Tuesday, September 14, 2010

ENT Visit

Wiped out from running

I am not quite sure how to fit the events of yesterday's ENT appointment into one post (it should really be three separate posts), but I am going to try.

The Never Ending Ear Infection

The "gunk" in Nolan's ear was not a sign of active infection. The ENT took a look and noted the material was definitely occluding the ear canal, but the eardrum and ear canal skin looked great. There did appear to be a large perforation behind the tube. She took him back to the Big Ear Sucker of Doom and removed the gunk. She also looked at the eardrum under the microscope, and noted the tympanostomy tube was actually lying on top of the eardrum. She removed it, and the "perforation" disappeared- it was just an optical illusion cast by the shadow of the displaced tube.

I was so greatly relieved by the news of the finally-resolved infection, that I didn't notice her grabbing the pneumatic otoscope. She made a "hmmph" sound and I looked up. She looked at me and said, "Fluid."


So the never-ending-ear-infection is gone, but a new one is starting. The left tube is starting to extrude from the other ear as well. These were intermediate-length tubes, so they should have lasted for at least a year. They lasted for about 4 months.

Surgery is scheduled for October 12 to place a fourth set of PE tubes. This time, they'll be "long-term" tubes- I suspect they will be placing "T-tubes" into his ears on this occasion. The negative of T-tubes is that they must be surgically removed. The benefit is that they will not fall out in another 3 months, so we should be able to go for a longer period of time between surgeries.

The Random Hearing Test Results

Obviously, we need to figure out what Nolan's hearing levels truly are, and why his hearing levels fluctuate so much. We also need to determine the exact type of hearing loss for each frequency. Since we have three different bone conduction results from two different sites, we are going to have a full hearing test run at Buffalo Children's (WCHOB) sometime after his fourth set of tubes is placed. This test will be used as a "referee" for all of the other tests. Unless, of course, we get a fourth result. Anyone want to take some bets?

The Whole Apnea Thing

We're quite thrilled that the central apnea has all but disappeared. Unfortunately, the obstructive apnea has only gotten worse with time, and the ENT is not pleased. The neurologist labeled the obstructive apnea as "moderate," but the ENT heartily disagrees. It is quite severe, but she believes the neurologist downgraded her reading because she doesn't want to put a C-Pap mask on a child with a recessed mid-face (the pressure of the mask would only cause more mid-face retraction as his skull grew).

While the neurologist wanted to try a few steroids to see if they would help with the apnea, the ENT was appalled at this idea. Those drugs are only used for very mild obstructive apnea- and they're only used for apnea caused by congestion. Nolan's apneas are completely unrelated to congestion (for that matter, so are his chronic ear infections).

To determine the best course of action, the ENT wants to find out why Nolan has such severe obstructive apnea. Since he's going to be sedated for the tubes on October 12 anyway, she is going to perform a flexible bronchoscopy while he's out. A scope will be passed through his airway and into his lungs to find the level of obstruction. We should find out the results on the day of the procedure, so we will have more guidance on how to treat the remaining obstructive apnea.

We are going to have a busy October, but at least we'll have a bit more information on Nolan's hearing and breathing issues!


Joey @ Big Teeth and Clouds said...

It has to be reassuring at least to know that you'll have tubes that will stay put and do what they're supposed to.

You guys will be in my thoughts and prayers as you conquer your appointments/surgeries this fall.

tammy said...

I don't know how I've missed so many of your posts, but I had some catching up to do on your blog! You post way faster than I can get on here and read! ; )

I am LOVING all the online scrapbook pages you created! I have got to give this a try. I started a scrapbook for Ryan when he was a baby. I got to when he was 8 MONTHS ... he's now FOURTEEN! LOL

I can't believe how big Nolan looks in the picture with his hair spiked! It seems like just yesterday I met you along this journey and our boys were so small. Time sure does fly.

I'm really praying for you that Nolan's ear infections get better and that this last set of tubes does the trick. I'm praying even more for you that once you get through Oct., your winter is a peaceful one with very few appts. You are one busy momma and your boys are so lucky to have you!

Julia said...

Hmmm, quite a visit. And sounds it's going to be a hectic fall. I do hope you get some solid answers and results soon. I'm very glad to hear about the central apnea clearing up, because that seemed like it would ultimately be the hardest to treat.

rouchi said...

I can imagine your state with such a handful of jobs.I really hope this phase is soon over and you can put up your feet.You are great with your regular posting inspite of so many jobs in your hand.