To make sure ear infection is gone re-examine child


September 15, 1992|By Dr. Modena Wilson and Dr. Alain Joffe

Q: I missed the follow-up appointment to check on my baby's ear infection. Does it matter if I skip it? She took all the medicine prescribed and seems fine now.

A: It is impossible to tell whether your baby's ears are back to normal without looking deep inside to get a view of her tympanic membranes (ear drums). At the time the ear infection was diagnosed, you probably took your daughter to the doctor because she had fever and was irritable. She may have even indicated in some way that her ears hurt.

During an ear infection, the space behind the ear drum becomes full of pus as the body reacts to the presence of bacteria. The medicine prescribed by your daughter's doctor was an antibiotic designed to kill the types of bacteria that cause ear infections. Because she seems fine now (the pain and fever are gone), we suspect the medicine was at least partially successful.

However, even if the infection has been eliminated (all the bacteria have been killed), your daughter's ears may not be fine. Often fluid remains in the space behind the ear drum for a number of days, or even weeks, after the infection has been cured. When that space is filled with fluid, the ear drum cannot vibrate freely in response to sound, and hearing may be temporarily decreased.

Doctors are concerned when children have diminished hearing at the time they should be learning to talk. Short periods of compromised hearing probably cause no lasting harm. On the other hand, long periods of decreased hearing worry us. If fluid remains behind the ear drums for a long time, most doctors will try additional medicines and, if that fails and hearing tests are abnormal, may eventually recommend surgery to drain the fluid.

It is the worry about subtle hearing deficits and the possibility that low-level infection remains that prompt doctors to ask you to come back following treatment for an ear infection. The bottom line? We think your daughter's ears should be examined again. If you have a regular check-up scheduled for her in the next few weeks, you might wait until that time. If not, you should re-schedule her follow-up appointment.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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