Toddler health: Chronic ear infections

Our 20-month-daughter has chronic otitis media. Recently the infection broke through on gantrisin maintenance. We saw an ENT when she was only 10 months old and repeated tries at clearing this up with antibiotics seem futile. Your thoughts?

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ABOUT THE EXPERT

Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

This is one the most difficult problems we, as pediatricians, face because chronic and recurrent ear infections are so common, and yet, no one is sure which is the best way to handle this chronic problem. In deciding what is the best treatment course for your child, one must first figure out whether the problem is separate recurrent ear infections or chronic inflammation with fluid in the inner ear called chronic otitis media with effusion.

SEPARATE RECURRENT EAR INFECTIONS

The only way to diagnose this is to have the ear infection successfully treated and then have the child return to the doctor for her to confirm that indeed the infection is gone and all the fluid behind the ear has disappeared. Many times children are not returned to the doctor for this ear re-check. Then, when the next ear infection occurs, we don't know if 1) The ear returned to normal and this is just another ear infection requiring treatment OR 2) The ear always had fluid behind it, and the child is suffering from otitis media with effusion which is a set-up for multiple ear infections.

OTITIS MEDIA WITH EFFUSION

Most of the time, otitis media with effusion spontaneously goes away within three months and causes no problems. So, the question becomes, if the fluid doesn't go away within that time, does it cause any problems. The answer to that is, we don't know for sure. The obvious concern would be about possible hearing loss and subsequent speech delay. But while otitis media with effusion has been shown to decrease hearing while the child actually has it, no studies have shown that this transient decrease in hearing delays speech or learning.

It is difficult to tell from your description if your daughter has had difficulty from recurrent ear infections, otitis media with effusion or both. You can expect your ENT to try to distinguish this. If your daughter has had many recurrent ear infections, it becomes a judgment call as whether to place tubes. Multiple things must be considered including exactly how many separate ear infections she has had over the last year, as well as risk factors for ear infections including large daycare settings, smokers in the house, and bottle feeding.

If it seems she suffers more from otitis media with effusion, the most important thing will be to document how good her hearing is. If there is a decrease in hearing greater than or equal to 20 decibels in both ears, tubes should be considered. Otherwise, continued watchful waiting might be the best course. As you can see, there are many factors in both diagnosing the exact problem as well as what to do about it. Ultimately, both you, your husband, and your ENT should decide together. Do not hesitate to get a second opinion if you are uncomfortable with the first.

Good luck to you.

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