To take DS13 back to GP with a foul smelling discharge from ear?

[JimJimJim]

DS13 was given antibiotics at Christmas (wasn't seen by GP, was a telephone consultation) when presenting with symptoms of possible ear infection (painful ear, snot like discharge from ear), sinus pain and cough. He was seen after 4 days as the ear wasn't much better. Dr examined him at that point and said because of the discharge she couldn't see the ear drum but it was possible the ear drum had burst, causing all the discharge, but that it would likely resolve itself and to go back in 6 weeks if his hearing was affected at that point.

The discharge is reducing, but it absolutely stinks! It is still slightly snot like, less stringy now but still a slight yellow in colour. He still has a runny nose and cough, which we have all had. No fever, seems ok in himself. He had a covid jab today but feeling fine after that so far. He is slightly deaf and we have to shout to get him to hear us!

Do I just leave this to run its course or go back for them to have another look at the ear given this horrible smell?

I had an ongoing ear infection when I was pregnant, and the only thing that eventually cleared it was micro suction of the goo and then it was packed with an anti microbial dressing.

Some GPS have a special interest and will micro auction in the surgery, so it would be worth asking if that's an option to be referred if ENT at the hospital is a long wait. Microsuction would at least let them see his eardrum and work out a plan - it sound gross, but the relief was instant for me!

I agree he needs it swabbing to check what antibiotic is appropriate. When my DM has had this happen they’ve sent her to ENT the next day.

He has had issues before - 2 sets of grommets and a few times when he has needed ciprofloxacin ear drops to treat gunky ears, but even then I don’t remember them smelling like this.

My DD had grommets and ended up with a cholesteatoma, apparently it’s not uncommon where grommets have been fitted. I’d also say her ENT said oral antibiotics aren’t great for ear infections so an examination and possible change of medication may be in order.

Thanks for that. Interesting about the grommet use. We used to get referred straight into the ENT team when he had ear infections before but it’s been a number of years now. They never gave oral antibiotics before, always the drops which seemed to do the trick within a few days.

GP here. Completely reasonable (and I’d recommend) asking for a duty Doc appt.

I don’t say that lightly as I’m not long from my day as the duty (urgent care) GP in my surgery today.

Swabs also sound like they may be helpful (without knowing the full history or presentation)… lots of pathogens plausible incl pseudomonas (given the smell you describe) or Candida (yeast- at risk if have had recent antibiotics) which need assessment and slightly different treatment.

E mail the practice now so that someone reads it in the morning

I had a about four ear infections over an 18 month period a couple of years ago, my ear drum kept bursting. Then I had a really nasty one in October 2020, ended up at the ENT emergency clinic. My ear drum had burst again and I’ve got permanent hearing loss in that ear now and am waiting to have a hearing aid fitted.

so it’s worth going back.

Thanks all. Have managed to get him an appointment this afternoon so will see what they say then.

Well the GP appointment was a bit frustrating! The positives were that he could see some of his ear drum which appeared to be an improvement on last time when they couldn’t see it at all. And they said DS isn’t systemically unwell and the ear discharge is reducing so seems to be heading in the right direction.

He completely dismissed the smell - said it could be normal for the discharge to smell as things were improving. And also dismissed the fact that he is having hearing loss currently - said that was normal for perforated ear drums and it would only be in 6 weeks if he still had hearing loss then that they would refer to ENT/audiology.

I asked about a swab - he said no point as the result wouldn’t really change management - if not systemically unwell they wouldn’t give antibiotics. I asked about ear drops (which we have used before) and he said he wasn’t sure they would be tolerated with a perforated ear drum.

So then he asked me what I thought we should do!

We have settled on trying the ear drops and seeing if they improve things with a review in 3 weeks if hearing loss still there or sooner if becomes systemically unwell. Unfortunately he had covid jab yesterday and flu jab today so if he does get a temperature I’m not going to know what the cause is - the ear issue or a jab side effect.

Mentioned my concerns about long term hearing loss but that wasn’t really responded to.

If the discharge doesn't improve, ask again for a swab. If the infection affects the small bones in the ear, it will damage his hearing.

How long would you give it? He's had it for almost 3 weeks so far.

He won’t necessarily be unwell if it’s cholesteatoma My dc had it in both ears at separate times, neither time was dc unwell both times surgery was required, 5 operations in all. The smell was putrid. That was the only symptom. Luckily minimal hearing loss.

It was because the ‘ear infection’ was clearing up that we were referred to ent. Three weeks is a long time for it still to be ongoing.

OP the drops are fine with a perforated ear drum. DS had a perforation for 3 years and drops were the only thing that cleared his constant infections & discharge. I made our ENT consultant write to the GP so that it's on his file that he needs drops not antibiotics as GP just kept prescribing antibiotics which were useless.

This is what my doctors is like, I never understand how so many people always seem to get tests and swabs and knowledge about whether they have a virus or bacterial infection. Ive never been tested for these things

A week maximum? The person I knew who needed an op after mastoiditis was confirmed, was not in pain but had discharge. It's a very serious condition and not all GPs are aware of it. Ask for a different GP.

Not trying to frighten you but GPs cannot possible know loads about everything in detail. Mine is lovely but useless with ears. I went twice with really painful ears and was told that they were fine, viral apparently. Woke in the night to excruciating pain and blood all over the pillow. Ear drum burst. Sat here now with pain in left ear and I wear hearing aids in both ears. Ear drums have never recovered and are unlikely to.

This exact same thing happened to my daughter and sadly, she is now deaf in that ear.
I would definately demand a e.n.t appointment.

Oh gosh I’m so sorry to read that. Can you tell me what happened with her?

Maybe see what the wait for out of hours appointments are?

Yeah sure, she was only about 6, she is 22 now...exactly the same ear infection..smelled really offensive ect...like a tangy discharge. It seemed to clear but then came back with a vengeance.
We ended up taking her to A&E it was a weekend and they sent her home with it and told us to see her g.p.
This was ongoing for months and much later we realised she was deaf.
Its traumatizing and its hindered her enormously.
She kept getting quincies on her tonsils and we eventually got them taken out..but she still gets so many infections..I wish I had pushed harder for a referral at the time. But I sadly didn't.

I had childhood cholesteatoma. Recurrent ear infections that never seemed to fully go away, smelly discharge and so on. Multiple doctors treating it as one off problems. By the time it was addressed, most of my ear was destroyed and I was perhaps lucky it didn't progress past that.

So be cautious, pushy and advocate with the GP. I would suggest trying another service or consider paying for a CT scan privately if you can afford to and the issue goes on.

I’d def. go back to the GP. Insist if necessary. Or insist on seeing a different one.

As a child my Dbro had an ear infection that was dismissed by a GP who branded my mother a fusser, and actually wrote that (‘a very fussy mother’) in a referral note to the ENT consultant after she absolutely insisted. (Having suspected as much, she steamed it open!).
He was admitted to hospital instantly for an op, the infection was by then so bad, and was left with a sufficiently acute hearing loss in that ear to later prevent him joining the Royal Navy, which had been his first choice of career.

I would consider leaving a message with the surgery saying ‘I’m concerned it’s possibly cholesteatoma and that hearing loss may occur’ and asking that your concern is marked on your child’s file. It may be the doctor will reconsider accordingly or get a second opinion.

My 9 year old had this in August last year. He is finally getting a mastoidectomy on Monday to treat his cholesteatoma.

i also had a cholesteatoma as a child and needed a mastoidectomy. My hearing in that ear isn’t great now. Foul smelling discharge was the main symptom. i had two sets of grommets as well prior to this.

I would see a different GP and ask for a referral to ENT. If you can afford it and there’s a long waiting list it might be worth paying to see a consultant privately for peace of mind. They’ll probably clean the ear out using microsuction and can have a close look.