Suggest treatment for repeated upper and lower respiratory tract infection and ear infection
To Rule out primary ciliary dyskinesia
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Greetings of the day
Being a parent myself I understand your concern and apprehensions.
As the child is having repeated upper and lower respiratory tract infection along with presence of ear infection( I assume it could be otitis media that is infection of middle ear cavity, I would consider the possibility of following
1. Primary Ciliary Dyskinesia
2. Aspiration from Gastro-oesophageal reflux
3. Allergic Rhinitis/Bronchitis.
In my opinion I would Consider Primary Ciliary dyskinesia more likely and rule it out. Primary ciliary dyskinesia (PCD) comprises those respiratory disorders having in common the malfunction of airway cilia. The abnormality results from various inherited primary structural defects in the cilia that lead to repeated and chronic lung and sinus infections. The ciliary malfunction in PCD is not a result of acquired repeated pulmonary infections, conditions in which the ciliary abnormalities revert to normal, unlike in PCD.
The clinical presentation of PCD: Individuals with PCD may have unexplained respiratory distress during the newborn period or may survive to adulthood without overt chronic sinusitis and airway disease symptoms. In one study of PCD, 100% of children had productive cough, sinusitis, and otitis. Many present as neonates with nasal congestion, rhinitis, and cough.
As the child is having repeated nasal congestion, cough and otitis I would consider it one of the important differential diagnosis for the symptoms.
II): Aspiration of gastric contents in the airway could lead to hypersensitivity of the airway and cause repeated Lower respiratory tract infection . The presentation of night cough could also suggest diagnosis of gastro-oesophageal reflux
III) Allergic: Possibility of allergic sinusitis/ cough also needs to be considered.
I would suggest you discussing these probabilities with your son's Pediatrician and rule out these as the cause.
In the meantime I would suggest the following
1. Steam inhalation: It will be a good habit to cultivate. Steam inhalation for 10-15 minutes each session twice a day. Give it regularly even if she is alright. It helps reduce nasal congestion and also clears the nose. You can buy a good quality electronic steamer
2. Monticope suspension: It has antihistaminic and mast cell stabilizer which will help reduce airway hyper reactivity and reduce the incidence of future attacks. It has to be used for 4- 6 months after which it can be stopped. 2.5 mg of Montelukast once daily
3. Wash the bed sheets pillow covers and cloth of baby in hot boiling water: It will remove the dust , mites and allergic substance present in it.
4. Decoction: To a cup of milk + 20 tulsi leaves( Holy basel)+ 1 spoon of turmeric + small piece of ginger + 4 black pepper + 2 spoon of sugar. Bring it to boil. Filter it and feed her warm daily. It will reduce airway congestion and also Tulsi will boost immunity. Depending on your geographical location holy basel may or may not be available
5. Chyawanprash : 1 teaspoon twice a day will be beneficial to build up immunity
6. Himalaya Septilin syrup 5 ml twice a day will also boost immunity. Continue giving her for 3-4 months.
7. Chest Physiotherapy
8. Head elevation while sleeping
Do get back to me for any further assistance, will be glad to assist you.
Do keep me updated
Dr Deepak Kishore
Consultant Pediatric Surgeon
Primary ciliary dyskinesia needs to be considered
That is the reason I have mentioned that Primary Ciliary dyskinesia has to be strongly considered and ruled out as the cause.especially with the history dating back to neonatal age group. As nothing seems to have helped, I would suggest you to consider this probability and discuss it with Pediatrician. Laryngomalacia/bronchomalacia could be contributing factors, but the symptoms attributable to them improve with growing age.
I would also require additional information
1. What re the X ray findings?
2. Has CT scan be done?
3. Was the child evaluated for Gastro-oesophageal reflux?
Awaiting your reply
Before this last round of 2 antibiotics , he had the cough so bad, they did 4 antibiotics and 3 rounds of prednisone which was 3 months ago. WE also live at an elevation of 8000 feet in Colorado. Planning a move to Arizona where its drier hoping to help him...and get to a lower elevation.
Will require further investigation
I come across such patients and I routinely document the severity of reflux and also demonstrate reflux into tracheobronchial tree.
He would require following workup/investigation
1. Workup for Primary ciliary dyskinesia
2. HRCT (High resolution Computerized Tomography)
3. Tube Oesphagogram and Barium swallow study to document reflux grading and reflux into tracheobronchial tree
4. Immunology study to rule out Primary immunodeficiency
5. CT scan of Para nasal sinus and Mastoid and middle ear cavity.
It would be very helpful if you could discuss this with your Physician and plan accordingly.
Do start warm saline gargling and steam inhalation. I am quite sure it will provide much relief.
Wishing you and your family a very happy and healthy life.
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