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Hello, ENT question - My son has been having recurrent

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Posted on Wed, 13 Feb 2019
Question: Hello, ENT question - My son has been having recurrent swollen tonsils, ear pain, vertigo, ear infection, scalp infection x 4 years (was on abx for a year and discovered dietary changes of avoiding sugar and dairy kept the pustules at bay - now just irritated at times), he had impetigo recently and has had fatigue off and on for a couple of years. He had mono at age 21. He had his wisdom teeth out at age 19 and had recurrent infections of one area with repeated surgical procedures to remove bone fragments/infection. He eventually at age 22 had a surgeon fix the surgical area to prevent recurrent infections. I am wondering if the wisdom tooth situation could be the cause of his recurrent infections. He also has a lowered immune system and gets sick easily/ doesn’t recover fast like the rest of the family.
doctor
Answered by Dr. Kaushal Bhavsar (37 minutes later)
Brief Answer:
Yes, malposition of tooth can cause localized infection.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
Tooth extraction as well as malposition can lead to recurrent local site infections.
Lower immunity can be due to variety of causes.
1. Malabsoption of food from intestine
2. Bone marrow hypo functioning
3. Renal hyperexcretion of nutrients.
So please let me know
1. Have you checked for Malabsoption Syndromes?
2. Has he ever undergone bone marrow biopsy?
3. What is his urine report? Is he excreting proteins in urine?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Kaushal Bhavsar (9 hours later)
His urine has been checked for glucose and was normal. He hasn’t had any of the other testing you are referring to. His doctor said his labs look ok and there is no indication of anything serious. However, she may refer him to an immunologist pending some additional labs she just ordered. My son does have a lot of issues with intolerances to Foods and says there is undigested food in his stool sometimes. I just want to know why his immune system is not good so we can treat the underlying cause.
doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
I have already mentioned the causes for low immunity.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Low immunity can be due to variety of causes that I have mentioned in my first reply. I see there is a plan to visit an immunologist. If I were his treating doctor, I will surely suggest bone marrow biopsy, urine protein examination and lower GI scopy.

Let me know what the immunologist has to say.

I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar (1 hour later)
Thank you so very much
doctor
Answered by Dr. Kaushal Bhavsar (15 minutes later)
Brief Answer:
I am glad that my advice is helping you.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I am glad that my advice is helping you.
It's always encouraging for doctors to hear positive feedback from patients.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar (10 hours later)
We got these lab results and his doctor said she wasn’t concerned about a malignancy. She sent him for an X-ray and some additional immune tests. What do you think of these labs that I uploaded? Do you still have the same recommendations? Thank you again
doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
All reports are normal.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
I have gone through the reports you have attached.
All blood reports are normal.
Protein levels are normal, so no need to worry for Malabsoption or renal hyperexcretion.
What about bone marrow biopsy?
I know it is not indicated as his CBC is normal.
And what about vaccination?
Is he properly following vaccine schedule?
I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Kaushal Bhavsar (22 hours later)
Hello again, He is up to date on all vaccinations. He hasn’t had a bone marrow biopsy. We did get the attached results back today, so his doctor has referred him to an immunologist and also to an ENT because he keeps getting tonsil inflammation and ear pain. We see another doctor who is an MD but more holistic and she thinks he may have Lyme disease. We are waiting for a couple more tests. His primary doctor said he doesn’t have Lyme because his western blot was negative and those are 99% accurate. The holistic doctor said tney are often negative because the bugs create a biofilm around themselves and they often cannot be detected after the initial infection. We aren’t sure what to think. We will see the ENT and immunologist and see if they can find a primary cause.
doctor
Answered by Dr. Kaushal Bhavsar (4 minutes later)
Brief Answer:
You should definitely meet immunologist.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
I also do not think it is lymes disease.
In my opinion, you should definitely meet immunologist and discuss all these.
Also discuss about need for bone marrow biopsy.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wishing good health to your son . Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Kaushal Bhavsar

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Hello, ENT question - My son has been having recurrent

Brief Answer: Yes, malposition of tooth can cause localized infection. Detailed Answer: Thanks for your question on Ask a doctor forum. I can understand your concern. Tooth extraction as well as malposition can lead to recurrent local site infections. Lower immunity can be due to variety of causes. 1. Malabsoption of food from intestine 2. Bone marrow hypo functioning 3. Renal hyperexcretion of nutrients. So please let me know 1. Have you checked for Malabsoption Syndromes? 2. Has he ever undergone bone marrow biopsy? 3. What is his urine report? Is he excreting proteins in urine? Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your son. Thanks.