Advice regarding this medical diagnosis (re: 2 1/2 yo's ears/tubes)

[StaceyinLA]

Dd asked me to post. Ear issues in children aren't at the forefront for me, having never had a child with an ear infection.

 

Dgs is 2 1/2. He doesn't talk much at ALL, and when he does, it's very mumbly and monotone. He has trouble making consonant sounds and almost just "hums" words (he does it with his mouth open but not really moving his lips). He started speech therapy a couple of months ago. Before that, dd did take him to a new pediatrician in VA (he had only ever been seen by one here in LA) to see if he had anything going on with his ears. He said there was a SLIGHT bit of fluid, but not even worthy of meds, and there has been zero evidence, ever of him having an actual ear infection.

 

FFWD to today. Dd decided she wanted an ENT to see him just to be SURE there was nothing wrong, check his hearing, etc. I guess she felt like she needed to really be sure that there wasn't an underlying issue that could be affecting his speech. Everything looked good upon initial examination, but the dr. wanted to do a hearing test (which is what dd wanted anyway). Basically, they said instead of the spikes they should see on the printout from the test, his was basically just a single level, indicating he certainly IS experiencing somewhat of a hearing loss. No signs of infection at all though.

 

Dr.'s diagnosis is that there COULD be mucous buildup behind eardrum causing the problem. Her treatment is penicillin for 10 days and steroids for 5, see her in 2 weeks and if no improvement - tubes.

 

I guess this is where the advice part comes in. I just don't see how, with no infection present, antibiotics are going to do ANY good. And steroids? My thought is why not something like an antihistamine to dry up any kind of buildup like that.

 

I realize I am no doctor, but I KNOW what antibiotics are used (and overused) for, and I just don't see how that's the answer when he has NEVER had an ear infection and has zero signs of one now. It just seems like there may be a better way to dry up mucous in that middle ear area. 

 

Obviously if his speech is being affected, dd wants to get to the bottom of it, but not by just throwing drugs and potentially unnecessary surgery at the problem.

 

Does anyone have any experience with this type of scenario? Any suggestions or ideas? I would appreciate some input. Dd is holding off on starting meds at least until tomorrow so she can hear the responses of the hive!

 

 

Oh, ETA - dgs is still nursing, and does nurse at night in bed. I know there can be issues with buildup from formula-fed babies drinking while lying down, and I was thinking that I read it can affect breastfed babies/toddlers as well. I can't remember from my LLL leader days - anyone have input on that as well?

[Mrs Mungo]

I've never been in this exact situation. *However* doctors generally have protocols to follow that start with the treatment that contains the fewest risks and ramp up from there, if the least invasive treatment doesn't solve the problem. That's just how it works with *any* potentially serious problem. We've frequently had to start all over with things like this each time we move because doctors tend to want to start at the beginning to make sure they aren't missing anything along the way.

[Ellie]

:grouphug:

 

Antibiotics can help.

 

Does he get any dairy whatsoever? Because dairy is a mucus-causing food. If he is, that would be a place to start.

 

Bfing at night--or any other time--would absolutely *not* cause any fluid build-up in the ears. Bottle-feeding might, but only if the formula is dairy-based.

[StaceyinLA]

Thanks. He does drink some dairy now, though he didn't for a long time. I know breastfeeding isn't a problem by any stretch, but was just wondering about nursing so much lying down. I thought I just remembered something about milk being able to pool in the sinuses or something. Since breast milk is technically a bodily fluid, and mostly water, I figured it wouldn't be an issue, but wanted to at least mention it.

[mom2myboys]

Steroids are usually used to treat inflammation, which sounds reasonable. Maybe they are trying to rule out inflammation putting pressure on parts of the ear? It would make sense. I think the antibiotics would be to make sure that there is no infection hiding somewhere before they perform surgery. I have had antibiotics prescribed before surgery in the past. 

 

I agree with Mrs. Mungo that this is likely a protocol starting with the least invasive procedure first. Can your DD ask for more information from the doctor on why this course of treatment is recommended? 

[prairiewindmomma]

I'd want to do a free hearing screen through early intervention by an audiologist.There's not enough info from what you shared. The ENT's plan to try to use steroids and abx is reasonable under the scenario given depending on the audio screen.

[gardenmom5]

A hearing test should be done by an audiologist. He needs to go there before any surgery. It should be done in a sound proof room.

[Ameena]

No experience. I would probably go ahead & give the antibiotics, as they won't do much harm if it isn't the problem.

 

HOWEVER - I would want to see some type of testing / proof that there is mucus present before I jumped to tubes. Without having had any ear infections, and no symptoms - I wonder if perhaps he just was born with partial hearing loss. Tubes wouldn't do anything for that, and might make it worse.

[mom2myboys]

Babies use their jaw/mouth differently when they nurse vs. when they use a bottle. I think that is why BFing lying down is not an issue, but using a bottle can become a problem for some kids. 

[StaceyinLA]

The audiologist at the ENT's office did perform the hearing test. They took him into a sound proof room. I was not with them for that part, but dd described the process. 

[kitten18]

I think it sounds reasonable. I would starts with the antibiotics and steroids and then go from there.

[InterestingCase]

When giving the test, an audiologist has a way of testing the hearing "behind" the ear. Through doing this, you can clarify whether the hearing loss could be coming from fluid or inflammation impeding the passage of sound. It has been awhile since my last exam, so I cannot remember the details of how it works, but for me, it clearly shows whether the reduced hearing comes from fluid/infection impediment vs. true hearing loss.

[Ellie]

Thanks. He does drink some dairy now, though he didn't for a long time. I know breastfeeding isn't a problem by any stretch, but was just wondering about nursing so much lying down. I thought I just remembered something about milk being able to pool in the sinuses or something. Since breast milk is technically a bodily fluid, and mostly water, I figured it wouldn't be an issue, but wanted to at least mention it.

 

Really, he doesn't need to drink milk, and if there's the slightest chance that eliminating dairy could help, that would be the thing to do.

 

No, there is never a problem with a baby nursing while lying down. Not ever. Never blame b-feeding for anything, lol.

[Paige]

A good audiologist should be able to tell if his hearing is affected by fluid or not. Kids don't test the same with w/ hearing loss due to neurological issues.

[Lolly]

Not sure about the tubes, but for now it sounds like the antibiotics and steroids are a good plan. Antibiotics will not only take care of a possible infection (you can have an infection with no visible signs), but also help to reduce inflammation and swelling. 

[thessa516]

My son needed to have tubes put in because of something similar. No infection, but hearing loss. When the doctor put the tubes in, he suctioned out the inner ear. He told me it was like glue in there. This cleared up the hearing issue but we are still dealing with speech issues. I wish I would have done the tubes sooner just because of the hearing issue.

[NavyMommy]

From what you describe that sounds like what the audiologist is going off of is the tympanogram (sp?). That's simply a measurement of how well the ear drum is moving in response to stimuli. If it's abnormal there is "something" behind it causing whatever irregularities they're seeing. The problem with a child that young is that actual hearing tests (including testing around the ear drum to see if that's the problem like PP mentioned) is very hard because the child isn't as responsive. If you add in speech problems that makes it more complicated because part of the testing requires the child to replicate the sounds they're hearing.  

 

It sounds to me like they're going with a conservative approach before heading to tubes. If it is in fact that he doesn't hear well that will make a WORLD of difference in his speech when it gets fixed. DD became 1000% clearer in her speech and enunciation once she was able to correctly hear the sounds.

 

FWIW both of my kids have tubes. DD got them older (at 4) because of speech problems that kept getting pushed off when we had to move. We discovered she wasn't hearing as well as she should which caused the speech. We're currently investigating a second set for DS for the same reason (the first time he had TONS of ear infections).

 

From what I remember your DD and I are in the same area, we may be seeing the same doctors. Feel free to PM me if you have any more questions!!

[joannqn]

My now 12 year old son had severe delays when he was younger, including speech.  One of his problems was articulation; he never voiced the last sound in any word.  He had fluid build up and no infection in his ears for two years.  Because the only hearing loss was in the higher end and supposedly didn't affect speech, they never told me.  The ENT didn't know if tubes would help or not; he said we'd have to try them and see.  We chose to try them.  His teacher, his speech therapist, and I all noticed an immediate improvement.  Did it solve all of his delays?  No, but it definitely helped.  

Note: His delays ended up being caused by malnutrition caused by severe lactose intolerance.  We fixed the lactose intolerance, and he caught up in all delayed areas. 

[StaceyinLA]

Really, he doesn't need to drink milk, and if there's the slightest chance that eliminating dairy could help, that would be the thing to do.

 

No, there is never a problem with a baby nursing while lying down. Not ever. Never blame b-feeding for anything, lol.

 

Yes, I am in agreement here, as is dd. He didn't for a really long time, but her husband drinks it and he drank some and really liked it, so she's been letting him have some. Obviously, that is something she will probably put an end to. He has been fine with nut milks and coconut milk.

 

I also agree about breastfeeding. Dd is clearly in agreement as she is tandem nursing him and his 15mo sister. I would have never encouraged her to quit, but just possibly work on not letting him nurse lying down so much. At this point though, I'm not even gonna worry about that being an issue, since it isn't! ;-p

[StaceyinLA]

I very much appreciate all the responses. It looks like she will go ahead and start the antibiotics tonight and steroids tomorrow as instructed and we'll go from there.

[gingersmom]

.

[magnificent_baby]

Ds had speech problems at that same age. He was on heavy duty IV antibiotics at birth, so wanted to be sure no hearing loss. Failed the first hearing test (booth with an audiologist). We were sent to a children's hearing specialty facility (very well known for hearing experts), and he PASSED this one. He eventually outgrew his speech problems. 

 

Do you have any specialty hospitals near you for hearing specialists? I'd want a second opinion before meds and/or surgery, even if it meant a little traveling. 

[quelle.que.soit]

I would refuse antibiotics and steroids and take to a chiropractor.

[kitten18]

You absolutely need to go see an audiologist for hearing test. It was the first thing we were told to do before beginning speech therapy.

 

If at all possible I would go privately and not rely on early intervention.

The OP said he was tested by an audiologist at the ENT office.

[mysticmomma]

I'd start the antibiotics and steroids. I would also cut all dairy and head to a chiro.

[Tap]

The treatment makes sense as a first step.   The steroids are to help with any inflammation.  The tubes that fluid travels through in the ear are extremely tiny.  The slightest bit of inflammation can mean the fluid may not be draining as well as it should.  If he has a strong immune system, he may be fighting off any infection that the stagnant fluid may be harboring, but it is hard to tell/impossible to tell if there is a low grade infection.  The course of antibiotics are to help him get rid of any infection that could be hiding in there.  It may not be an obvious infection (with red bulging ear drums), but that doesn't mean it isn't there. 

 

The one two punch of steroids to get rid of inflammation and antibiotics to treat a hidden infection makes perfect sense to try if the child is getting referred for a more invasive procedure.

[catz]

I'm definitely anti unnecessary antibiotic. But sometimes small infections fester. My dd had a long lasting cough and we took her in after she seemed off. It wasn't super clear she had an infection. But within 48 hours on antibiotics, it was clear something was going on that was very much helped by the antibiotics. It had been 6 weeks of coughing on and off for her at that point.

 

So in this case, I would let them try the first line. In some ways, I'd be more likely to try antibiotics if he hasn't had dxed infections over and over because it's something different. If my kid had 6 antibiotic prescriptions in the past year, no I wouldn't opt for my antibiotics (although, the steroids are different). And this was the situation with my own child. I'd follow the antibiotics with probiotics.

 

I had a toddler end up with tubes for the record. She spoke a little later than her brother, but her speech exploded after they were placed. She had tubes placed at 14 months. They last until she was 5 and she had almost no problems after tubes were placed.

[gingersmom]

The OP said he was tested by an audiologist at the ENT office.[/

[Shellydon]

The test you are describing in a tympanogram.  The ear drum didn't move as much as it should indicating that there is fluid behind the ear drum.  If the fluid is very thick, it can't always be seen with an otoscope.  It is called otitis media with effusion or 'glue ear.'  The medication is the first step, but in my experience, he will most likely need tubes. 

[Shellydon]

Was it in a soundproof booth?

 

It is necessary for a tympanogram, which was the test she described.

[KatieJ]

I would refuse antibiotics and steroids and take to a chiropractor.

 

This is what I would do today.  It's not what I did 20 some years ago when faced with the same situation.

My son starting having ear infections at about 2 yrs old.  Not many, but fluid was hanging around between them.  Evntually  we realized he was not hearing us.  Speech was slow coming along as well, but he was proving to be a slow starter when he was not motivated to learn, so we weren't overly concerned about that.  Hearing, well that was a different story.

 

Eventually we had tubes put in after going thru the above mentioned  testing. 

They spointateously came out in just a few months.  They put in the heavy duty ones that had to be surgically removed.  So he was put under 3 times in 3 years.  I hated it. 

But his speech developed normally, his hearing was fine and we moved on.

 

As a 20 something he still has the occasional ear infection and now has scarred and apparently sensitive ear drums.  He ruptured them diving off a pontoon boat about 4 years ago. Very painful.

 

So what we did by having the tubes put in was put a bandaid on the problem.  Now we know he is probably dairy senstivie and had I known and understood that back in the day, I would have changed his diet. I know know that  good chiropractic care would have taken care of the spine and he may not have those sensitivities today.

[Liz CA]

For what it's worth, 20 years ago we were in a similar position except ds talked pretty well. We opted out of tubes and the eustachian tubes angled out as his face grew. We went through a couple of rounds of antibiotics and I took him to the chiro. After 2 chiro visits, there seemed to be less ear infections - impossibe to tell if it was coincidence as ds was growing or if the adjustments helped drainage. By age 5, he had no more problems and there is no hearing loss.

[StaceyinLA]

Ok I am pretty pro-chiropractic, but I'm curious as to how it can help. I've never heard of it being used for this. We can certainly get him in. He actually went during infancy.

 

The meds are started, and I know dd is just going to feel better if she follows through with that, just in case fluid buildup has caused an infection.

 

Dairy has been stopped completely.

[KatieJ]

Stacey.  Chiropractic adjusts your spine where all your nerves run thru.  If you have a pinched nerve at the vertebrae that affects your ears/sinus, then your ears/sinus are not functioning properly.  Same for all body systems.  If you get your spine straightened out, those nerves are now functioning again, and your body can then heal those organs. 

Our family ( 5 of the grandkids included) now see a chiropractor who specializes in Torque Release chiropractic.  He specializes in pregnancy and pediatric care, but he takes of us grandparents as well.  Personally I would look for a chiro who has this type of specialty.  We have been helped by him more in 5 months than others we saw for years and many rounds of PT for my husband and his back.

HTH

[Murmer]

My son had the exact same speech issues when he was 2.5 years old...NEVER had an ear infection!  We found out he had fluid build up in his ears when he shoved a piece of styrofoam down his ear and had to have an ENT remove it.  We did not have an antibiotic offered but we did have tubes put in...the fell out in June and Aug of last year (based on Dr. appt were we asked)...by Sept we had hearing problems again and in Nov were referred back to ENT (because we kept taking him in and showed evidence of fluid over 6 weeks with no sickness).  Tubes were put back in Jan 3rd...and we are again having a speech explosion...I would make sure your daughter follows up and possibly pushes for tubes...because without ear infections regularly the parents are the only ones that can see the speech/hearing issues that result from infectionless fluid build up and it really does effect the child's ability to learn and talk.  Good luck!

[Dmmetler]

When my DD was that age, they tried Nasonex instead of tubes, because my DH has chronic ear issues (and is on his third set of "permanent" tubes) due to the fact that when he got tubes as a child, his Eustachian tubes stopped functioning. Apparently Nasonex can sometimes improve Eustachian tube functioning enough in children to get them through that hump until the tubes straighten out and function better on their own, which then avoids surgery and also avoids the speech/language issues that can come from chronic fluid buildup.

 

The downside is that it's an off-label use and therefore insurance often doesn't cover it (our pediatrician and ENT both collected "samples" for DD to keep us from having to pay to fill the regular prescription too often), while they do cover tubes.

[bethben]

Two things-- my daughter has a cleft lip/ palate which is known to cause ear problems. When she drinks milk, she fails the hearing test. When she doesn't, she passes. Take what you will from that. Also, my 2nd ds didn't really say much of anything until 2 1/2. He's just fine. I'm not sure what the reason was.

 

Beth