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This one is about: Dr Canady - Ear Infection Treatments & Pic-lines Comment

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A Cleft-Talk member writes:

Now on to the subject of this post, since our son was born he has constantly had ear infections. Tubes were placed when they did his lip-tongue adhesion and palatal prosthesis at 5 weeks. He is now 5 months and has never been off oral antibiotics longer than 5 days. His pediatrician gave up on his ears and now we only see the ENT for this. He put a "wick" in his ear last Wednesday (it's basically a piece of cotton that goes in the canal and you put antibiotic drops on it) he said it might fall out and we are scheduled again for this Wednesday, well it lasted all of an hour and a half. Our ENT says we are running out of options and that about all that is left to do is either drill out the mastoid bone (sorry I have no clue what that means, but I DON'T think so!!) or a pic-line and IV antibiotics. (A pic-line is like a permanent IV that you give antibiotics through at home? I think) Has anyone ever heard of this?

Dr. Canady's Response
Wide Smiles Medical/Surgical Consultant

Draining ears can certainly be a problem, particularly in kids before their palate is closed. (And in my experience, about 50% of the kids AFTER their palate is fixed, at least for a while...)

A few years ago there was a flurry of activity about treating kids with draining ears that were culture positive for pseudomonas on IV Abx and daily ear suctionings. I have not kept up religiously with the peds oto literature about this, but the original rationale was to treat them as if they had an actual mastioditis or osteomyelitis. This is still done today and is accepted treatment.

The problems with draining ears are:

1. The kids can't hear very well while their ears are draining and they may have language delay as a result of this.

2. Draining ears are a foul-smelling mess, but are safer than non-draining ears in terms of abscess formation, meningitis, etc. (A basic surgical principle is that drained wounds are better -- that was all they had in the Civil War to treat infections and abscesses!!)

I usually try drops, then drops and oral antibiotics, then irrigations with normal saline (to wash out the pus) followed by drops and continue the oral antibiotics. Usually, this will work. Some kids (especially young kids prior to palate repair) may have relatively horizontal Eustachian tubes and may actually reflux from their nasopharynx into their middle ear--these kids will continue to drain no matter what you do (in my experience).

I have admitted kids for IV antibiotics (we are not "enlightened" enough out here to send these kids out of the hospital with a pic line yet...) and in the right situation, I see nothing wrong with this -- but it should be done only in rare cases (which can be 100% if it is your kid...)

Hope this helps.

John Canady MD

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