Thanks to Dr. Arnold for pointing out that I was not at all clear about
which diagnosis I was talking about at various points in my reply. I
agree with his point. If AOM with secondary OE then let it drain, but
clearing debris is sometimes helpful sans wick. If primary OE then let
it drain, clear canal when needed and use wick when in indicated. I
have seen the wick wind up deeper in the ear with some discomfort and
removed them for this reason but it maybe that they would have fallen
out on their own eventually anyway. I removed them because the thought
of having a mini-tampon in the ear against the TM for a ? period of time
caused me to get "anxious" about leaving it in. This is why I started
using the suture trick. No worries about it getting lost.
I completely agree and have practiced the wait and see or wait and fill
method of antibiotic prescribing for a number of years for AOM, however,
I am not sure this literature parental acceptance would be equal to that
of similar studies with kids who were just in great pain and now have
pus and blood running out of their ear. I still try but I believe many
parents get that look in their eye that says, "How much longer will this
guy talk, the pharmacy closes in 30 minutes."
On a related topic......what is the group's favorite choice for TM
analgesia for tympanocentesis?
Randy Cordle MD
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