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FORUMS > Ask Dr. Ledereich
Replying to Topic: Ear infections in patient with trache
Created On 1/24/05 2:05 PM by ag


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ag
Junior Supporter

Posts: 17
Joined: Jan 2005

1/24/05 2:05 PM
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My son is ventilator-dependent and has a trache. He frequently has pussy discharge from his ears which his doctor doesn't usually treat because putting him on antibiotic is not something we like to do (he's had many bouts of pneumonia). He doesn't usually get fever with it but sometimes seems to be in pain when I touch his ear. (He's unconscious so we can't ask him if it hurts.) Is there anything we can do to prevent these ear infections?
 
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P. S. Ledereich, MD
Doctor

Posts: 43
Joined: Jan 2005

1/25/05 12:48 AM
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This is a tough problem, and my prayers go out to you.
Some thoughts (obviously, I do not know who your
son is, and how old he is, and what his medical condition(s)
is underlying why R"L he is unconcious and trach dependant.
Please use my suggestions as a way to start a dialogue with
his own physicians who know his case well).

1) Does he have tympanic membrane perforations when there is no leak?
then consider observing "water precautions" to avoid water from getting into an ear.
Bacteria grow in conditions where it is dark and warm (such as an ear), and all you need
to do is to add water and the bacteria can grow. Simply avoiding moisture in the ear canal
will help prevent this.

2) Consider placing "ear tubes" if there is repeated acute infections, with the
ear drums rupturing.

3) Consider adenoidectomy, as the adenoids act as a source of the bacteria to
seed up the eustacian tube into the ear.

4) There is very little you can do physiologically about these problems - if he is not
swallowing, then his eustacian tube is not equallizing the pressure in the middle ear
correctly.

5) You can get antibiotic ear drops, when he has an acute event (eg ciprodex, cipro otic)
to fight the infections locally. I often do this for patients who are not trach dependant, and otherwise
healthy.

6) Consider finding out if he is producing excessive nasal mucous. This can block the eustacian
tube and cause an otitis media/ear infection. If he is, consider treatment of the mucous and
help the eustacian tube function.

Again, my prayers are with you and your son for a refuah sheleima bkarov.
Please let me know what you find out.


-------------------------
P. S. Ledereich, MD
Family Ear Nose and Throat Care
1033 Clifton Avenue, Suite 204
Clifton, NJ 07013
Telephone: 973 470 8266
144 Route 59
Suffern, NY 10901
Telephone: 845 357 8302
 
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ag
Junior Supporter

Posts: 17
Joined: Jan 2005

1/25/05 2:42 PM
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Thank you for your response. My son is almost 5. He was born healthy but at age 2 months had a cardiac arrest due to viral meningitis and has been unconscious, ventilator dependent and tube fed since then. I spoke to our doctor and he said all his ventilator dependent patients suffer from recurrent ear infections and he wouldn't opt for tubes or adenoidectomy because putting him through sedation is risky and the surgery wouldn't be justified. He definitely has a lot of mucous and secretions from his trach (not more than other trach patients but he still needs to be suctioned every few hours). He has no swallow and needs his mouth suctioned constantly. The doctor said that as long as the ear infections aren't causing a fever, we should look at it like a runny nose and nothing more serious than that. The only thing he recommends is painkiller when he seems to be suffering. Keeping water out of the ears is something I will try; I'm usually so occupied with keeping water out of his cannula that I don't pay much attention to his ears. There's not much else I can do without his doctor's consent so I guess we'll have to leave it at that. Thanks again.
 
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P. S. Ledereich, MD
Doctor

Posts: 43
Joined: Jan 2005

1/29/05 10:47 PM
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See my comments below:
>Thank you for your response. My son is almost 5. He was born healthy but at age 2 months
>had a cardiac arrest due to viral meningitis and has been unconscious, ventilator dependent
>and tube fed since then. I spoke to our doctor and he said all his ventilator dependent patients
>suffer from recurrent ear infections and he wouldn't opt for tubes or adenoidectomy because
>putting him through sedation is risky and the surgery wouldn't be justified.

Why would "surgery" not be justified?
The fluid in his ears may be more than "a runny nose", because the fluid can be
blocking his hearing. You do have quite an unfortunate situation with him. Yes, you say
he is "unconscious", but do you know how much he hears? It is quite possible that he
does hear what is said to him. Fluid causing a conductive hearing loss would decrease that
small amount of stimulation that he would otherwise have. It is possible that he could use
tubes to help him hear better.
Sedation is risky in every patient. Your son, having a trach, would have a lower risk with
the sedation, as one of the main problems with sedation is respiratory compromise. The fact that
he has a tracheostomy would actually decrease his chance of that problem. He already gets "pain killers",
so a little sedation to help improve his hearing may be worthwhile. But, :

>He definitely has a
>lot of mucous and secretions from his trach (not more than other trach patients but he still needs
>to be suctioned every few hours). He has no swallow and needs his mouth suctioned constantly.
>The doctor said that as long as the ear infections aren't causing a fever, we should look at it like
>a runny nose and nothing more serious than that. The only thing he recommends is painkiller
>when he seems to be suffering. Keeping water out of the ears is something I will try; I'm usually
>so occupied with keeping water out of his cannula that I don't pay much attention to his ears.
>There's not much else I can do without his doctor's consent so I guess we'll have to leave it
>at that. Thanks again.

That is true. You must always follow your doctors consent. But you can always ask questions.

I wish you alot of help from Hashem.


-------------------------
P. S. Ledereich, MD
Family Ear Nose and Throat Care
1033 Clifton Avenue, Suite 204
Clifton, NJ 07013
Telephone: 973 470 8266
144 Route 59
Suffern, NY 10901
Telephone: 845 357 8302
 
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ag
Junior Supporter

Posts: 17
Joined: Jan 2005

2/6/05 12:56 PM
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Thanks again for responding. Due to the severity of my son's brain damage, doctors tend to be mezalzel when it comes to issues like stimulation. In other words, they feel that in his situation, nothing is going to help him improve anyway. In addition, he had a hearing test at age 2 months which indicated that he doesn't hear at all in his left ear and that his right ear is only slightly better. This was way before he started having ear infections. We still continue to play music for him and speak to him but we don't see any response to sound. We try to focus more on visual stimulation since he sees quite well and even tracks a little.

Our doctor agreed that having a trach would make sedation less risky for him but that he's still at risk for pneumonia afterwards or neurological problems due to his delicate condition. He's been sedated several times in the past with no complications, Boruch Hashem, but we were always warned beforehand that for him it's more risky.

We've learned to make the best of our situation and once in a while Hashem gives us a reminder that we should be grateful when things are status quo even though we wish they would be better. This past Shabbos, right before kiddush, my son's saturation began to drop. I bagged him but felt air escaping and even though I was using 15 liters of oxygen, his saturation continued dropping rapidly until it reached 43 and he was very blue. We had to call a nurse on Shabbos and, to make a long story short, after several minutes he stabilized. Apparently the cannula had moved slightly out of place so that neither the vent nor the bag could get any air into him. It was very frightening and the relief afterwards was overwhelming. Boruch Hashem, though he took quite a while to calm down afterwards (he was gasping terribly and had to be kept on oxygen until Shabbos morning), he's back to his good old self now and we're happy it ended well.
 
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