Pediatric Otolaryngology

Contents

Ear infections and fluid in the ears

Otitis media (ear infection) is the most common reason for children to visit a doctor, second only to the typical viral upper respiratory tract infection. Prior to antibiotics, this was a significant cause for long term disability, and even death. Ear infections can present as either recurrent episodes of fever, pain, and ear drainage, or can simply be persistent fluid behind the ear drum with hearing loss.

Even with current antibiotic treatment ,children may sometimes need further evaluation by a specialist who can attempt to identify an underlying cause and recommend treatment, such as alteration of the antibiotic, therapy for the cause, and even placing tubes in the ears (myringotomy tubes) to lessen and prevent future infections. If tubes are needed, they are inserted into the eardrum during a brief outpatient procedure. Tubes typically remain in the eardrum for about a year and are extruded into the ear canal as the eardrum grows. Usually children do not require more than one set of tubes—although many do.

Hearing loss

Although children are routinely screened for hearing loss at birth, there are exceptions in which hearing loss can be missed. Even more likely is the development of hearing loss after birth. The role of the ENT doctor is not only to evaluate the child with suspected hearing loss, but to provide families with information on prognosis and treatment. Treatment will be based on whether the hearing loss is temporary and correctable, or permanent and even progressive.

Tympanic membrane perforation

Although there are many causes for your child to develop a hole in the eardrum, the majority occur following an ear infection, extrusion of ear tubes, or trauma. A hole in the eardrum may cause some degree of hearing loss, depending on its size and/or drainage from your child’s ear. Your child may be referred for a hearing evaluation and discussion of treatment options.

Speech delay

Your child may be referred for evaluation if their speech is progressing slowly or not at all. They will be thoroughly evaluated to determine if conditions such as hearing loss, tongue tie, or adenoidal enlargement are involved so that appropriate treatment can be recommended.

Tonsil and adenoids/sleep apnea

Tonsils and adenoids serve as part of the body’s immune system by recognizing infectious agents and allowing the body to devise a “plan” in order to protect itself. The truth is that the body has numerous organs and tissues (i.e. lymph nodes) that provide the same functions as the adenoids and tonsils, so that the latter's removal does not significantly alter the immune system.

The tonsils are two round structures located at the back of the throat, while the adenoids are in the back of the nose. The function of the tonsils and adenoids in fighting infection causes them to become chronically infected and enlarged, which may cause the following:

  • Recurrent tonsillitis/pharyngitis (sore throat, strep throat)
  • Obstructive sleep apnea with snoring
  • Nasal obstruction with mouth breathing
  • Trouble swallowing

Your child may be referred to us for evaluation to determine if removal of the tonsils, adenoids, or both may improve their health. Removing the tonsils and adenoid is a safe procedure performed as an outpatient using the latest technology to reduce pain and hasten recovery. You can expect your child to be on a soft diet postoperatively and be out of school for a week with avoidance of vigorous activity for up to 2 weeks.

Pediatric neck masses

A mass or lump in you child’s neck/face may be frightening at first, but the majority are benign or infectious and easily cured. A rapid swelling with pain and redness following an upper respiratory infection is usually a lymph node (swollen gland) and typically responds to antibiotics if treated early. Other commonly encountered masses include benign cysts or solid lesions. You may be referred to us in order to determine the cause of the swelling so appropriate management can be provided.

Ankyloglossia (tongue tie)

This condition occurs when the frenulum, a thin membrane of tissue which attaches from the floor of the mouth to the tongue, connects too far forward—preventing normal tongue mobility. This can cause an infant to have difficulty nursing or bottle feeding, slowing normal weight gain. In addition, older children with tongue tie may have speech difficulties. A simple office or outpatient procedure to release the frenulum provides immediate correction of the problem.

Chronic sinusitis/allergic rhinitis

Unlike adults who suffer from headaches, facial pressure, fatigue, and nasal congestion, children may present with persistent cough and nasal discharge. Your child may be referred for evaluation to determine the cause and discuss treatment options. Sinusitis commonly occurs because of the following:

  • Uncontrolled nasal allergies
  • Enlarged adenoids
  • Anatomic variations, such as a septal deviation
  • Cystic fibrosis
  • Immunologic disorders

The majority of sinus infections can be treated or eliminated by management with medications with occasional surgery being reserved for those with persistent, significant or recurring symptoms.

Additional information

To learn more about pediatric otolaryngology, please visit our academy website.