Q: My 3.3 years old son gets ear infections often due to adenoids. The doctor asked us to wait for a year more before deciding on any operation, since the adenoid shrinks with age. Is it advisable to wait or can we go ahead with the operation since he still gets ear infections? Because of the recurrent ear infections, we have to give him antibiotics (at least 4 times in the last 2 months). Is it advisable to give so many antibiotics?

A:You might already know what are the tonsils. They could be easily seen, when you ask your child to open his mouth. They are almond like tissues, situated at the entrance of the throat, one on either side. The adenoids are tissues similar to the tonsils. They are situated in the highest part of the throat right behind the nasal cavities. These two structures enlarge during every episode of cold or sore throat. They become normal when the cold resolves. There is a tube called the Eustachian tube, which connects the middle ear with the nose and the throat. Whenever there is a cold, the infection from the nose and the throat reaches the ear easily. This may cause some mucus to collect inside the middle ear. Such an event reduces the free mobility of the eardrum and results in a hearing impairment. Usually, such fluid collections usually resolve in a few weeks completely. Occasionally, the infection worsens further and the pus goes on accumulating. At one stage, the pus may, by itself, create a hole in the eardrum and escape. This is the cause of ear discharge,. Once such a hole is formed, the chances are that it will heal completely. Sometimes, this does not happen. Whenever there is another cold episode, obviously the mucus discharge will again reach the middle ear through the Eustachian tube and this time, it will drain through the ear. Repeated infections of the nose and the throat may lead to almost continuous dear discharge. This causes much distress. Also, the child may not hear well. Hence, it is prudent to prevent such a situation, by removing the source of infection, namely the adenoids or tonsils or both. There is no age limit for this surgery. As with every other surgery, the guiding principle will be to do it when necessary. The adenoids and the tonsils are known to enlarge at two periods - once around the 3-4 years of age and again by around 6-7 years of age. Hence, some doctors might advise to refrain from surgery during these periods. But such waiting is justified only when the tonsils and adenoids show only enlargement. But, once the ear discharge has occurred, such waiting does not serve any purpose; it will only delay the definitive treatment and prolong the misery. I will advise you to ask your own doctor about the necessity for the operation and the details of the surgical procedure. He will also explain to you about the risks of surgery. Certain laboratory tests are available to reasonably assess the risks of anaesthesia and the risks of this particular surgery. Take a decision after a discussion with your ENT doctor and with your paediatrician.