Pediatric Otolaryngology
Airway Obstruction
Cochlear implants
Ear infections / Ear tubes
Excessive Drooling
Hearing loss
Neck Masses
Nose bleeds (epistaxis)
Sinusitis
Speech disorders
Tongue tie
Tonsillectomy and Adenoidectomy
Tracheotomy
Ear Infections
Ear infections may present as thick yellow/green drainage from the ear canal. Ear tubes do not prevent all ear infections. The tubes usually reduce the frequency of the infections. The infection will now be easily treated with topical drops, usually Ciprodex or Floxin drops. If an infection occurs, please call the office for treatment.
 Ear Tubes
A myringotomy with tubes is a surgical procedure that makes a small hole in the eardrum through which fluid can be removed from the middle ear. A tube is inserted in the hole, allowing air into the middle ear. This prevents fluid from building up again.
The incision created for the ear tube usually does not hurt. Your child may feel irritation and discomfort due to a change in the middle ear pressure and an increase in hearing. Ibuprofen or Tylenol should be adequate to control postoperative pain.
Thin, pink, watery drainage is normal and can last up to three days. If the drainage becomes foul smelling, thick or green/yellow please call the office for further evaluation.
The procedure is performed on an out-patient basis, usually at Albany Medical Center's South Clinical Campus. Routinely, it takes less than an hour and the patient will be discharged later that day. Regular activity is encouraged the day after the procedure.
Water exposure should be avoided the first 24 hours postoperatively. Any treated water (bath, shower, or chlorinated pools) exposure is acceptable, therefore no ear plugs are necessary. Untreated water (Lakes, ponds, or ocean) exposure will require use of ear plugs. Diving is discouraged. Ear plugs can be purchased at: our office, drug store or you can create your own using cotton balls sealed with Vaseline.
Airplane travel will be fine due to the ear tube equalizing ear pressure.
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Removal of tubes is rarely required, unless a special tube called a T-tube is inserted. Usually a tube will fall out in 6 months to 1 year. As the eardrum heals, the tube extrudes and begins to travel out the ear canal. If the tube is still in after two years, we will evaluate the need for a possible removal. Leaving a tube in place for longer than 2 years may result in a persistent perforation (hole) in the ear drum that may need to be repaired surgically.
Follow up care will involve an appointment every 4-6 months to evaluate tube placement. If you have any concerns sooner please call the office 518-262-5575.
Excessive Drooling
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Tongue-tie (Ankyloglossia)
Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually tongue-tie is a non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.
Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. After birth, the lingual frenulum continues to guide the position of the incoming teeth. As we grow, it recedes and thins.
The tongue is one of the most important muscles for speech and swallowing. For this reason having tongue-tie can lead to eating or speech problems. For more information on this go to www.entnet.org/KidsENT/tongue_tie.cfm.
Neck Masses
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Pediatric Sinusitis
Your child’s sinuses aren’t fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth.
The following symptoms may indicate a sinus infection in your child:
- a “cold” lasting more than 10-14 days, sometimes with a low-grade fever
- thick, yellow-green drainage
- post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
- headache, usually in children age six or older
- irritability or fatigue
- swelling around the eyes
You can reduce the risk of sinus infections for your child by reducing exposure to known allergens and pollutants such as tobacco smoke, reducing his/her time at day care and treating stomach acid reflux disease.
How will the doctor treat sinusitis?
Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function.
If your child has acute sinusitis, symptoms should improve within the first few days. Even if your child improves dramatically within the first week of treatment, it is important that you continue therapy until all the antibiotics have been taken.
Chronic sinusitis: Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek consultation with an ear, nose and throat (ENT) specialist. The ENT may recommend medical or surgical treatment of the sinuses.
Diagnosis of sinusitis: An x-ray called a CT scan may help to determine how your child’s sinuses are formed, where the blockage has occurred, and the reliability of a sinusitis diagnosis.
When is surgery necessary?
Only a small percentage of children with severe or persistent sinusitis require surgery to relieve symptoms that do not respond to medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of the your child’s sinuses and makes the narrow passages wider.
Your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis, or obstruction of the back of the nose, can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.
Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.
Pediatric Obstructive Sleep Apnea
Sleep disordered breathing in children, from infancy through puberty, is in some ways similar to adult sleep apnea but has different causes, consequences and treatments. A child with SDB does not necessarily have this condition as an adult.
The premiere symptom of sleep disordered breathing is snoring that is loud, present every night regardless of sleep position, and is ultimately interrupted by complete obstruction of breathing with gasping and snorting noises. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnea.
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and the sleep is disrupted. In most cased a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky and ill behaved.
Diagnosis of sleep disordered breathing
The first diagnosis of sleep disordered breathing in children is made by the parent’s observation of snoring. Other observations may include obstructions to breathing, gasping, snorting, and thrashing in bed, as well as unexplained bedwetting.
A child with suspected SDB should be evaluated by an otolaryngologist. If the symptoms are significant and the tonsils are enlarged, the child is strongly recommended for tonsillectomy and adenoidectomy. Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen. The majority of cases fall somewhere in between, and the physicians must evaluate each child on a case-by-case basis.
A sleep study is the standard diagnostic test for sleep disordered breathing. This test is performed in a sleep laboratory.
Treatment for sleep disordered breathing
Enlarged tonsils are the most common cause for SDB, thus tonsillectomy/adenoidectomy is the most effective treatment for pediatric sleep disordered breathing. T&A achieves a 90 percent success rate for childhood SDB. Of the nearly 400,000 T&As performed in the U.S. each year, 75 percent are performed to treat sleep disordered breathing.
Airway Obstruction
Children put many things in their mouths (including food) that can cause trouble. When you know that a child has ingested a foreign object, consider this a medical emergency and seek immediate attention. If your child is choking – cannot breathe, is gasping, cannot talk, or is turning blue – call 911 or an ambulance immediately.
Parents should be alert for these commonly ingested items:
- Pebbles, nuts, hot dogs, grapes, seeds, small button-shaped batteries, toy parts, buttons, marbles and coins
Aside from choking, trouble may happen if the object becomes lodged in the “airway” tube (trachea) instead of the “eating” tube (esophagus), which may make the child’s distress harder to see. Children may experience symptoms differently; some children can even have vague symptoms that do not immediately suggest ingestion. While most swallowed foreign objects pass harmlessly through the esophagus, the stomach and intestines, a foreign body may also cause harm if it has associated toxicity or becomes lodged in the gastrointestinal tract.
Parents should suspect their child might have swallowed a foreign object if breathing or swallowing difficulties persist longer than two weeks despite medical treatment.
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Laryngomalacia
Laryngomalacia means floppy larynx. When breathing in, this floppy laryngeal tissue is drawn into the opening of the airway. The collapse of tissue into the airway causes bumpy airflow, which produces a low-pitched fluttering noise. The noisy breathing, or stridor, is first noticed at birth or during early infancy. The stridor is sometimes more noticeable when your baby is lying lat on his back, or when relaxed or asleep. When your baby is crying, the stridor may decrease or become less noticeable due to increased muscle tone in the laryngeal area.
As your baby grows and is more active, the stridor may become louder. Your baby may even produce this noise at will or learn to control the noise. You may notice nasal flaring or pulling in of muscles in the neck or chest during breathing in. During feeding, your baby may also need to suck harder and, therefore, might swallow more air. This will cause him to have more gas and possibly vomit or spit up. Increased vomiting may contribute to poor weight gain. In most children, the symptoms go away by 18-24 months of age.
Laryngomalacia usually requires no treatment and, there is no known cause of laryngomalacia. In rare cases, if the baby fails to gain weight or has significant difficulty breathing, a simple surgical procedure may be performed to correct the problem.
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Tonsillectomy and Adenoidectomy
The tonsils are located on each side of the mouth cavity behind the tongue. They are easily seen, especially if enlarged. The tonsils are sometimes removed because they are large and may interfere with breathing and swallowing. More often, they are removed because of repeated tonsillitis (infected tonsils).
The adenoids are in back of the nasal passages and upper throat near the Eustachian tube opening. They are hidden from view by the palate. Frequent ear infections and obstruction to breathing caused by enlarged or infected adenoids are common reasons for their removal.
How are chronic tonsil problems usually treated?
Doctors typically recommend performing a tonsillectomy based on the following guidelines:
- 3-4 episodes of infectious tonsillitis per year for three consecutive years
- 5 episodes of infectious tonsillitis per year for two years
- 7 episodes of infectious tonsillitis in one year
Recovering from tonsillectomy and/or adenoidectomy
Be sure to give your child enough time at home to recover. Limit activity for 1 to 2 weeks after tonsillectomy or adenoidectomy. Also, expect your child to have some ear pain 1 to 2 weeks after tonsillectomy.
White patches in the throat are normal after tonsillectomy. These patches are part of the healing process; they are not a sign of infection. Bleeding may occur after the first week, when the white patches come off. Keep the throat moist with lots of fluids. This will help prevent crusting and bleeding.
When to call the doctor
Discomfort, mild pain and a slight fever are normal after surgery. But call the doctor if your child has any of the following:
- fever over 101°F
- severe pain that prescribed medication does not relieve
- bright red bleeding
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Tracheotomy
What is a Tracheotomy?
Creation of an opening called a stoma in the front of the neck directly into the windpipe (trachea). A plastic curved tube, called a tracheotomy tub,e is placed into the opening to maintain this stoma. This is what your child will breathe through.
We breathe through our nose and mouth, therefore, the air is filtered, humidified and warmed before it reaches the trachea or lungs. If a tracheotomy is in place, it is necessary to take added precautions to ensure the airway is protected with the use of special equipment and appropriate tracheotomy care.
Reasons a child might require a tracheotomy would be a malformation causing an obstruction of the airway, severe laryngomalacia, bronchopulmonary dysplasia, narrowing (stenosis)of the trachea, paralysis of vocal cords, or trauma.
If your child has a tracheotomy placed you will learn proper care of the stoma site, how to change both the tracheotomy tube and the tracheotomy ties, suctioning, assessment of respiratory distress and tips for daily living. We now have a Tracheotomy Teaching Program to suit your teaching needs. If you would like a copy of our teaching packet please contact our office.
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