Blinded by Science? The Odds Narrow

Michael Alexander is suffering from his fourth ear infection in as many months. Mike and I have become pros at diagnosing these, and I knew the pediatrician would prescribe yet another round of tummy-torturing antibiotics this morning. Our normally happy son was inconsolable last night and cried nonstop from midnight until shortly after 4 a.m. His temperature spiked above 104 yesterday, the first sign that the evil infection had returned with a vengeance.

About one in five children with a cold or other respiratory viral infection develops a middle ear infection (acute otitis media) that may range from mild to severe, according to a study published in the February issue of The Pediatric Infectious Disease Journal. Michael Alexander was hit with the first one following a viral infection. When he returned to her office a month later with another ear infection, his pediatrician warned that this could likely become a chronic problem.

According to the study by Dr. Stella U. Kalu and her University of Texas Medical Branch at Galveston colleagues, just 7 percent of the 294 children children ages 6 months to 3 years had inflammation of the eardrum without fluid in the middle ear. In Michael Alexander's case, that fluid is causing hearing loss in both ears. Neither of his eardrums is vibrating at all due to the amount of fluid, said the otolaryngologist, or ear, nose, and throat (ENT) doctor, he saw last week. Among the children studied by Kalu's team, eardrum inflammation was rated mild in 8 percent, moderate in 59 percent and severe in 35 percent. Michael Alexander's infection has been severe in both ears all four times. And now he's got a sinus infection.

The Galveston study said that children with the infection were treated without antibiotics whenever possible. Michael Alexander's case has been so severe, that he's been treated with antibiotics every time. During his last bout we learned he's allergic to Cefdinir, an antibiotic used to treat ear infections, when he broke out in hives on a Sunday afternoon. Now Michael Alexander is a candidate for a tympanostomy, a surgical procedure which involves the insertion of tubes to allow fluid to drain from the middle ear. Mike, who suffered from chronic ear infections as a child, had "the tubes." (Mike also had his adenoids removed, and jokes that's how I could tell him apart from an alien replicant. I explain in the next paragraph why this is no longer a course of action.) A tympanostomy requires a general anesthetic and children typically recover completely within a few hours. The surgeon makes a small incision in the eardrum -- a myringotomy or removal of fluid -- and then inserts a tube to allow continuous drainage of the fluid from the middle ear.

A tympanostomy isn't recommended until a child suffers from four ear infections in six months, but the ongoing treatment with antibiotics in the meantime may not be the best route. I haven't resisted the antibiotics for Michael Alexander because I know it works quickly (save for the allergy) and eases his excruciating pain. A paper in the April Journal of Clinical Microbiology found that in most children with chronic otitis media, biofilms laden with Haemophilus influenzae cling to the adenoids, while among a similar population suffering from obstructive sleep apnea, that pathogen is usually absent. Biofilms are resistant to antibiotics. Earlier clinical studies had suggested that adenoids might be reservoirs for middle ear pathogens, and a 1987 study had suggested that adenoidectomy was effective in treating children prone to middle ear infections. But in 2006, Luanne Hall-Stoodley of the Wellcome Trust Clinical Research Facility in Southhampton, England, found that in children undergoing installation of tympanostomy tubes for treatment of chronic otitis media, the culprit bacteria inhabited biofilms attached to the middle ear mucosa, along with other bacteria that cause ear infections. "We therefore wondered if these pathogens might also form biofilms on the adenoid surface," said Hall-Stoodley.

I'll spare you the nitty gritty science behind the Southhampton team's study, but it's important to note that new treatments are likely to be more effective. "I think that scientists have begun to think about chronic otitis media in a new way, and investigation of the pathogenesis of this complex disease will help in the design of novel therapies that do not depend on antibiotic treatment alone," said Hall-Stoodley. "Chronic middle ear infection can cause hearing impairment, which can affect verbal ability and education in children."

In March, the Centers for Disease Control announced that ear infection diagnoses had plunged by nearly 30 percent over the past 15 years. I wish my son wasn't bucking that trend. As the odds narrow, Mike and I are likely to consent to a tympanostomy when Michael Alexander returns to the ENT in three weeks. For now, I just hope this last dose of antibiotics dulls his pain. I can't bear his cries and my inability to console him. My ears are hurting, too, along with my throat. But it's the pain in my heart that's worse. I'm trying to be well-informed without reading too many articles on the risks and arguments against a tympanostomy. Odds are I'll be blinded by science.

"A science is any discipline in which the fool of this generation can go beyond the point reached by the genius of the last generation." _ Max Gluckman, South African-born British social anthropologist

Terrible, Horrible, No Good, Very Bad Day

I didn't wake up with gum in my hair, but it turned out to be a Terrible, Horrible, No Good, Very Bad Day for (Michael) Alexander('s Mom).

Michael Alexander has been battling a cold for a couple days. Mike and I also have been stricken with a stomach flu of some sort, but I will spare you the details. Suffice it to say, it's been a tough few days, the last two with practically no sleep. Our normally happy son couldn't be consoled the last two nights, crying from pain that was clearly beyond the obvious sniffles and cough. I suspected an ear infection and called his doctor's office yesterday. It was booked solid all day, but the nurse offered me the last appointment for today.

I muster enough ambition to drag myself downstairs, lugging laundry, ahead of the appointment. It will be quick, I think, since we have a real appointment and aren't just walking in during the daily sick hour. We'll be back just in time to transfer the loads to dryers. Running through the torrential rain, we arrive at the doctor's office a few minutes early. Michael Alexander is dry thanks to his stroller rain cover. I am drenched, my trench coat rendered useless other than soaking up about five pounds from the deluge. My eyes irritated from the congestion and sinus pressure, I wear my glasses out -- a very rare, and very bad choice. I lock up the stroller and attempt to carry Michael Alexander inside without getting him soggy from my coat.

The office is busy, as expected, and the waiting room is especially cramped as I am the only solo parent to accompany a child. How do these people always get time off? My frustration is compounded when two families arrive with a nanny to assist the couple. What I wouldn't have given to have someone help me haul the car seat and take a taxi, or at least run in for the stroller lock while I watch Michael Alexander. My wet hair plastered to my face, my jeans and sneakers slick, I sit downstairs, feeling inferior among the cabbing couples. We wait nearly two hours. So much for getting back in time for the laundry. My success keeping Michael Alexander dry as I carried him into the office and back to the stroller is squashed when I find someone had removed the rain cover. It was a little windy, but not windy enough to topple the cover. Someone clearly unfastened the Velcro. I cry as I compose my rage.

Michael Alexander is diagnosed with a double ear infection and a slight bronchial infection. We use a nebulizer at the office, and the doctor prescribes one for home, along with Albuterol (a stimulant) and Amoxicillin. The doctor calls the trinity of treatment into Bigelow and I expect to pick up and pay upon arrival. "We got the call, yes," the pharmacist says. "We will fill it now." OK. I'm not sure why it hadn't already been filled, but I am assured it was now being filled "now." A half hour later, I am still soaked, my sore throat raw, my nose running and my head about to implode from the sinus pressure. I am struggling to soothe my son, who now needs a change and more milk. I ask about the order. "Oh, it will be a half hour." Another half hour? I was told it would be filled "now!" Bigelow, by the way, doesn't accept our insurance card, so it's an out-of-pocket payment for a wait that makes the chain stores seem charming. (Well, not really.) At this point, the only thing that keeps me from committing myself to Bellevue is my suffering son. I nearly storm out of the tony landmark chemist, but compose myself enough to raise my voice just enough to speed the process.

Michael Alexander smiles as soon I give him his first dose of antibiotics while I am instructed on how to assemble the nebulizer's tubes and dispense the medication. My son is easily comforted, as the fast-acting antibiotics take nearly immediate effect. It takes me a little longer to regain any semblance of sanity. I'm not quite there yet. More than three hours later, we hustle home, again pounded by rain. The rain, of course, started just before we left in the morning and stopped shortly after we returned home. The trip home seems to take twice as long, as the water-fearing masses huddled under obnoxious oversized umbrellas seem completely oblivious to my need to get home quickly. The slow-walkers, who have no business in a city like New York, are especially loathsome in inclement weather. Those who lurk under awnings and construction canopies are the worst. How pathetic is one's existence if s/he has time to wait for the rain to taper? I am disgusted by this always, and annoyed on a day like today.

I barrel into our building and try to distract Michael Alexander as we head to the basement. I adamantly abhor the practice of leaving loads in the washers and dryers, and I often fantasize about dumping the dissenters' duds onto the floor, but I have only ever carefully placed an abuser's clothes into a cart. (Of course, I curse them under my breath, but I have never taken it out on their washables.) I am more upset than outraged to find one of my wet loads dumped onto the filthy floor. The machine from which they were ejected was not in use, so at least I am able to *quickly* rewash our sheets and towels.

Michael Alexander went down for a nap about 15 minuets ago, but already is tossing and turning. I feel guilty for stealing this time to write, but it might be my only respite in the next few days. Did I mention that Albuterol is a stimulant? I need to administer it three times a day, sanitizing the mouthpiece ahead of every use. He's waking. My 15 minutes are up. The way today's been going, putting away laundry will be my break. At least it's dry.

Michael Alexander's on the mend, albeit slowly, thanks to modern medicine. I just hope this Terrible, Horrible, No Good, Very Bad Day ends with a relaxing evening. And maybe even some sleep! And maybe I'll order Judith Viorst's children's classic. Even the worst days can spur the best literary memories.