Child ear infection. Info required.

[Sceptict11]

"Unfortunately we can only do that once the infection re-appears and perferates the eardrum again. No signs, no symptoms, no point."

Sorry to disagree.

It would seem your daughter has suffered recurring bouts of otitis media. Each re-occurrence risks compromising her hearing.

It could be argued that whilst the child's ear is "quiet" opportunity should be taken to resolve any underlying problem.

I have stolen the next piece from Sheryl's post !

"Sinbin, you say your wife took her to the doctor -- did you also go? I ask because in Thai culture it is very hard for patients to question doctors. Before giving up it may be worth you going back, records in hand and insisting in seeing the senior doctor in charge of the clinic."

​I absolutely agree with that advise.

[sinbin]

Update on my daughters ear problem. History so far. Years of discharge and antibiotics from at least 6 doctors. We even took her to the teaching hospital in KK and had she had a CT scan on her head. Doctor said problem was due to cyst. Later that was over ruled by a senior doctor. Told to go home and just continue taking antibiotics.

Did that for a period of time but infection kept/keeps on reoccurring. About 8-10 months or more ago we took her then to Bangkok Hospital in Korat. Showed the CT scan, from KK, to the doctor/surgeon. He agreed that there was no cyst. He said that in a baby the last thing to develope in a new born is the ear canals. Many children are born with weak ear canals which is the reason as to why children get ear infections so easy. As time goes by the ear canal will mature and the infections should subside. As I said, that was about 8-10 months ago and things are still the same. Infection after infection every month.

Our usual ENT doctor now wants to take samples of the discharge. He's already done this before and it was found to be the normal bacteria found in an ear infection, which he treated with the strongest oral antibiotics he can prescribe. Okay the infection gets zapped but within 2 weeks it's back.

My wife has asked if he can operate to do something about the problem. He says no, due to my daughters size. She's 6. So we have a senior doctor at KK teaching hospital not wanting surgical intervention, and neither the surgeon in Korat, along with her usaual doctor/surgeon.

Sorry if I'm going on a bit now but I/we just don't know what to do. We don't see any way forward and this taking of antibiotics isn't working. She doesn't suffer pain and KK say her hearing hasn't been affected.

[Halfie]

Is there any possibility that you can take her outside of Thailand for treatment?

[Sheryl]

Before resorting to that should bting her to BKk.

There seem to be 2 issurs here: 1. The initial diagnosis of cholestreatoma which seems subsequently to have been doubted....you need s definitive expert opinion on that.

2. If there is no cholestreatoma then the reason for such frequent infections. Frequent ear infections are infeed common in children and do get outgrown, but if it is truly every single month that is excessive and suggests that the infections are not being fully eradicated.

I need a few days to get you a suggestion on whom to see in Bkk as my computer is down. In the meantime please gather all the medical records including the CT film and - very important - the results on cultures done on the discharge. And try if you can to accuratly count the number of times in the past year that this has flared up.

[sinbin]

Is there any possibility that you can take her outside of Thailand for treatment?

We considered it but we flew to Phuket for a holiday and she screamed blue murder when the plane took off, and landing, due to her having a perferated ear drum, I assume? So we won't do that again.

Regarding Sheryl's quote

but if it is truly every single month that is excessive and suggests that the infections are not being fully eradicated.

But as far as the teaching hospital in KK, Suranaree Military Hospital Korat, Bangkok Hospital Korat and numerous other specialists, they do eradicate the infection on having giving her courses of antibiotics. She's currently once again on ear drops 'Tarivid' and oral liquid 'Augmentin'. She's on that for 2 weeks and the infection will clear up as usual. All's well and good the doctor can do no more. Go home.

The infection will come back as it normally does and we will then take her to the hospital in BKK recommended by Sheryl. The first thing they'll do there is put her on antibiotics, because they have to clear up the infection first to see what's going on. They, as all the other hospitals/specialist, will find nothing on inspecting post treatment.. Nothing there, problem gone. Take her home and bring her back if it reoccures. We take her back, they have to put her on antibiotics to kill the infection before they can look in her ear. And so it goes on and on.

I don't know why, and I don't understand, why her other ear doesn't get infected but her tongue does, in the form of bad oral thrush. That's the first sign of the return of the infection. I may not find my answeres to her problem on here but it helps to write about it. Thanks to all who have replied.

Edited September 6, 2014 by sinbin

[Sheryl]

How do you know the infection fully clears up? Relapses so soon afterwards almost always mean it was not fully eradicated, and usually points to the development of drug resistance in the bacteria responsible. You really need to get the report of sensitivity tests, if they were done. The pattern you report is strongly suggestive of partial antibiotic resistance. If so, there are most definitely "stronger" antiobiotics that what she is now on.

Given that cholesteatoma seems to have now been ruled out (and there is no hearing loss, which there usually would be if a cyst was present) I think no need to see a head and neck surgeon, rather just a good ENT specializing in pediatrics. Suggest either of these:

Assoc. Prof Kitirat Ungkanont – Siriraj Hosp. To see her privately there call center 1474 http://www.siphhospital.com/en/index.html

https://www.bumrungrad.com/doctors/Weerachai-Tantinikorn#

In some cases the insertion of small tubes to help the middle ear drain is helpful. That (which can be inserted as an outpatient procedure) and a longer course of different antibiotics to completely eradicate the bacteria responsible are the two most likely approaches which sound not to have been tried.

It might be best to wait until the next occurrence to go to Bkk. Meanwhile. try to find out if the pus that was cultured had a sensitivity test done and to get copy of the reports.

good luck.

[spidermike007]

Be very careful with the antibiotics. Some classes of those can cause permanent tinnitus. That is not something I would wish on my worst enemy. Do your research.

[hotsoup]

We have had medical problems! Even if your child is not Thai....Start, again, with the Bangkok Childrens Hospital aka Queen Sirikit National Institute of Child Health, 420/8, Thanon Phaya Thai, Ratchathewi, Bangkok 10400 Thailand

Phone number

+66 (0) 1415 ext 2615

Email

[email protected]

Endless queues, but doctors trained outside Thailand and required to repay their debt to Thailand for their training.

If you have the $ I would go there and stay away from Private Hospitals and Provincial ones....we still had to go

back to the UK.!! Thai private hospital nearly killed our daughter!

Edited September 6, 2014 by hotsoup

[sinbin]

I have the report of her ear sample and it is identified as 'Pseudomonas Aeruginosa'. She's just finished her 2 week course of antibiotics and now he's put her on another 2 weeks of 'Cefdinir'. After this it's definately a trip to BKK . Thanks to all posters.

If you have the $ I would go there and stay away from Private Hospitals and Provincial ones....we still had to go
back to the UK.!! Thai private hospital nearly killed our daughter!

I didn't think they'd be anywhere better than a teaching hospital such as the one we went to in KK.

[hotsoup]

For heaven's sake!! Where are you from? If from the UK take her back to Great Ormond Street. Alder Hay or wherever. if from France go to Lyon. if the US Boston. It is money sure, not rocket science. Sheryl says Srinakarindra is 'best' . If anyone thinks surgery is a solution..find the hospital EXIT now. PM me ?? If you are in real difficulty I will give you the name of a GP in London who will talk to you on skype/phone. Teaching hospitals? This your daughter. I spent 10 years discovering that private hospitals in Thailand are useless..and a few more finding the only one that was remotely competent. The post about your wife not being able to 'face down' a doctor' is critical, too. You have to do it.

[Sheryl]

I have the report of her ear sample and it is identified as 'Pseudomonas Aeruginosa'. She's just finished her 2 week course of antibiotics and now he's put her on another 2 weeks of 'Cefdinir'. After this it's definately a trip to BKK . Thanks to all posters...

The issue is, what did the sensitivity report show? there should be a listing of different antibiotics showing the degree of response to them. I am starting to suspect this was not done, which may be the problem. With this history she has almost certainly developed some degree of drug resistance....

[Mike45]

I'm familiar with the practice of putting tubes in the ear canal. Its minimally invasive and fairly common to have it done on a child that has many ear infections around Boston.