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Suggest treatment for fluid in middle ear

Answered by
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 7367 Questions

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Posted on Wed, 13 Aug 2014 in Ear, Nose and Throat Problems
Question: My twin daughters are aged 3 now. In the month of march we had gone to visit the doctor for flu shots ( first time to be given) and the doctor said that she had ear infection so she won't be able to give the flu shots. She prescribed antibiotics (giving antibiotics for the first time ever) and they had it for 10 days. Afterwards the shots were given and the fluid had reduced slightly but not completely. The doctor told us to meet the HOD of ENT at Manipal hospital XXXXXXX and get an impedance test done. We got the tests and it showed that there is fluid in the middle ear behind the ear drums. Is called the Otitis Media - http://en.m.wikipedia.org/wiki/Otitis_media. .
Though they never had any symptoms what so ever like ear pain or fever the fluid just refused to go.
We followed up every month with tests and anything that could cause cold like cold water or ice creams and so on where avoided. The entire summer they were given steam 3 times a day everyday.
So finally 10 days back afternoon twin 2 complained of ear pain. We were scheduled to have an appointment with the doctor for their check up next week but we went on 15th July evening and the doctor said that they fluid has increased ( she had viral fever with cold and cough 3 weeks back) and the fluid is creating pressure on the ear drum.the doctor has again given antibiotics augmentin dds along with montek lc kid for a week.
Now since I have started Montek LC kid for the twin 1 , she has been coughing constantly... Even while sleeping she keeps coughing. What should I do now... I am really fed up with all this. I really what to know what is going on and is there any solution for this fluid in the ear apart from surgery and this constant cough because of Montek LC kid and the cold that is non stop .
doctor
Answered by Dr. Sumanth Amperayani 24 minutes later
Brief Answer:
Looks like allergy related cough unrelated to ear

Detailed Answer:
Hi...thanks for consulting on health care magic. I understand your concern. I am very happy to hear that they have not received any antibiotics till now.

I have a few questions for you -
1. Is there a family history of XXXXXXX sort of allergy or asthma?
2. Are both kids coughing?
3. Does the cough get aggravated by seasonal changes?
4. Does it always start with fever?

Suggestions -
1. Cough is not because of MontekLC
2. The present cough looks unrelated to mmiddle ear fluid.
3. This cough I think could be an episodic viral wheeze or a multi triggered wheeze. Please don't think that am putting forth another possibility to add yo your agony....but this way, both seem to treatable/ controllable issues rather than putting them together & getting things complicated.
4. As the middle ear fluid problem is going on since 5 months now, I suggest you go by the ENT surgeon's opinion.
5 if I were your treating pediatrician I wouldn't club both problems & treat the current cough with a wheezing medication & leave the ear fluid to my ENT colleague for the good.

Hope you find my answer helpful. I suggest you get back with answers to my questions.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sumanth Amperayani 1 hour later
Thank you for reply doctor. Answering to your questions.

1. I have dust allergy and my mother in law has asthma, correct me if I am wrong. Isn't cough a side effect of montek lc kid.

2. Only twin 1 has cough since we have started them on montek lc kid.

3. This has never happened to them before. They started schooling last yr October. Every since they started they have been falling sick. I agree that it's all about immunity but I am sure there must be something apart from surgery prescribed by ENT.

4. No it doesn't start with fever .

Wheezing ? But she is just coughing , like a dry cough. There is not whistle kinda noise while coughing or anything of that sort ? Plus wheezing has so many categories. Not saying that u might be wrong but maybe I didn't explain the condition properly.

Also isn't augmentin dds an antibiotic ? That has been given to twin 2 twice for ear infection.

What causes ear infection so often ?
doctor
Answered by Dr. Sumanth Amperayani 11 hours later
Brief Answer:
suggestoins

Detailed Answer:
Thanks for your trust in me.

Coming to your queries -

1. Coughing can be a manifestation of wheezing at this age. There is even a variant called cough variant asthma.
2. Augmentin DDS is an antibiotic
3. The kids' problem doesn't seem to be recurrent to me - it is persistent.
4. With a family history of asthma and starting with fever - this cough could as well be a multi triggered wheeze
5. Usually no cause can be attributed if the recurrent ear symptoms in well growing children
6.. I will be the 1st person to accept if I am wrong and am willing to stand corrected. This always do because it is not about me being right or wrong, its about somebody's health and life as far as my profession is concerned. I accept your suggestion in the right sense.


Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Sumanth Amperayani 44 minutes later
Doctor please read my questions and replies properly.
First I mentioned that they were given augmentin dds and u reply that u are very happy they have not been given antibiotics which made me ask u if augmentin is not an antibiotic.
Secondly u asked if it starts with fever , I said no and u reply that it starts with fever I have mentioned so.

Did I mention anywhere at all that this is persistent???

Kindly go through the details and reply. Or any other doctor who could give me a reply which makes more sense
doctor
Answered by Dr. Sumanth Amperayani 35 minutes later
Brief Answer:
Clarifications below....

Detailed Answer:
Dear XXXXXXX

I am sorry if my previous answers were not clear. Let me clarify.

1. MontekLC kid is a drug combination used for allergic cough and it will not cause cough.

2. I follow a policy of antibiotic stewardship which promotes the use of antibiotics, only when required and not when not required. Therefore I was very happy your children did not use antibiotics until 3 years. I understand the were given antibiotics only for the first time now and they had it for 10 days. I appreciate the fact that your children were not ill treated with antibiotics unlike many who misuse it. The fact that antibiotics was not used for 3 years despite all illness until now was appreciated.

3. Please accept my apologies in the answer number 4 of mine - that I mentioned with fever. It was a typing error. I stand corrected. Please read here under -
'With a family history of asthma and starting without fever - this cough could as well be a multi triggered wheeze'.

4. I understand you never mentioned the word persistent. I agree with you. It was a suggestion from me that it (the ear problem) this could be a persistent problem with normalcy in-between and not a recurring one. You can discuss about this opinion with your treating doctor.

If you are clear now, we can continue to discuss further. Else, I would be happy to let go off your case. You can write to the customer support team to transfer your question to another expert. But I do hope I made sense now.

If you are not happy with the interaction you had with me, I suggest you can ask for a refund and at the same time with the same question and pay you can consult any other doctor who could give you a reply which makes more sense.

I am sorry if I have not understood your query properly.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Prasad
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