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What is the treatment for frequent perforation of the ear drum?

Q: My daughter is 5 years and 6 months old. Last year she had persistent common cold and cough. She completed the antibiotic course twice. She then took the OPD treatment in hospital for common cold. Her urine test was normal, small amount of pus was seen but the doctor said that there is nothing serious. Earlier this year the common cold and cough appeared again. She also complained of ear pain. After some time a remarkable amount of pus and blood came out of her right ear. The ENT doctor examined her and perforation was found, which healed itself after treatment (Distaclor dt 125mg). Her CBC report was normal. As per the doctor the fluid inside didn't dry and the treatment was stopped earlier than it ought to be. After some time the perforation was seen again in the same ear. The doctor has advised to remove the tonsil for permanent solution. Unsatisfied with the opinion, we went Mumbai and took opinion of two ENT specialists. The first doctor advised us to remove the tonsil as a permanent solution. He said, even after tonsil removal, there are 10% chances of recurrence. The second doctor advised not to opt for tonsil removal. He prescribed a medicine to dry the fluid behind the ear drum. This doctor talked about implanting a foreign body in case the fluid is not drying or accumulates again. Impedence test was carried out showed fluid in the right ear, left ear is normal. The x-Ray is also normal and there are no enlarged adenoids seen. Is the removal of tonsils advisable? Should we go for a foreign body implantation? Is frequent perforation dangerous? Does it effect the performance of hearing in future? What are the other options? Which medicines will help overcome the problem?

A:The tonsil removal is not advisable, only if there was history of recurrent sore throat up to 5 to 6 times a year, and a throat swab proved Strep Infection or associated mouth breathing, snoring and nasal discharge. Removal of adenoids in cases where the drum collects fluid behind the ear, is very essential. But if the adenoids in your case are normal in size, you can wait. The foreign body is called a grommet. It is a small hollow tube which, is put in the ear drum and it helps suck the fluid out of the ear and equalise the pressure changes around the ear drum. Yes, I think this will help your child if there is confirmed collection behind the drum. Yes, the frequent perforation effects the performance of hearing in future. No, there are no other options available, just have trust and faith in your ENT specialist, this is no serious surgery or disease to treat. Too many advises from different doctors, however may delay the right treatment. Supervised medical management is an option which you can take after consulting the ENT specialist.


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