Advanced Pediatric ENT Center of Kentucky and Southern Indiana
Children and teenagers must not be confused with adults for the diagnosis and treatment of Ear, Nose and Throat related conditions. While there are fundamental similarities with an adult, a young person’s stature, weight, immune system, physical and mental development require special care and consideration. Proper dosage and selection of medications; observation of acute and chronic (reoccurring) ailments, and watching for the non-verbal signals a child presents are paramount in the treatment of your child.
At Advanced ENT and Allergy we have the trained staff, facilities and the equipment required to treat all areas of Pediatric Otolaryngology. We will work closely with the family, the pediatrician, and most importantly, our younger patients to get your child healthy and well.
How Do I Know When My Child Has Sinusitis?
Sinusitis in children is different than sinusitis in adults. The following symptoms may indicate a sinus infection in your child:
Symptoms of Pediatric Sinusitis:
- a “cold” lasting more than 10 to 14 days, sometimes with a low – grade fever
- thick, yellow-green nasal discharge
- post-nasal drip, sometimes leading to or exhibited as a sore throat, cough, bad breath, nausea and/or vomiting
- headache, usually in children age six or older
- low energy
- swelling around the eyes
Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, when your child remains ill beyond the usual seven to ten days, a serious sinus infection is likely.
You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.
When Snoring Isn’t So Cute – Children and Sleep Apnea
It’s often cute when children try to imitate their parents. However, when it comes to snoring, it is no laughing matter and is abnormal in children. In reality, children are not smaller versions of adults and snoring usually indicates a more serious underlying problem, such as obstructive sleep apnea (OSA). As we drift into the deeper stages of sleep, our muscles progressively relax allowing our tonsils to shift inward. In children with enlarged tonsils, this shift frequently blocks the breathing passageway leading to sleep arousal, a lighter stage of sleep, and higher level of consciousness. As a result, children experience a poor night’s sleep causing exhaustion the next day regardless of the amount of sleep time.
Recent studies have shown that children’s school performance suffers significantly as a result of poor sleep patterns and interruptions of quality sleep. Attention Deficit Disorder, and behavioral and disciplinary problems, are more evident in children with OSA. Even your better student will suffer without a good night’s rest.
What is the solution? First, an accurate sleep history is essential. Children who snore should be evaluated by an Otolaryngologist (ear, nose and throat specialist), especially if they have enlarged tonsils. If OSA is diagnosed, removal of the tonsils and adenoids is recommended as the first line of treatment. Recently, the introduction of a new procedure, “Partial Intracapsular Tonsillectomy and Adenoidectomy” (PITA) has decreased the severity of the traditional T&A procedure generally performed on children who have chronic tonsillitis or strep throat infections. Therefore, patients make a quicker recovery and are able to return to their normal diet and activities sooner. Whether a PITA or the traditional T&A technique is performed, children are happier and healthier once their sleep apnea has been resolved.
What Are Ear Tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. These tubes can be made out of plastic, metal, or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.
Who Needs Ear Tubes?
Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or Eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure), usually seen with altitude changes such as flying and scuba diving.
Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age of ear tube insertion is one to three years old. Inserting ear tubes may:
- restore hearing loss caused by middle ear fluid
- reduce the risk of future ear infections
- improve behavior and sleep problems caused by chronic ear infections
- improve speech problems and balance problems
How Are Ear Tubes Inserted?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).
Ear Tube Surgery
A light general anesthetic (laughing gas) is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.
What To Expect After Surgery
After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications are present. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily. Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud. The otolaryngologist will provide specific postoperative instructions for each patient including when to seek immediate attention and follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary, except when diving or engaging in water activities in unclean water such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.
Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:
- Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
- Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problems with hearing.
- Infection – Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.
- Ear tubes that come out too early or stay in too long – If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by the otolaryngologist.
Frequently Asked Questions
Q. Should I have my child or teenager’s hearing tested before he/she goes back to school?
A. Yes. According to the National Institutes of Health (NIH), hearing loss affects approximately 17 in 1,000 children under age 18. Most children have their hearing evaluated after birth or in the first few years to determine any congenital conditions. However, hearing loss is also caused by things like infections, trauma, and damaging noise levels, and the problem may not emerge until later in childhood.
The proportion of American teens with slight hearing loss rose by 30 per cent in the past 15 years, and the number with mild or worse hearing loss has increased by 70 percent.
One in every five teens now has at least slight hearing loss, which can affect learning, speech perception, social skills development and self-image; one in 20 has more severe loss. Because hearing loss is cumulative, these teens are at high risk for significant hearing problems as adults.
Hearing tests in older children are usually done at ages 4, 5, 6, 8, 10, 12, 15, and 18, and at any other time if there’s a concern. Several methods can be used to test a child’s hearing, depending on age, development, or health status.
Signs of hearing difficulty or loss in a child can include: limited, poor, or no speech; frequently inattentive; difficulty learning; often increases the volume on the TV; repeated ear infections; and failing to respond to conversation-level speech, or answering inappropriately to a spoken question.
If the hearing test reveals a problem, it is important to have the child’s hearing difficulty further evaluated by us so we can rule out medical problems that may be causing it, such as otitis media (ear infection), fluid in the ear, excessive earwax, or an inner ear hearing loss. Many treatment options are available and our ENT physicians will be able to determine the right therapy.
Painful ear infections are a rite of passage for children – by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat surgeon) may be considered.
Q. Each year, it seems like it gets harder and harder to get my child out of bed for school in the morning. Is it just growing pains or is something physical going on?
A. It could be both! Even though most people associate sleep disorders with adults, children also commonly suffer from sleep-related health problems.
Obstructive sleep apnea, also known as sleep-disordered breathing (SDB), is not uncommon in children. However, SDB in children has different causes, consequences, and treatments. The number one indicator of SDB is restless sleep and labored breathing. This includes loud snoring that occurs every night, regardless of sleep position; snoring is then followed by a complete or partial obstruction of breathing, with gasping and snorting noises. Consider making a tape of your child’s snoring and make a consultation with one of our ENT physicians for a complete evaluation of your child’s problem.
Q. My children participate in several different team sports in the fall. Should I be worried about injuries to their heads or necks?
A. Team sports and general playtime are great exercise for kids. On the down side, they can result in a variety of injuries to the face, including broken noses, facial cuts, and general bumps and bruises.
Many injuries are preventable by wearing the proper protective gear, and as a parent, your attitude toward safety can make a big difference. Check with your child’s coach to make sure they have and are wearing all the necessary protective equipment. Also check with the coach after each practice to see if your child sustained any injuries while playing.