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Title: Steriods May Help To Remove Middle Ear Fluid In Children

Category: Child Care


In a recent study published in the Pediatric Infectious Disease Journal, Drs. Berman and Grose did a study in Denver on 53 patients treated with either trimetheprim sulfa for 30 days or trimetheprim sulfa for 30 days plus seven days of prednisone. They followed the children for six weeks and found that the children receiving prednisone cleared up their middle ear effusion (the fluid in their middle ears) much better than those who did not receive the prednisone. From the conclusions of their study they recommend at least a trial of one week of prednisone in any child who maintains fluid in their ears longer than six to eight weeks.

Middle ear tubes (polyethylene tubes) placed in the middle ears of small children is the most common operation done in the United States today. Many of the children who receive tubes could possibly avoid the necessity of the tubes if a trial of prednisone were tried. This is a conclusion of the study mentioned as well as several other studies over the past ten years. Another possible means of heading off tubes is to keep a child on a night time dose of antibiotic, usually amoxicillin or gantrisin, for an extended period of time, ranging from one to six months. The risks of this are primarily an allergic reaction to antibiotic which is low. By prophylaxing the middle ear with antibiotics in this way, the risks of recurrent infections are decreased significantly and frequently the fluid will resolve over the months in which the child is watched.

For any child who continues to have documented thick fluid in the middle ears for an extended period of time (usually over three months) despite aggressive trials of either antibiotic and/or prednisone, then tube placement is indicated and a consultation with an Ear, Nose and Throat doctor is warranted. A speech and hearing therapist can also help in this regard by testing a child's hearing in a sound proof room to see if their hearing is adequate for class-room instruction or for hearing well enough to develop language normally. If it is found that the child's hearing is severely impaired and this process con-tinues for several months, it is wise to discuss this with your pediatrician and your Ear, Nose and Throat doctor and consider tubes as a means of reversing the problem.

One misconception that many parents have is that their child will have permanent hearing loss if they have fluid in the ears. Fortunately fluid in the ears is 100% reversible either through medical treatment or through placement of tubes, and so the hearing should return completely to normal. The one thing that may cause hearing loss over time is repeated, bad infections which scar the ear drums. This is another good reason for prophylaxing children with low dose antibiotics who are prone to recurrent infections.

In summary there are well established treatments available to children who are prone to recurrent ear infections and who are maintaining fluid in their middle ears and it is wise todiscuss these options with your pediatrician and/or ENT specialist.