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

Fall Fodder and Foibles

Fall is an emotional time of year. When I was younger it signaled the excitement of going back to school. As a child and teenager, I had always imagined the only career that involved going to an office (if only for office hours I set myself) that I would ever pursue was academia. My father was a professor and my mother a high school teacher, amid myriad other occupations and odd jobs. I grew up going to my father's classes, passing out Blue Books and quietly copying the text books word for word in perfect block letters. (After my father died, my mother found some. She was initially very concerned when she thought at age 4 I really understood macroeconomic theory.) I loved my father's office, where I'd sit on his lap in a distressed leather chair punctuated with rivets and surrounded by books piled from floor to ceiling. As I grew older, I never imagined there could be another office that didn't completely stifle your creativity and passion. I was right, I later learned through experience. But I also learned that academia was rife with bureaucracy that could be nearly as soul-sucking as the corporate world. When I accidentally stumbled upon journalism, I was tempted but still not ready to give up my dreams of ivory towers, or public school brick.

As students head back to school, each year becomes more complicated. I am so far removed from the life I once thought I'd embrace as mine. I was very young during my first round in grad school, a PhD candidate before I was 20. I jumped from fifth grade to seventh grade and then earned my B.A. in three years, so I was by far the youngest student. Upon graduating, I studied at Oxford, at Trinity College right across from the Bodleian Library. It was a scholar's dream to read in the same library as the dons, and it was tough returning to the U.S. system. Once back in the U.S., I was working several jobs, including one at the local newspaper. The other students were all TAs who scoffed at my toiling at menial jobs rather than devoting every second to my studies. I begrudgingly gave up to devote myself to my more-than full-time newspaper career. I returned to grad school twice again, the last time as the oldest student in the group and the only one studying part-time as I was working full-time as a journalist. After all these years and restarts, I am still ABD. I still consider going back, but for now it seems like a lost dream.

One of the reasons I chose to live in the Village is the proximity to NYU. For more than a decade I essentially lived on the campus, in rent-stabilized walkups haunted by students. Now we live in Union Square, where plenty of parents shell out a small fortune for their adult children to live in a luxury doorman building. I guess after footing the $40K-plus tuition bill, a few more grand a month isn't so much. I love being around students and professors, but sadly the banter that I miss from my days as a student is as elusive as my doctorate. Sadly, it seems most NYU students spend more time sifting through the racks at Banana Republic than the pages of Plato's Republic. I'm sure they think really deep thoughts while shopping. You know, like "No discounted thing is of serious importance." Translation: Always pay retail. Daddy's platinum card will cover it. Or, "If one has made an accessorizing mistake, and fails to correct it, one has made a greater mistake." Of course I know there are plenty of very bright NYU kids who work their way to a sub-minimum wage assistant's job in their chosen field. I'm merely complaining because I miss the debate that I had always expected to be a part, if not the bulk, of my daily life. Alas ... I shall take comfort knowing college students still maintain at least one Platonic ideal: "He was a wise man who invented beer."

Even in a cultural mecca, the conversations center on the mundane and the maddening. Nonetheless, I do enjoy eavesdropping as sport, and it's so much easier to do it with a baby in tote. You can get away with a lot as a "new" mommy, lingering to listen to less-than-enlightening exchanges among the unthinkers or our time. Much of what I hear makes TV seem like an academic platform. What's more troubling is what people say to strangers. Fall days like today are made for long walks soaked in the 62-degree sunshine. More people are out, making for more unsolicited comments. Note: Unsolicited comment is a synonym for harassment. If I want your opinion, I will ask for it. Yesterday, a woman who appeared a little disheveled yet suitable for the general population asked me: "Can I look at your baby?" Firstly, madam, you are looking at my baby. Secondly, what is it that you've been banned from and by what authority that prompts you to make such a request? Crazy, maybe. But hardly among the worst offenders. I am befuddled by those, predominantly older women, who feel entitled to offer their insights into infancy. Odder yet is that many of these self-anointed sages have never raised children of their own. Their own experience, or lack thereof, aside, their meddling can be maddening and I have yet to meet a parent who isn't equally annoyed. Does my child look healthy? Yes? Happy? Yes. Then perhaps I am doing a decent job of caring for him. As for the students I slammed (again, this was a generalization and NYU is singled out only for its proximity and prolific real estate ownership), at least most teens and 20-somethings, even those who don't know their epistemology from their ethics, are respectful of mommy and me time. They hold doors when their parents' and grandparents' peers push past strollers only to amble at snail's pace hauling their grocery carts and dragging their lapdogs.

Come fall, if I can't be in a classroom, at least I can (try to) learn from my everyday experiences. When the rude intrude, I strive to shake the snark and "Be kind, for everyone you meet is fighting a hard battle." My battle just happens to be fending off ignorance and intrusion.