exam, took me through some exercises and posture positions in his office, and then said, (I'm not sure it will make it through the filters) "I can dick around with this if you want, but if you want it fixed you'll need surgery." Having the surgery reccomended by someone who specializes in non-surgical approaches made me feel far better about the surgery. As I was coming out of the anethsesia I could tell it was "fixed". Two months later (after working hard with my PT) I could barely remember the pain I had lived with for six years.

Don't discount surgery. But having it reccomended by someone who tries to avoid surgery will make you feel a lot better about going into it.

that being said, don't ever NOT get a second or 3rd opinion before you DO elect to have surgery (either on yourself or your child)

i too had back pain that progressed over a period of a couple of months. When i was finally convinced it was just that i had "thrown my back out", I went to an orthopedic clinic. The doctor i saw took x rays and came in to tell me i had blah-de-blah, and that he was going to TRY some steroids, but if that didn't help, it was going to require surgery.

I got the script for the steroids two days before christmas 2007. By christmas day, i could not stand straight up, and spent christmas and the week following in a chair due to excruciating pain.

on my return to raleigh, i called the doctor to inquire how long i should expect the steroids to kick in and bring me some relief. he said, "come on back in and we'll get you set up for surgery"....

when i went in, i was left waiting in the waiting room in pain so bad, other patients were saying i could go AHEAD OF THEM....i was called into the exam room and made to wait ANOTHER 30 min before a NURSE PRACTITIONER came in to see me. I was so angry, i told them to give me my x-rays and that i was going somewhere else. (which they did)

a friend of mine suggested that i see a chiropractor. I was in so much pain, i agreed to anything. I called to get an appt (at a duke approved chiro) and was told i could come in that afternoon...

I went in, he said, "well, you've got blah de blah" and we can get you started on your treatment today....They gave me the hot towel on the back while getting the little electro-muscle stimulator thing on the base of my spine and then i went in for my "adjustment"

long story short...he fixed it...i mean he FIXED it that day...i stood up, i walked out under my own power....it still hurt, but NOTHING like when i had walked in...

three weeks later, i was pain-free and on a 4-6 week adjustment schedule.

I'm not sayin.......i'm just sayin...

[bjornolf]

Chiropracters are awesome. The problem is finding one that's good. Many of them are quacks and/or hacks. We had a guy out in California that was UNBELIEVABLE. He was this little japanese guy, but he was REALLY aggressive in his treatment, and he could turn you into a pretzel in seconds, but when he was done, you felt GREAT. He was amazing. My parents used to fly out to California, one of the main reasons of their trip being to see him.

[cspan37421]

http://www.chirobase.org/12Hx/mencken.html

[Cavlaw]

I was a perfect candidate for tubes when I was a kid, as I had a TON of inner ear infections (more than a dozen before I was 10).

My parents, a dentist and an ER nurse, were resistant to having them put in, and I'm glad for it. The thought just creeps me out. It was a near thing, though, and they now say a few more and they would have done it. Fortunately, they were very diligent in getting me in to the doc straightaway every time I got one, so it was treated and I never suffered any noticable hearing loss. My iPod has been far worse for that.

They did have the advantage, though, of the ear infections not starting until I was old enough to express that I had pain in my ear. It would have been more difficult for them to be appropriately diligent about it had I been only 10 months and limited to crying without explanation.

[unexpected]

I had ear tubes placed in my ears when i was about 7 years old. I still remember going to the hospital and getting them put in. In 1991, you still had to go under fully- it was not an outpatient procedure like it is now.

I loved them- they fully stopped my ear infections until I had them taken out when I was 13. I was allowed to shower without earplugs, but I always went swimming with ear plugs. I actually rather enjoyed that actually. I hate the feeling of water in my ears, and as I was on a swim team, it helped me focus.

When I got them removed at 13, I started having ear infections again. From the ages of 13-23, I had SEVENTEEN ear infections. Anytime I got sick, a cold, minor congestion, anything, I would get an ear infection. The doctor recommended to my parents that they put the ear tubes back in, but my parents decided not to. By this point, I had gotten so good at self-diagnosing my ear infections, that I only had discomfort for 1-2 days, so it wasn't a big deal.

When I got them removed, I also had the same problem with the perforation in my ear drum for a little while. The pain for that was HORRIBLE.

[OZZIE4DUKE]

I had ear tubes placed in my ears when i was about 7 years old. I still remember going to the hospital and getting them put in. In 1991, you still had to go under fully- it was not an outpatient procedure like it is now.

I loved them- they fully stopped my ear infections until I had them taken out when I was 13. I was allowed to shower without earplugs, but I always went swimming with ear plugs. I actually rather enjoyed that actually. I hate the feeling of water in my ears, and as I was on a swim team, it helped me focus.

When I got them removed at 13, I started having ear infections again. From the ages of 13-23, I had SEVENTEEN ear infections. Anytime I got sick, a cold, minor congestion, anything, I would get an ear infection. The doctor recommended to my parents that they put the ear tubes back in, but my parents decided not to. By this point, I had gotten so good at self-diagnosing my ear infections, that I only had discomfort for 1-2 days, so it wasn't a big deal.

When I got them removed, I also had the same problem with the perforation in my ear drum for a little while. The pain for that was HORRIBLE.

I suggest you read greybeard's post, #23, above and perhaps look into it if you are still having problems with ear infections.