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Thursday, August 21, 2014
Ear, Nose, and Throat Disorders
My 5 1/2 yr old son is currently being treated for an ear infection. 4days ago the school nurse called to inform me that he came to her office for a cotton ball - he said he had water coming out of his right ear. No pain - no fever. He had this drainage (clear watery fluid) for about 24hrs. It was draining enough that when he picked his head up, or to the side, it would come out & run down his neck (not just drops of fluid). After 24hrs, the drainage slowed down & became thicker & slightly yellow. When the MD saw him he prescribed antibiotic ear drops. My son had ear tubes placed at 2 1/2 yrs old (3yrs ago). MD said ear tube still in place & he wants to look at it after the inflammation goes down. MY CONCERN: I am not convinced he has an ear infection - NEVER had any pain or fever. Also, paperwork with ear drops says not to use when there is a perforation in the tympanic membrane & my son complains of it hurting his neck when drops are applied. When I asked him where it hurt, he pointed to his throat - said it felt like the medicine was running in there. Any answers or suggestions would be greatly appreciated!!
All of what you are describing is fairly typical and makes sense from what you are describing.
In many children, inserting tubes for chronic ear infections serves several purposes. One is to reduce the frequency of ear infections (not necessarily eliminate, but clearly reducing the # of ear infections). Second, a benefit of tubes is that they allow an ear infection (if one develops) to drain out rather than remaining trapped inside the middle ear space. If fluid or pus are trapped in the middle ear, most children complain of pain or at least pressure. With a tube in place, that doesn't occur and the first sign or symptom of an ear infection in a child with tubes, is drainage, without pain.
Since the ear is connected to the throat by the eustachian tube, it is common for drops placed in the ear canal, to pass through the tube, through the middle ear, down the eustachian tube and into the throat, where it can be tasted. Occasionally, patients complain that the drops burn or sting as they pass through. This ought to be discussed with your physician. Similarly, there are several drops that are primarily indicated for ear canal infections and don't have specific indications for otitis media (middle ear infections - e.g. children with open tubes). However, there is also decades of clinical experience using ear drops for both middle ear and external ear infections. The risks and benefits of using specific ear drops in a child with tubes is something that you ought to discuss with your physician.
Daniel Choo, MD
Associate Professor and Director, Division of Otology/Neurotology
College of Medicine
University of Cincinnati