Delta Medix Pediatric ENT Center
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 (recurring) ailments, and watching for the non-verbal signals a child presents are paramount in the treatment of your child.
At Delta Medix ENT and Allergy we have the trained staff, facilities and the equipment required to treat children of all ages, even as young as birth. 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. 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 might be aggravated by allergies. However, when your child remains ill beyond the usual seven to ten days, a 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.
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 Disorders as well as 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. 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 may also be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PETs (pressure equalization tubes). These tubes can be made out of plastic, metal, or Teflon and might 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 1 to 3 years 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 might also 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 infections (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 hearing loss, speech problems, and changes in the structure of the eardrum and/or middle ear bones. Other less common conditions that might warrant the placement of ear tubes are dysfunction of the eustachian tube from Down's Syndrome, cleft palate, or barotrauma (injury to the middle ear caused by a rapid reduction of air pressure) which is usually seen with altitude changes such as flying, scuba diving, or medical conditions that require hyperbaric oxygen therapy.
Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed under anesthesia. The average age of ear tube insertion is one to three years old. Inserting ear tubes will:
- reduce the risk of future ear infections
- restore hearing loss caused by middle ear fluid
- improve speech problems
- improve behavior and sleep problems caused by chronic or recurrent ear infections
- reduce the incidence of chronic ear disease that might later require major ear surgery
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 eardrum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife). If an ear tube is not inserted, the hole will 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 for ventilation.
Ear Tube Surgery
A light general anesthetic (laughing gas) is administered for young children.. A myringotomy is performed and the fluid behind the eardrum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops will be administered after the ear tube is placed and might 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 adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when 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 infections 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 might also prescribe antibiotic ear drops for a few days.
To avoid the possibility of bacteria entering the middle ear through the ventilation tube, some physicians might 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 might not be necessary, except when diving or engaging in water activities with unclean water such as baths, lakes, or 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, these might include:
- Perforation – This is rather uncommon but can occur when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (eardrum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
- Infection – Ear infections can still occur in the middle ear or around the ear tube. How-ever, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. However, in some cases an oral antibiotic might still be needed.
- Ear Tubes Come Out Too Early Or Stay In Too Long – If an ear tube expels from the eardrum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long might result in perforation or may require removal by the otolaryngologist.
Content provided by American Academy of Otolaryngology Head & Neck Surgery