Three

Three years ago, the amazing Nolan was born. I walked into the hospital at 10:30pm, and just after midnight he was in our arms (yes, less than two hours' worth of labor: don't hate me). He is rather cuddly because of the crisp morning, so he is enjoying watching Mickey Mouse Clubhouse and relaxing on the couch. His birthday party is tomorrow, and he is extremely excited to play with his friends and decorate dinosaur cupcakes.

His ear infection has not gone away. The other night, I gave him the Ciprodex and Tobramycin drops, and he screamed for over an hour. It was horrible: he sweated and writhed in agony, and I couldn't help him.

He begged me to take him to the doctor, "Go doctor. Doctor put fists (gloves) on and take eardrops out!"

When he begged me to take him to the ENT to have his ear suctioned out, I knew he was in tremendous pain. The next morning, I did not give him his drops. I called the ENT's office to talk to the physician's assistant. He didn't want to stop the drops until we had the culture results back: if it was a resistant infection, at least we would be slowing the growth until we knew what would work. His solution was to stop one of the drops. We were allowed to stop the Ciprodex- it hasn't been working for six weeks, so there seemed to be no reason to continue it. We had to press on with the Tobramycin, however, which created a rather unhappy morning for all of us.

Fortunately, with only one set of drops, the agony seemed to last for a relatively brief fifteen minutes. I gave him the Tobramycin again last night, then rocked him for about an hour. With a sippy cup, blanket, and Mommy, he slowly quieted and was past the pain.

I haven't given him the Tobramycin yet this morning, and I am glad I held off. The ENT's office called with the preliminary culture results. This is not the full report, but it gives us a pretty good indication of what is going on with the little guy. The culture grew out fungus rather than bacteria. The antibiotic drops are only making his infection worse, not better. I am so, so grateful they cultured the ear and waited before prescribing some systemic, heavy-duty antibiotic. We are to stop the Tobramycin completely, since it will only wipe out the natural flora of the ear and allow the fungus free reign in Nolan's ear.

While fungal infections of the outer ear are fairly common (swimmer's ear), fungal infections of the middle ear are quite uncommon. The best guess is that he had a bacterial infection, which was treated with antibiotic drops. The drops wiped out the natural flora of his ear via the PE tubes, which allowed the fungus to start growing in the middle ear. His earmolds weren't helping the situation, trapping moisture and creating a perfect environment for the fungus to grow.

The next step is to pick up an anti-fungal suspension from the pharmacy. Lotrimin isn't typically used for the ears, so we were told to get some funny looks from the pharmacist. We were warned about two things:

1. The culture results are preliminary. The full report could show fungal and bacterial growth, so we may have to start the Tobramycin in addition to the anti-fungal. We'll have the full report on Monday, but with the preliminary results, treatment for the fungus can begin immediately.

2. Fungal infections in the ear can be very difficult to treat. The Lotrimin drops alone may not clear the infection. If the infection persists, a more "mechanical" method will be required. This involves suctioning everything out and painting the inside of the ear with gentian violet. Gentian violet is ototoxic, so I really, really hope the Lotrimin takes care of the infection.

I truly hope the Lotrimin takes effect before his party tomorrow!