Dear Doctor Friends and Colleagues, 12 June 1997 I am writing to seek your guidance regarding the medical problem 'paediatric otitis media'. Although I am a doctor (with specialisation in anaethesiology) and also the mother of the child concerned, we live in a third world country and have certain constraints in obtaining the latest medical wisdom here. My husband got your address by searching the internet, a relatively new technology for us and I am using his email. The brief case report is as follows. My infant son, born on 4 April 1996, suffers from frequent attacks of otitis media. He is a full-term, vaginally delivered mature baby of Apgar score 10. For the first four months he had only breast milk, no supplementary food was given. He preferred breast feeding in lying position. From the very first month watering from nose and sneezing were of common occurrence. When he was about five months, a purulent discharge was noticed for the first time from his left ear. Amoxycillin suspension was started immediately (125 mg tab, 1/2 tab thrice daily) but two days later purulent discharge from right ear also began. Amoxycillin was continued but the clinical response was unsatisfactory. A culture test showed the growth of staphylococcus aureus, sensitive to ampicillin and erythromycine etc. Augmentine (amoxycillin + clavulanic acid - 5 ml thrice daily) was administered and continued for a course of five days. Discharge from both ears diminished. About a month later he had cough and cold. Antihistaminic drug and nasal drop were used right away, but within two days purulent discharge from right ear occurred. Augmentine was once more given for a period of seven days. Local toiletting with rectified spirit was performed two to three times daily. After doing otoscopy, the concerned ENT surgeon diagnosed central perforation in both ears. Since October '96 till date my son has had several attacks of otitis media, necessitating the use of antibiotics. During March '97 he was given Keflor (cefaclor) for two weeks. Since then, he has had no aural discharge, but with changes of temperature and humidity he becomes restless and sticks a finger into one of his ears, as if in discomfort. I am afraid of perforation again. Our ENT surgeon advises us to avoid cold and coughing, but, for a baby, specially having a suspected allergic background, that's difficult to do. Frequent use of antibiotics may affect his growth, immunity etc, I am afraid. He does not seem to have a hearing problem. I seek advice on what the latest effective treatment is. How can future complications best avoided? What all can be done to prevent the child catching a cold? What should be done if purulent discharge comes out through the ears again? Is local toiletting along with systemic anti- histamine and nasal decongestant sufficient for therapy? Is the use of antibiotics mandatory? Should we perform any special tests? With best regards, Dr Chandra Mukhopadhyay E-mail: Department of Anaesthesiology Phone: 091-033-3375345 (extn 349) SSKM Hospital Telefax: 091-033-3374637 Calcutta 700 020 INDIA Home Phone: 091-033-4664299