Pediatric ENT

Ear, nose and throat disorders represent a large proportion of health care problems in children. Children not only experience many of the same problems adults do, but often times more frequently.

These problems are usually treated at first by pediatricians or family practitioners. However, when the problem fails to resolve, becomes more severe, or is a complex problem with a recognized need for a specialist’s attention, the child is referred to an tolaryngologist.

Common Childhood Ear, Nose, and Throat Ailments

Otitis Media (Ear Infection)

The most common pediatric disease seen by an otolaryngologist is persistent or recurrent ear infections (otitis media). While most ear infections are short lived, otitis media can also be serious because the infection in the ear can spread to nearby structures in the head. It also is the most common cause of hearing loss in children. Hearing loss, especially in children, may impair learning capacity and even delay speech development. If treated promptly and effectively, a child’s hearing can almost always be restored to normal. In addition, the pain associated with an ear infection can be severe causing extreme discomfort for the child. Occasionally, the build up f ear fluid persists despite treatment with antibiotics. In such instances, hearing loss or a predisposition to recurrent ear infections may necessitate insertion of ear tubes

Otitis media is caused by the accumulation of infected fluid (pus and mucus) behind the ear drum. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Persistent or recurrent infections, or infections complicated by headache, dizziness, nausea or vomitting require appropriate and prompt evaluation.

Congenital Abnormalities of the Ear

Congenital abnormalities are abnormalities of the shape or structure of the ear existing from birth. This may include an underdeveloped outer ear, a narrowing of the ear canal, or even complete absence of the ear canal.

Microtia describes underdevelopment of the outer ear. Microtia can be surgically repaired depending on the extent of the abnormality.

When the ear canal fails to completely develop, the result is a very narrow ear canal. This leads to difficulty in examining the ear, collection of wax and debris in the canal and hearing loss. Some of the more common syndromes include: Hemifacial microsomia, Treacher-Collins, Goldenhar, Trisomy 22, Fanconi’s, Klippel-Feil, Crouzon’s, DiGeorge, and others. Canal stenosis is repaired by widening the canal by canalplasty.

Adenoiditis and Adenoid Hypertrophy

The adenoid is a lymphatic tissue like the tonsil at the back of the nose above the palate. A lymph node contains lymphocytes, cells that help to fight infection. The adenoid is a part of a group of lymph nodes that include the tonsils that are found around the back of the throat and act to help process infections in the nose and throat. Sometimes the adenoid tissue gets infected and the infection can last for weeks or months. This is called adenoiditis.

In most children, the adenoid enlarges normally during early childhood, when infections of the nose and throat are most common. They usually shrink as the child gets older and disappear by adolescence. However, in some children, the adenoid continues to become larger and block the passage behind the nose. This can result in snoring, breathing through the mouth, and a hyponasal sound to the speech. This can also result in otitis media (middle ear infections) because of blockage of the eustachian tube. In such cases, removal of the adenoid tissue can be considered.

Tonsillitis

The tonsils are located in the back of the throat. They are part of a group of lymphoid tissue that process bacteria and viruses that cause upper respiratory tract (nose and throat) infections. They also help to produce proteins (immunoglobulins) that help the body fight infections. Although the tonsils have a role in helping treat infection, the tonsils can become a harbor for infection if repeatedly infected. When this happens, removal of the tonsils will improve the child's health. The tissue referred to as the tonsils; is located on either side of the back of the mouth. Viruses are the most common cause of tonsillitis. The second most common cause is a bacteria known as Streptococcus (Group A Beta hemolytic Streptococcus), otherwise known as strep throat.

Sinusitis

The sinuses are air-filled cavities located in the bones of the face. The sinuses are divided into groups based on their location and are named maxillary, ethmoid, frontal, and sphenoid sinuses. Sinusitis is a condition in which your child suffers from inflammation or infection of one or more of the sinuses. Anything which causes blockage of the natural drainage openings of the sinuses can lead to infection. This means colds, flu, allergy or bacterial infection may be responsible. Blockage may also occur from polyps, which may be caused by allergies or chronic infection. Once blockage of the natural drainage passageways has occurred, mucus builds up behind the blockage. This may lead to inflammation and, eventually, infection of trapped mucus, otherwise known as acute sinusitis.

While sinusitis most often responds to antibiotics, recurrent or persistent infection may require allergy treatment or surgery. Rare complications of sinusitis may occur from spread of the infection to the eyes or brain which may require medical and sometimes surgical attention.

The link between children, colds, ear infections, sinus infections, and tonsils and adenoids infections

It's the time of the year for holidays, celebrations, vacations, and yes, unfortunately, the time of the year for many of our young ones to bring home the sniffles. While getting the usual cold is perhaps unavoidable, stopping the chain from progressing to ear infections and sinus infections should help our children feel better faster.

So how does the chain work? Why are children such easy targets? The answer is that small noses have tight spaces which easily get blocked with even the smallest amount of swelling. When these tight spaces get blocked, normal routes of communication for air and fluid flow in the ears and sinuses to the nose also get blocked. When mucous or fluid builds up in the ears or sinuses and is unable to drain, the mucous gets stagnant. This stagnant mucous becomes a ready target for bacteria and thus an infection most likely will occur.

Children are also easier targets than adults for infections because our body's defense system is one which will only get wiser with time. In essence, the body helps to prevent infections by remembering how it fought a particular virus or bacteria the first time, limiting or even preventing a second infection to the same virus or bacteria in the future. Hence, adults get less infections than children because their immune system is more experienced. A typical adult gets about three colds per year, while a child may get six or seven.

So how do we prevent the chain? First and foremost, we prevent the chain from ever starting. Simple things like washing hands, avoiding sharing of drinks, covering our mouths and noses with our elbows or arms during sneezing and coughing, are the basics.

If the chain starts, as it typically will with a cold, consider using over the counter cold medicines with a decongestant, if your child is otherwise healthy. If you are unsure about your child's health, check with his or her physician, but most children are able to take decongestants without trouble. The decongestant will help keep the sinuses and the ears from building fluid by decreasing the swelling in the nose. Decongestant medications typically used are medications such as pseudophedrine or phenylephrine which are usually grouped with other medications for cough and fever (i.e. Tylenol Cold or Dimetapp). Children's Tylenol can be used in addition to a decongestant if the decongestant product does not have Tylenol in it. Tylenol can be used to help with fevers and can help your child feel better. Chicken soup and steam can be added if desired.

Colds are generally marked by congestion, runny nose, and a low grade fever, as well as a mild sore throat. Almost all colds are caused by viruses, which do not respond to antibiotics. However, colds can lead to bacterial infections as we described above, at which point antibiotics may become necessary. Drainage for a typical cold is clear to hazy. If colored drainage, bad breath, or higher fever is noticed, a call or visit to a physician is warranted. Most colds improve within 5-7 days, but if your child is not showing improvement in this time frame, a visit to the doctor could also be worthwhile.

Sore throat without nose congestion, or a particularly bad sore throat also warrants evaluation and a throat culture to help distinguish viral infections from strep throat which will require antibiotics to get better. Development of ear pain or fluid draining from the ear is also an ominous sign for the development of a bacterial ear infection which may also require antibiotics to get better.

As we mentioned, frequent colds are expected in our younger children as a part of their immune system's learning process. However, frequent infections of the ears, sinuses, and throat should not be considered normal and can be harmful to your child's health. Frequent ear infections may lead to hearing loss from fluid build up in the ears, or even more serious ear conditions. Frequent throat infections can lead to swollen tonsils and adenoids causing night time breathing problems such as snoring, sleep apnea, as well as increased frequency of ear and throat infections from bacteria that stay in the tonsils and adenoids. Treatment with medication or surgery may be indicated in these situations. In these situations, a visit to an ear nose and throat specialist may be helpful.

Cleft Lip

A cleft lip is a notch or gap in the tissue that forms the lip. A cleft palate is an abnormal opening in the palate. It results from the failure of the roof of the mouth to completely close during the development of the fetus during the first four to eight weeks of pregnancy.

Cleft Palate

A cleft palate can range in length from a split in the uvula (bifid uvula) to a cleft or gap completely through the soft and hard palates. The cleft most often exposes the underside of the nose, but occasionally the cleft will be "hidden" if the lining of the mouth is smooth and unbroken (submucous cleft).

With a cleft palate, the tongue has a tendency to fall back into the mouth and block the airway. In some children, the jaw bone (mandible) is also small which makes breathing even more difficult. This is treated by helping to keep the airway open with positioning of the child or insertion of various devices designed to help breathing.

Fluid in the middle ear (effusion) and repeated ear infections are present in many children with a cleft palate. This is a result of the abnormal insertion of the muscles to the tube that drains the middle ear (Eustachian tube), which results in problems opening up the tube to equalize pressure and to help drain any fluid if present.