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Suggest treatment for ear infection

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Posted on Wed, 8 Apr 2015
Question: My son has been ill for 2 months now. It started with blocked nose and cough at night, general fatigue and dark red patches under his eyes which got worse at night. The right eye was always worse. After 2 weeks he got earache in his right ear and was diagnosed with an ear infection. His right tonsil was up too. 7 days amoxycillin and he got better. 5 days later he was unwell. Took him back to doc who said it was tonsillitis. He had pus and both tonsils up. A week later wasn't gone so doc took a swab. Swab came back as strep 4 days later by which point he seemed to be on the mend. Doc insisted on 10 days of penicillin. He got worse on penicillin and by day 10 had more pus than ever. That was 2 weeks ago. He finally seemed brighter, more energy, better appetite had stopped drooling by this Tues. But on Weds he fell asleep twice in the day, had a temp of 37.5 and a terrible headache. His voice had also gone hoarse again and he woke in the night cause it hurt so much to swallow. The next day his face was very flushed, almost bright red but todsy this has gone down as has his temp. His tonsils are still up but no pus. Do you think this is persistent strep infection or a series of unrelated infections/viruses?
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Answered by Dr. Krunal Karade (1 hour later)
Brief Answer:
In my opinion , it is a persistent strep infection remaining inside tonsils

Detailed Answer:
Hi,
Thanks for the query.

I have read your query , reviewed your medications and understand your concern.

As per your clinical history it appears that your son are most probably having chronic tonsillitis . In my opinion , it is a persistent strep infection remaining inside tonsils .

If I were your treating Doctor for this case , I would advice him
Regular antiseptic Mouth Wash twice daily like Betadine &
anti inflammatory analgesic Paracetamol .

Consider for tonsillectomy if tonsillitis affecting his daily routine life .

Hope this information helpful to you .If you have any further questions I will be happy to help.
Regards.


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Krunal Karade (15 hours later)
Hi. Thank you for your reply. Just to confirm, is it possible then to still have strep even if no pus is visible on the tonsils? Though I think I occasionally get a foul whiff, when I check his breath it smells ok. Also, would strep explain the flushed face and red under eyes? He also now seems to be waking up with small pink blotches on his neck which go once he's had paracetemol. Could these be caused by strep too? Thank you
doctor
Answered by Dr. Krunal Karade (9 hours later)
Brief Answer:
Yes , it is possible to have strep deep inside the tonsil .

Detailed Answer:
Thanks for the follow up query.

Yes , it is possible to have strep even if no pus is visible on the tonsils deep inside .

Flushed face , redness under eyes & small pink blotches on his neck is because of inflammation due to product release by strep bacteria .

That why it get relief by anti inflammatory analgesic Paracetamol.

Hope this information helpful to you .
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Krunal Karade (14 hours later)
Thanks for your response. Very helpful. In terms of your reccommended treatment, Betadine is not supposed to be given to children. My son is only just 4 and will likely swallow it. I have found Care Chlorhexidine Digluconate 0.2% w/v antiseptic mouthwash which apparently is suitable. Will this be as effective?
Also, you don't mention antibiotics. Do you feel another course or a different antibiotic is not worthwhile? I'm afraid I don't know the strain of strep he has but the doc said it was rare and that it should respond to penicillin and one other antibiotic. When it didn't respond to penicillin their opinion was it prob won't respond to another. What do you think?
doctor
Answered by Dr. Krunal Karade (5 hours later)
Brief Answer:
In small children , Chlorhexidine antiseptic mouthwash is more effective

Detailed Answer:
Hi,
Thanks for the follow up query.

In small children , Chlorhexidine antiseptic mouthwash is more effective .

In case of chronic tonsillitis , antibiotic will not reach deep inside tonsil .
Infection will flare up after 10-15 days of completing antibiotic course .

Better to use regular Chlorhexidine antiseptic mouthwash to maintain good oral hygiene than repeated course of antibiotic . Tonsil have holes inside it tissue , where food we eat get lodge & cause infection . Hence , good oral hygiene is most important in chronic tonsillitis cases .

Consider for tonsillectomy if tonsillitis affecting his daily routine life .

Hope this information helpful to you .
Regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Krunal Karade

ENT Specialist

Practicing since :2009

Answered : 1000 Questions

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Suggest treatment for ear infection

Brief Answer: In my opinion , it is a persistent strep infection remaining inside tonsils Detailed Answer: Hi, Thanks for the query. I have read your query , reviewed your medications and understand your concern. As per your clinical history it appears that your son are most probably having chronic tonsillitis . In my opinion , it is a persistent strep infection remaining inside tonsils . If I were your treating Doctor for this case , I would advice him Regular antiseptic Mouth Wash twice daily like Betadine & anti inflammatory analgesic Paracetamol . Consider for tonsillectomy if tonsillitis affecting his daily routine life . Hope this information helpful to you .If you have any further questions I will be happy to help. Regards.