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Suggest treatment for fluid behind ear drum - Online Doctor Chats

Date : 26-Mar-2014
User rating for this question
Very Good Posted in: Ear, Nose and Throat Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User:My son has been seen by pediatrician 2xs in 3 weeks for fluid behind eardrum .. She says blow up balloons, take sudaphed pe daily and it's very painful. He doesn't want to do anything he's miserable
User:Using hot water bottle prn aleve Tylenol
User:No relief
Doctor:I read the post. How much and how frequently are you giving tylenol to him?
Doctor:May I know his current body weight?
Doctor:Is he running fever?
User:Occasional temporal sinus pain which causes sensitivity to light & nausea. Does sinus washes bid
User:No fever. No infection upon exam. But fluid remains after 3 weeks
User:9 years old
User:Once or twice day alternating ibuprofen when severe
Doctor:OK, let me brief you.
Doctor:Yes, presence of fluid in the ear can cause severe pain. I understand the trouble he might have.
User:Usually 1 Tylenol 325 mg followed by 1 ibuprofen ( am & pm) not giving q4 hours
User:Ok I'm listening
Doctor:In such cases, I suggest my patients to take round the clock analgesics.
User:Ok Tylenol / ibuprofen or both alternating?
Doctor:If you are using tylenol in a syrup form, I would suggest you titrate his doses to 400mg which can be taken q 4th hourly.
Doctor:Ibuprofen may be added twice daily.
User:He swallows pill
Doctor:Encourage him to blow balloons.
Doctor:If he is swallowing pill then you may continue with 325mg. If you are able to find 125mg tablets, you may add to it. Both pills round the clock.
User:325 mg Tylenol (1?) ibuprofen/or do you recommend aleve or Motrin ?
Doctor:Ibuprofen in the dose of 200mg twice daily is an addition pain relieving options I suggest if round the clock tylenol isn't able to control the pain.
Doctor:In simple terms my prescription would be
Doctor:1. Tylenol round the clock in required doses (400 - 500mg) every 4th hourly.
User:How long until we should get further testing. Tympanogram irrigate fluid etc.. When should it go away
Doctor:If the pain continue to persist despite continuous tylenol
Doctor:then Ibuprofen may be added for addition benefits.
Doctor:There is no serious harm in taking both ibuprofen and tylenol.
Doctor:But make sure you keep ibuprofen doses below 200mg.
Doctor:Since its already been 3 weeks
Doctor:I would not recommend that you wait for more than couple of weeks.
User:Okay good to know. Ibuprofen 200 mg per day or per dose
Doctor:Ibuprofen 200mg per dose. You may repeat the dose after 12 hours incase he needs it.
Doctor:Chronic presence of fluid behind the ear drum will need a therapeutic procedure - a grommet insertion.
Doctor:Therefore if he continues to be in pain for more than couple of weeks from now
Doctor:you should take him to an ENT surgeon
User:What would the likely treatment be for this if persists? Hypothetical ... Steroid? Antibiotics? If so which antibibiotics cover this & if no infection why antibiotic? Preventative ? Curious.
Doctor:for evaluation and tympanometry.
Doctor:Antibiotic is essential in case he has fever and ear discharge.
User:And tympanometry measures pressure/? I'm not sure
Doctor:In most cases antiinflammatory medicines (pain killers), antihistamines and nasal decongestants are able to take care of this problem.
Doctor:Rarely when the condition becomes chronic, grommet insertion is indicated.
User:Heat isn't helping ? Do u recommend or stear away from? I've heard both
Doctor:Tympanometry is a test that measures mobility of the ear drum.
Doctor:Presence of fluid or eustachian tube block alters the movements of ear drum
Doctor:which helps the doctor assess the severity and chronicity of the problem.
User:Ok. Thank you so much!!! I have a few more questions. Just to be sure.
Doctor:Doctor will then be able to decide further treatment.
Doctor:Please proceed with the questions.
User:So heat/ no heat?
User:Hot water bottle heating pad?
Doctor:You can continue with heat therapy.
Doctor:Avoid giving him cold and refrigerated food products.
Doctor:If he is able to perform a steam inhalation
Doctor:that will be an addition treatment option.
Doctor:it is important that he blows balloon.
Doctor:if he finds it painful, give him chewing gum.
Doctor:chewing and swallowing movement has similar benefits like blowing.
Doctor:That should also help him.
User:Okay. He's also showing signs of sensitivity to loud noises especially when taken by surprise.from volume Music in car. To just talking to him up close
Doctor:I think we have less than 5 minutes left; please proceed with your question.
User:Vibration/ pressure?
User:Steam inhalation ?
Doctor:Yes, increased sensitivity to sound is well explained by presence of sound.
User:Boiling water over stove with towel over head / Vicks liquid?
Doctor:I mean inhaling vapors from hot water.
Doctor:You can add vicks liquid to the warm water. Stir the water and help him inhale the vapors.
User:Okay short on time grateful to u . Very helpful. Thank you so much. We will proceed with ent!!
Doctor:It helps to open the eustachian tube and drain the fluid out of his ear.
Doctor:Try these measures at home.
User:What about wax
Doctor:I prefer using vicks.
User:Should we try to irrigate
Doctor:Dewaxing is not going to be of much help.
User:Last question
Doctor:Yes please.
Doctor:No irrigation.
User:Okay that was it!! Have a wonderful evening and God Bless You
Doctor:Wish you the same.
Doctor:Thanks for consulting me.
Doctor:Bye for now.
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