My son has had ear infection after ear infection. It’s very hard for me to miss work to take him to the doctor. Is there any way I can determine myself that he has an ear infection? Should I buy a home otoscope and examine my son’s ears myself? If I do buy a home otoscope, how can I learn to distinguish between a normal ear and an infected ear?
San Mateo, California
Dr. Greene’s Answer:
Clearly, I am in favor of parents having as much information as possible about their children’s health (or else I wouldn’t be providing this service!). Still, home otoscopes are a mixed blessing. With training, a bright red, bulging eardrum is difficult to miss, but many significant ear infections are much less clear-cut — even with top-of-the-line instruments. You can obtain a home otoscope from a drug store or medical supply store for only about thirty dollars, but home otoscopes are of dramatically lower quality than the instruments your doctor uses.
It will still be important for your child’s physician to have an ongoing view of your child’s eardrums. The home otoscope may buy you some leeway on timing (allowing you to arrange your son’s office visits around your work schedule if necessary). This decision would be excellent to discuss with your physician, to see how it fits with his or her management strategy for your child.
I’m the kind of person who would probably buy one if I were a parent (a non-doctor parent, I mean). Still, although some parents I know love their home otoscopes, most feel that they would have done just as well without.
Most home otoscopes come with a few pictures that can give you a general idea of what to look for. The best idea, though, is to learn to use your otoscope in conjunction with regular doctor visits. Look in your child’s ears just before the doctor does and describe what you see. Then ask the doctor to describe your child’s eardrums to you. Look again, and try to cement the appearance in your memory. You will learn a little more each time, whether there is an infection present or not.
You will be at a disadvantage compared to your physician, since the optics and the lighting of physician otoscopes are far superior (they are also far more expensive!). Also, the home otoscope features no way to assess eardrum mobility, often a critical part of an ear exam. Even with much practice, some kinds of ear infections will be impossible to see, including many of those that might lead to PE tube surgery. Still, you can expect to eventually become fairly proficient at recognizing your child’s eardrums in a few different situations.
Frequent visits to your pediatrician can be quite inconvenient. Unfortunately children with frequent ear infections need to be seen by a skilled professional before a treatment plan can be established. Right now that may put a real burden on your family, but fortunately most children (and hopefully your son is one of them) don’t require this kind of attention for very long.
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