While cases may differ, I strongly disagree. We had several children who were prone to ear infections and “the pink stuff” was invariably effective at eliminating even recurring cases. Two of them occasionally had to escalate to the stronger ‘white stuff,’ which was even more effective at eliminating the infection within 24 hours.
Besides being painful to the child and wearying to parents, ear infections can lead to permanent hearing damage. While I agree 100% that doctors tend to over-prescribe and chief among those overages is antibiotics, the notion that ear infections can be ignored or treated only with palliatives is dangerous nonsense.
It’s only a slight exaggeration to say that, until about 100 years ago, a sick or injured person’s best bet was to go home, lie down in bed, and hope he got better on his own.
A full treatment of the debate around Otitis Media in children probably belongs in GD, but it’s germane to the OP to comment on it here, because it precisely illustrates why Doctors “don’t realize something doesn’t work.”
Full disclosure: I speak as a career ED physician who almost always prescribed antibiotics for OM, and did so knowing they are fairly useless. But explaining the nuances is such a complicated topic, it’s easier to let the parents feel like their kid was not just blown off by a know-it-all Doctor. Moreover, the follow-up pediatrician more often than not will prescribe antibiotics the next day for exactly the same reason: it’s just too long a topic to discuss with a parent.
Yes; complications of otitis media can be perforated tympanic membranes (not a big deal, and usually helps the pain anyway); mastoiditis (rare) and hearing impairment (another long story).
But…if you take a typical bawling kid with a fever and diagnose Otitis Media by inspection–or even think you have good evidence of effusion in the middle ear (a whole other topic)–it’s very hard to show prescribing antibiotics does much good.
Here is a recent Cochrane report; feel free to dissect out each of the countless studies that have tried to resolve this thorny issue. And if a pediatrician or ED physician reads any study, the additional layer they will throw in is how the diagnosis was made in the first place.
Anyway; not to sidetrack the OP, but simply to point out figuring out whether or not a therapeutic intervention does any good is really complicated in the clinical world. Persuading or dissuading the patient wrt any given approach is even harder (witness Angelina Jolie’s current decision).
I would bet even back in the day of bloodletting there were plenty of critical thinkers who didn’t feel it did much good for their patients. On the other hand, it was expected, it was fancy, it was dramatic, and the anecdotal world was full of miracle cures from bloodletting. There was very little downside to trying it, other than bumping off an occasional patient.
Until penicillin was discovered ca. WW II, mercury, arsenic, and bismuth were used as a treatment for syphilis. It did eradicate the spirochetes, but often took months or years.
Sick, sure. But seriously injured? Even without antiseptic technique, I can easily believe that there were plenty of men wounded in the American Civil War who survived thanks to prompt medical intervention. You can recover from infections; uncontrolled bleeding is a killer.
As late as 1900, physicians were still doubting the germ theory of disease-the workers on the Panama Canal project were being decimated by yellow fever and malaria. Once physicians like Dr. Carlos Finlay (Cuba), and Walter Reed (USA) recognized the way that yellow fever was transmitted (via mosquito bites), effective countermeasures were put in place-still some physicians disputed it.
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. Excellent;16296983]Sick, sure. But seriously injured? Even without antiseptic technique, I can easily believe that there were plenty of men wounded in the American Civil War who survived thanks to prompt medical intervention. You can recover from infections; uncontrolled bleeding is a killer.
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The Civil actually one of the crucibles of modern medicine. germ theory was just being developed, hence as a result a lot more people died of infection than would have just a few years later. Howevervl, many modern surgical techniques were either invented or perfected during the war. Like the Crimean War.
First off, a perforated tympanic membrane isn’t a complication, it’s a cure. It is, in fact, the only effective cure in my experience.
Secondly, the problem isn’t the pain of perforation, the problem is the hours and hours of steadily-increasing pain prior to the perforation. You would be absolutely amazed at how much pressure that little piece of skin can tolerate, and how many pain nerves exist in that general area.
So, yes, once the membrane is perforated the pain goes away. It is glorious. It would be wonderful, however, if there were a way to get to that state without spending the whole day in increasing amounts of agony.
That’s usually your best bet today if you’ve just got a mild viral infection. Anti-inflammatory medications can help if you’ve got an associated headache and different drugs for an upset stomach can be palliative as well but neither are really necessary most of the time (and they have had decent stuff to settle an upset stomach since well before 100 years ago.)
As it turns out, there is a way, and tympanostomy with a needle in expert hands is a perfectly good approach to an otitis media with effusion. Think of a bacterial OM as essentially an abscess; a trapped infection with pressure and inflammatory debris.
I’ve had a tympanostomy for a middle ear effusion done as an adult. It’s trivial. One sharp prick and you feel much better. Upset and uncooperative toddlers are kind of another story.
Very few docs except ENTs will perform a tympanostomy, though. We don’t typically do it in the ED. Interestingly, the whole controversy around tympanostomies with tubes for recurring OM arose for the exact reason that it makes sense to keep a chronic abscess drained. A whole other layer of debate and research…
