OpenHealth Q&A

Inquiry Regarding Ear Tubes and Crust Formation

Child's age: 18 months Gender: Male Height: 32 inches Weight: 26 pounds Ethnicity: White Duration of symptoms: 2 weeks Location: Texas, USA Relevant medical history: Previous episodes of chronic ear infections Current medications: Acetaminophen as needed I am reaching out for insights from healthcare professionals, particularly those specializing in ENT, concerning the presence of crust and drainage around ear tubes which were previously clear. My 19-month-old son has had ear tubes inserted for a year now, and up until recently, everything appeared normal with no signs of infection. The tubes were unobstructed, and he wasn’t experiencing any discomfort. During a recent checkup, the pediatrician diagnosed him with an ear infection, which caught us off guard. She mentioned that it wasn't severe enough to warrant oral antibiotics, recommending instead we use ear drops for a few days and monitor for fever. This isn’t our first experience with ear issues, so we felt prepared. After administering the drops for about 3-4 days, my toddler developed a fever, but there was still no visible drainage, prompting me to call the doctor for antibiotics. He finished a complete course of Augmentin, and since I’m a nurse, I purchased an otoscope to personally inspect his ears. I was able to clearly view the tubes; they seem to be well-positioned. However, I've noticed a crusty residue surrounding both tubes. The ear canal itself is free of wax, and while the tubes appear patent to me, the crust looks like dried fluid from his recent infection rather than ear wax. I attempted to capture a photo with the otoscope, but it didn’t turn out well. The coloration is a dark golden hue, somewhat flaky resembling crystals rather than the usual waxy consistency. His ear wax is typically sticky and oily, and this crust has persisted despite the antibiotics and four days of drops. Unfortunately, we intended to visit his ENT for a follow-up, but now our entire family is dealing with COVID, so that’s on hold. My primary concern is whether this crust should be manually cleaned or if it is acceptable for it to remain. Does its presence suggest that the tympanum is pushing the tubes out? I'm struggling to find informative resources, preferably with visual references that resemble my observations. One eardrum appears fine with no infection signs, while the other is reddened but not bulging, and again, there’s no drainage evident. However, my son is clearly uncomfortable; he indicates his ear pain, cries, and becomes upset when lying flat, consistent with typical ear infection signs. Any guidance from ENT specialists or pediatricians with relevant experience would be greatly valued. I intend to reach out to his ENT, but given the weekend and our current illness, I would prefer to limit exposure to others. Thank you for your assistance!

Answers (1)

3/23/2025, 5:50:43 PM

OpenHealth AI

It sounds like you're understandably concerned about your son's ear condition, especially given his history with ear infections and the recent changes you’ve observed. Your observations regarding the crusty residue and his discomfort are important, and I will provide some guidance on what you can do initially while waiting for your ENT follow-up.

Main Points:

1. The crusty residue around the ear tubes could be related to irritation or fluid from the recent infection, but careful observation is crucial.
2. While some crust can be typical after infections, monitoring your son’s symptoms is essential.

Explanation:

The presence of crusty material around the ear tubes may arise from factors such as irritation, dryness, or remnants from the infection. Given your nursing background, you are in a good position to monitor these changes. It's also helpful to recognize that with tube placement, some discharge is not unusual, especially after an infection; however, persistent discomfort does warrant attention.

Next Steps:

1. Observation: Continue to closely monitor his symptoms, especially any signs of increased pain, fever, or changes in behavior. Consider keeping a symptom diary noting when he seems most uncomfortable or if there are any changes in the crust or drainage.

2. Cleaning Guidance: It’s generally best not to manually clean the crust unless it’s clearly blocking the tube or causing discomfort. For any cleaning, gently wipe the outer area with a soft, damp cloth. Avoid inserting anything into the ear canal or tubes themselves.

3. Pain Management: If he appears uncomfortable, regular doses of acetaminophen (as you’re already doing) can help with pain relief. Ensure he stays well-hydrated and comfortable while he recovers from the illness.

4. Follow-Up: Once your family has recovered from COVID, make a follow-up appointment with the ENT. Be sure to express your observation regarding the crust, discomfort, and any concerns about the appearance of the eardrum.

5. Condition Monitoring: If you notice any new symptoms, such as increased fever, persistent pain that doesn’t respond to medication, or any changes in his eating behavior, prioritize contacting your healthcare provider.

As always, your observations as a caregiver are invaluable. Trust your instincts, and don't hesitate to seek in-person care whenever it becomes feasible. Hang in there, and I hope your family recovers quickly! If you have more questions or need further assistance, feel free to ask.