Thursday, December 29, 2005

Swelling behind the ears

Let's take this one apart bit by bit.

Q: My 12 year old child at board school came back with swelling at the back of both ears.

Two things come to mind: lymphadenitis (swollen lymph nodes) and mastoiditis (infection of the bone behind the ears). Lymphadenitis is the more common of the two, and by far the less serious possibility, but both require a visit to the doctor.

While at school we got report that he was in and out of hospital on about three occasions.

Why was he in and out of the hospital? This is important information.

As he came back by weekend, my wife gave him Augmentin. Two days later we took him to a Doctor who said the swelling was "normal". He examined the ear and said it was dirty and needed flushing. This flushing was done and no other medication was prescribed.

Ear, nose, and throat doctors are not big fans of flushing. Flushing can cause more problems than it solves. It can aggravate an existing infection, cause a different kind of infection (the notorious swimmer's ear), or, if done too forcefully, cause trauma to the ear drum.

I'm also wondering about the "swelling was normal" comment. Did he disagree, and think there wasn't any swelling? If he agreed there was swelling, well . . . this is never normal.

As for your wife giving your son Augmentin, if she did not have a full therapeutic course to give, this is a mistake. Even if she did have a full therapeutic course to give, it's risky to do this without a doctor's advice (for example, how does she know she's giving the correct dosage, or if this is even a proper antibiotic to use?) I encourage you to ask the doctor about this, in the future.

Last night, the child ran high temperature throughout and was complaining of some pains in the right ear which has a bigger swelling.

This reinforces what I said earlier: swelling is never "normal." The two conditions mentioned earlier (lymphadenitis, mastoiditis) are still the most likely possibilities.

We are very worried as we believe that this is not normal. We intend to see another Doctor using the information you may provide to us for discussion.

The doctor needs to determine if this is lymphadenitis or mastoiditis. Physical examination (including a good examination of the ear drums) may give the answer, but X-rays may be necessary. The distinction is important. Acute mastoiditis is a severe infection which may spread to the brain, leading to significant disability, even death. While lymphadenitis will usually respond to oral antibiotics, acute mastoiditis may require surgical intervention.

D.

2 Comments:

At 12:15 PM, Blogger Gabriele C. said...

Ick, don't get me started on mastoiditis. My father had it as child and ended up with severe hearing problems. The doctor who saw him first deserved to be knocked over he head with something heavy, like an iron bar. Repeatedly. He said children complained about pain in the ears all the time because they didn't clean them often enough. Gah.

 
At 12:13 PM, Blogger Douglas Hoffman said...

What a damned shame. I'd like to say this is uncommon, but we see that sort of negligence here, too.

 

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