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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for ear secretions causing the obstruction

Answered by
Dr.
Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Posted on Wed, 8 Apr 2015 in Ear, Nose and Throat Problems
Question: Hi. My son had recurrent otitis media with effusion. He had previous 5 surgery with maryngotomy and grommet insertion, the last three with T-tube. However the problem is early tube extrusion( usually after 3-4 months, even with the T tube). Also he had severe arregic sinusitis and bronchial asthma( treated by steroid spray and inhalers.
The problem with the last operation, there was a lot of wax in the canal with subsequent block of the tubes(3months after sugery) with extrusion of one tube. His hearing is markedly diminished. This is proved by audiometry and tympanometry. Glycerine drops given, with no improvemnt.
The local ENT surgeon is hesitant of the next step and what to do. Shall we remove the tubes?, do another surgery? go for mastoidectomy with tube insertion.
What about the use of hydrogen peroxide ear drops for the wax
What about removing the blocked tubes and re insert new tubes
How to care post operatively to prevent the blockage of the tubes by debris and wax.
please I need your kind advise
Regards
doctor
Answered by Dr. Shoaib Khan 2 hours later
Brief Answer:
Suggest the removal of current tubes and placement of silastic ones

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. Your query is indeed a complicated one and I would like you to know that the complication that your son is experiencing takes place in less than 10 % of children undergoing surgery with gromet and T-tube placement, so this is indeed a rare case which has to be approached with care.

In your son's specific case, the issue is with the ear secretions causing the obstruction/blockage of the tubes which is preventing the fluid from draining. In such cases, another surgery is recommend to remove the present T-tubes and place tubes with 'flanged arms'.

Advantages of these tubes with flanged arms are:

+Made of silastic
+Arms open behind the eardrum
+Rarely ever get clogged or blocked with blood or secretions from within the ears
+Can be left in place for longer durations of time (minimum 6 months)
+Normal T-tubes have a chance of being rejected by the eardrum, but these special silastic tubes are almost never rejected
+When the time comes for removal, it can be done as an outpatient procedure without anesthesia

In response to your queries in order sir:

+Hydrogen peroxide would not be sufficient to do the job here sir

+Yes, I too agree with removing the current tubes and placing tubes with flanged arms made of silastic

+The silastic tubes almost never get clogged or blocked due to the special material they are made of

I hope you find my response both helpful and informative. I also hope your son finds relief at the earliest. Please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan 9 hours later
Dear Dr.
Thank you for your valuable comment
I have some questions
1. what is the explanation or the pathology behind the failure of the previous operation? Is it the severe allergic rhinitis? obstruction of the tubes by mucos, wax/debris? obstruction by wax? or just bad luck...?
2. From my observation during visits to doctors after the last opeartions, I noticed collection of wax in the canal' Is there any advice to use any remedy to decresae wax collection, or increase the frequency of the visits to be cleaned by the doctor
3. Some doctors give an advice now to stop taking sugar, white bread, any foods or products of wheat or mixed with wheat(Makkaroni/indomee and so on), pepsi, chocolate and milk as they might incraese the allergy. Also an advice to use turmeric mixed with limon juice and honey as a simple remedy to decrease the allergy

4. We still use the nasal wash by normal salaine with steroid spary to treat the allergic rhinitis. He had a lot of sneezing and nasal mucoid secrions, specially in the morning.

5. We have done CT scan before for the sinuses, which have revealed sinuses with a thick mucosa, consistent with chronic sinusitis.
6. Because of the repeated nature of the problem, Some physcians thought of some sort of ciliary dyskinesia. Sweat chloride test was negative. There is no clinical evidence of immotile cilia syndrome. Biopsy and Electron microscpe study was not available. High resolution CT of the chest at age of 8 ys was done but failed to show evidence of cystic dilation of the bronchi at the lung bases. The only finding was chest hyperinflation with middle lobe atelectasis, which is thought to be consistent with asthmatic lung. Thereafter a mixture of bronchodilator with steroid inhaler was given.
7. An immunologist was consulted about the case. Investigations were performed, and follow up over 6 months was done. No conclusive evidence of specific immune deficiency was reached. Just a simple allegic state. Some advices given regarding avoidence of allergic materials and spicy foods.
8. The father and the mother are not smokers at all. and smoking is not allowed in the house by any means.
9. I appreciate your advice about going ahead for operations, but still I am afraid from future failure, putting in mind the previous failure and the long story over last 6 years.

Sorry for the long story
Regards

doctor
Answered by Dr. Shoaib Khan 4 hours later
Brief Answer:
I hope we can find some relief for your son soon

Detailed Answer:
Hello once again.

1. I think it is a combination of bad luck and obstruction by secretions within the ear (wax, debris, etc.)

2. Increase the frequency of visits to the doctor for cleaning. Also, some doctors allow the use of hydrogen peroxide whereas others don't for reasons unknown (some thing it hinders healing, some think the drops themselves cause the obstruction, etc.). But you should speak to your son's doctor if he/she permits the use of these drops. But with the placement of the silastic tubes, this should not be a problem

3. Yes, I agree. It may or may not be helpful, but is worth a shot. Do clear this with your doctor and take his/her permission before implying on it

4. He clearly is not benefiting much from it, but we should still continue with the nasal rinse and steroid spray. Also speak to his doctor if we can introduce systemic medications to treat the allergic rhinitis

5. Yes, this will be the normal finding in such cases

6. Treatment has to be consistent with findings, and with the current findings the treatment advised is accurate (though sadly not very effective)

7. This is good to know, as systemic conditions would be long term, and if at all it is an allergic state we should be able to reach more conclusive results by avoiding the allergens (in such cases, relocating is advised). I too was born and brought up in Oman (lived in Wadi Kabir)

8. Good to know, but dust cannot be ruled out; air filters can be used instead of air conditioners (which are mandatory in Oman due to the heat)

9. I understand, but the silastic tubes are built to prevent all such failures and I really hope you can consider it. This is the only option we have right now

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan 27 hours later
Dear Dr
Thsnk you for your valuable comments and advices
I want to ask about the use of otovent to treat eustachian tube obstruction and glu ear. Is it a worth trial? Befor surgery, or after surgery?
Regards
doctor
Answered by Dr. Shoaib Khan 19 hours later
Brief Answer:
Yes, it is harmless and if your doctor allows it you can try it out

Detailed Answer:
Hello sir.

It is worth a try, why not. but I would prefer you cross checking with your son's treating doctor.

Otovent is harmless and is quite averagely effective in draining fluid from the eustachian tube. But only if your doctor feels it is safe and will not cause you harm. Sometimes the process can interfere with the T-tube placement and so it will harm the T-tube placement and at times even obstruct the tube, so check with your doctor first. :)

I would also like to apologize for the late reply as I had a very busy day.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan 1 hour later
Thank you a lot.
Regards
doctor
Answered by Dr. Shoaib Khan 23 minutes later
Brief Answer:
Your son is in my prayers always

Detailed Answer:
You are most welcome.

Regards to Oman, my first home.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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