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  • Q&A with Australian Health Practitioners

    Should I get grommets for my child or grommets and adenoidectomy?

    Related Topics
    Ear, Nose & Throat Disorders Hearing Loss & Deafness Parenting
    My 14 month old has had 6-7 ear infections in last 6 months.

    After 4 different antibiotics, he has been on bacterium for 10 weeks (every time it's stopped ear infection within a week). Failed hearing tests and has intermittent balance issues.

    He has a constant runny nose (often clear) and excessive saliva since birth.

    History of reflux and allergies

    Rarely has fever or systemic response with ear infection, but screaming +++ and many all nighters.

    Should I go with conservative management and start with grommets or is he a candidate for grommets and adenoidectomy first up?

    Have seen a great ENT who asked me what I want to do.
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  • 3

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    Dr David McIntosh

    Ear Nose and Throat (ENT) Surgeon

    David McIntosh is an Australian trained ENT surgeon with international experience. His areas of interest are paediatrics, nose and sinus disease, and providing access to … View Profile

    Just like I know nothing about cars and rely on someone who knows about them to make sure my car works safely, so too should you feel confident in the guidance provided by a specialist in paediatric ENT. take on board the advice you have been given, and feel free to look over the information at our website www.entspecialists.com.au

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    Dr Alexander Lozynsky

    Allergy Specialist & Immunologist

    Consultant allergist and immunologist, with particular interest in allergic rhinitis and sinusitis, allergic respiratory disorders, food allergies and sensitivity and allergic skin conditions, including atopic … View Profile

    You mention that your child has allergies and reflux which are commonly asociated with recurrent ear problems, particularly middle ear effusion (“glue ears”). Large adenoids can cause obstructiion and dysfunction of the Eustachian tubes, resulting in increased negative pressure and retention of mucus in the middle ear, with impaired hearing and speech development if not treated early. Antibiotics, such as Bactrim, which you refer to as “bacterium”, are useful if there is secondary bacterial infection, but in many cases the thick mucus consists of various types of cells and normal (commensal) bacteria present in the nasal and respiratory passages.
    Nasal irrigation with saline, such as FESS ("Little Noses") and treatment of any associated allergic rhinitis with an oral antihistamine can be beneficial. In places like Sydney, children can be sensitized to house dust mite and exhibit allergic nasal and eye symptoms from as young as 12 months of age. There is also a close association with asthma and atopic dermatitis (eczema). If there are large adenoids then these may need to be removed in order to improve Eustachian tube function. However, it is best not to remove tonsils unless there are repeated episodes of documented bacterial tonsillitis or they cause difficulty with swallowing or sleep apnea. 
     Discuss with your GP appropriate referral for assessment and treatment of these condtions.

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    A/Prof Faruque Riffat

    Ear Nose and Throat (ENT) Surgeon

    The history of recurrent otitis media with poor response to antibiotics in the frequency you describe would certainly meet the criteria for recommendation of insertion of ventilation tubes (grommets). The others would be persistent fluid (effusion) in the middle ear, any significant complication of otitis media (mastoiditis, recurrent discharge) or structural abnormalities of the ear drum.

    Adenoidectomy does improve eustachian tube function, but also reduces the bacterial biofilm (slime) that resides in the nasopharynx (chamber at the back of nose where the eusthachian tube opens) to reduce the rates of glue ear, recurrent otitis media and recurrence after grommets extrude.

    There is no evidence for tonsillectomy in reducing otitis media.

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