Q. My 4-year-old daughter had recurrent ear infetions and finally had tubes inserted in the eardrums to prevent them. Recently she had an infection and drainage from her ear, and I'm worried about what that means.
A. Polyethylene tubes, commonly known as PE tubes, are tiny peephole-like devices placed in an opening made in the eardrum. They act to maintain an opening between the middle ear on one side of the eardrum and the ear canal on the other. This helps prevent infections from building up in the middle ear: If an infection should develop, it can drain into the ear canal.
When PE tubes are in place, a runny ear often follows a runny nose. However, you need not be alarmed about the drainage, and needn't keep your daughter out of school for draining ears that are being treated. The vast majority of ear infections do not lead to permanent ear damage or hearing impairment.
Your physician will treat the ear infection with antibiotics -- either ear drops, medicine by mouth or both. The infection, drainage and other symptoms should go away within a few days. If not, have your daughter's ear reexamined.
Physicians disagree about the effectiveness of PE tubes for recurrent ear infections. They are probably best used in children with signs of hearing loss, delay in normal speech development, or ear infections that don't respond to medical treatment.
Q. What do you think about the new nicotine chewing gum as a method to quit smoking?
A. I have mixed feelings about nicotine chewing gum, but overall I'm in favor of anything that helps people quit smoking. The gum supposedly works by satisfying a smoker's craving for nicotine, while avoiding the other harmful ingredients of tobacco smoke.
Nicotine gum has definitely helped some people quit. It seems to double your chances of staying away from cigarettes compared with will power alone.
The gum is available by prescription only. Depending on how much you use, it costs about $1 to $2 a day.
I have two small reservations about using nicotine gum. One is that a few people seem to become dependent on it after giving up cigarettes. Second, even though you get less nicotine from a piece of gum than from a cigarette, nicotine itself may produce some undesirable effects on your heart and nervous system.
But overall, I consider nicotine gum by far the lesser of two evils, and worth a try if other methods to stop smoking have failed.
One note of caution: Some people have complained that nicotine gum, which is stiffer than ordinary chewing gum, has caused problems with their dentures or dental work.
Q. My skin gets dry and itchy, especially in the winter. Hand lotions don't help. Is there anything I can buy that will?
A. Dry skin is itchy skin. Winter air lacks much humidity, and home heating robs moisture from the air. Less water vapor in the air makes for drier skin. So using a humidifier at home during the winter may help prevent skin dryness.
Loss of the body's protective skin oils will worsen the condition. Frequent washing with soap will remove these oils and make the skin drier and more susceptible to the irritation we sense as itching. The skin's ability to produce protective oils decreases with age, so older people often suffer from dry, itchy skin.
The more protective a barrier you can put on your skin, the better it will retain its natural water and oils. In increasing order of protection are lotions, creams, oils, gels and ointments. One technique that may help is applying baby oil or skin cream to wet skin after a bath or shower. Your pharmacist can help you find an agreeable cold cream or ointment. Common petroleum jelly, though somewhat messy, works well at restoring moisture.
If the itching persists or you develop a rash, see your physician to make sure it isn't something more than simple skin dryness.
Q. I take insulin for diabetes and have heard about diffrent ways of checking my blood sugar. What do you recommend?
A. There are a lot of products you can buy to check your blood sugar, or glucose. Most people with diabetes are familiar with urine tests that measure glucose in the urine as an indirect guide to the amount of glucose in the blood.
You can more accurately measure the blood glucose directly, using a drop of blood from your finger, which you prick with a needle-like device called a lancet. I recommend using a spring-loaded lancet, which is almost painless, rather than jabbing your finger yourself. You then put the drop of blood on a special pad that changes color depending on the amount of glucose in the blood.
You can either compare that color to a color chart to estimate the blood glucose, or place the pad in a pocket-size meter that electronically reads the color and digitally displays the blood glucose level on a screen. The meters are expensive (about $150), and the pads cost more than the strips or tablets used to check glucose in the urine. But if you need or want closer control of your blood glucose, I think direct monitoring is more accurate.
Many doctors believe that the better you control your blood sugar, the fewer complications you will have from diabetes. By monitoring your blood glucose, you will help your physician take better care of your diabetes. In fact, I think it's very difficult to adequately control diabetes unless the patient actively participates in his own care. Follow-Up
Several readers called in response to my answer about head lice last week, saying that they've had a difficult time clearing up an infestation and that treatment wasn't always as simple as I indicated.
I advise interested readers to write for more information to the National Pediculosis Association, P.O. Box 149, Newton, Mass. 02161. This organization provides helpful information on how to cope with the problem of head lice.