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Ear Nose and Throat (ENT) Surgeon
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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Allergy Specialist & Immunologist
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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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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