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Hello. I do not think he is a candidate for ear grommets just yet. He was mismanaged multiple times with the same antibiotic, to which his ear bacteria are obviously resistant. If he showed failure to clear the same ear infection after 2-3 different antibiotics or if he shows more than 4 separate ear infections over 6 months or more than 6 separate ear infections over 12 months, then he would meet clinical criteria for consideration of ear grommet surgery.
If he has serious hearing problems because of this, that is another criterion for consideration of ear grommet surgery.
The ear swab culture test will hopefully confirm the exact bacteria causing the infection as well as what antibiotics would work against it. This will allow the physician to prescribe an effective antibiotic choice. Also, I actually suspect that this is not four separate ear infections, but possibly the first one inadequately treated over all this time. Did you say his ear drum is currently perforated?
Correction: Perhaps 2 separate ear infections if the in-hospital intravenous antibiotics actually did clear the first infection.
Since his ear drum is perforated, it will not be possible to place a grommet until it has fully healed, which may take up to 8 weeks in most cases. If the ear structures are still intact, then hopefully this will not affect his hearing. There are OAE devices that can actually screen for hearing problems in children this young -- the ENT specialist or an audiologist may consider the use of such a hearing screening device.
You are quite welcome. Be sure call your GP 48-72 hours after the ear culture swab was sent for testing to confirm a good antibiotic choice.