Cohen Children’s Pediatric Otolaryngology Ear, Nose and Throat February is Kids Pediatric ENT Month! National health statistics reveal that pediatric ear, nose, and throat disorders remain among the primary reasons children visit a physician, with ear infections ranking as the number one reason for an appointment. From earaches to tonsils and adenoids, kids can suffer from a variety of ailments that require prompt diagnosis and treatment. Below are some frequently asked questions we receive from parents. We hope this can serve as a useful guide. My child suffers from recurring ear infections, what should I do? Acute otitis media (infection of the middle ear) is one of the most common infections in infants and children with 50% of all children having at least one infection by their first birthday. The child who suffers from recurrent bouts of acute otitis media or retains fluid in the middle ear (chronic serous otitis media) presents a different and potentially more serious problem. Children who suffer from recurrent ear infections may be predisposed by environmental factors such as daycare attendance and cigarette smoke or individual coexisting conditions such as food or inhalant allergies and asthma. Also, enlargement of adenoid tissues and small or abnormally positioned eustachian tubes may contribute to chronic, recurrent ear infections by contributing to retention of fluid in the middle ear which provides a growth medium for bacteria. Regardless of the causes, no child should be permitted to suffer from recurrent ear infections and thus subjected to the risks of their complications. Attempts should be made to determine if there are predisposing factors and eliminate them if possible. After these interventions have been tried and infections persist then consideration should be given to the placement of ventilation tubes (tympanostomy tubes) which are small tubes placed in the eardrum to drain fluid from the middle ear. In addition to prevention of infection, this procedure ensures that the child is able to hear normally during the time of language acquisition so that he or she will not suffer from speech delay in the future. If enlarged adenoid tissue is determined to play a role in your child’s ear infections, removal of the adenoid tissue may be recommended either with or without the placement of tympanostomy tubes. Ranked among the top Children’s Hospitals in the nation in 7 clinical areas. Cancer , Diabetes/Endocrinology, Neonatology, Nephrology, Neurology/Neurosurgery, Pulmonary and Urology . When should the tonsils and adenoids be removed? The tonsils and adenoids are concentrations of lymphoid tissue in the throat and back of the nose. The tonsils are paired, one on each side between the folds of the soft palate and can be seen at the back of the mouth. The adenoids are a concentration of non-encapsulated, tissue at the back of the nose or nasopharynx between the openings of the eustachian tubes. Tonsillectomy or removal of the tonsils often performed with removal of the adenoid tissue is one of the oldest surgical procedures in the world dating back at least 3,000 years. It remains one of the most common operations performed in the United States. Generally, the tonsils are removed when a child has had more than seven episodes of tonsil infection in the previous year, greater than five episodes of infection per year in the previous two years or greater than three episodes of infection per year in the previous three years. Another indication for tonsillectomy is airway obstruction causing sleep disordered breathing with or without obstructive sleep apnea (OSA). The decision for your child to undergo tonsillectomy with or without adenoidectomy is best arrived at in consultation with an otolaryngologist (Ear Nose and Throat doctor) taking into account your child’s individual medical problems and history. The procedure itself is performed under general anesthesia and may be performed in an outpatient setting, as a short-stay patient or as an in-patient depending on your child’s individual medical situation. My child has episodes of noisy breathing. Should I be concerned? Airway abnormalities in children that narrow or restrict air flow often make their presence known by intermittent noisy breathing. Both congenital and acquired airway abnormalities may become life-threatening problems, if they remain undiagnosed and untreated. Narrowing or restriction of the upper airway may occur in any location between the nostrils and the bronchial tree of the lungs. The causes of upper airway compromise range in complexity from simple enlargement of the adenoids and tonsils to complex congenital derangements of the normal anatomy of the upper airway. Typically, airway problems that are at or just below the level of the larynx (voice box) exhibit a characteristic high-pitched sound on either inspiration (inhalation), expiration (exhalation) or both. It is not uncommon for an airway abnormality to initially be diagnosed as croup until repetitive bouts of airway distress and the characteristic airway noise point to the possibility of an underlying structural abnormality. Abnormal airway noise may indicate a significant airway problem and may require evaluation by a specialized airway surgeon. After a complete medical history and examination, in office fiber-optic laryngoscopy may be performed with or without radiographic (x-ray) evaluation of the airway. Cohen Children’s Medical Center of New York in partnership with the New York Head Neck Institute is proud to offer the Comprehensive Airway Respiratory and Esophageal (CARE) team (a multidisciplinary team designed to care for children with complex airway challenges including tracheostomy dependence, recurrent croup and congenital or acquired airway stenosis). Feel free to visit our website at: http://www.northshorelij.com/ccmcny/ccmcny-our-services/careteam-services. What should I do if I am concerned about my child’s hearing? Today, most children are screened at birth for the presence of congenital hearing loss. However, after this time period hearing loss may be acquired as a consequence of many environmental factors. If your child has suffered multiple ear infections, a serious infectious illness requiring hospitalization (eg. meningitis), head trauma, exposure to drugs that are toxic to the inner ear, there is a family history of congenital deafness, or your child has other congenital abnormalities then you may want your child evaluated by an otolaryngologist. Also, if you have observed behavior that makes you question your child’s ability to hear normally, then evaluation is warranted. How would I know if my child has obstructive sleep apnea (OSA)? Continuous snoring is the primary symptom of OSA in children. OSA in children, unlike adults is often difficult to recognize and thus requires a higher degree of suspicion for examination and diagnosis. Approximately, 10% to 20% of children snore intermittently; most of these children do not have OSA. Other symptoms and signs of OSA in children who snore include: failure to thrive (weight loss or poor weight gain), problems sleeping and restless sleep, mouth breathing, daytime behavioral problems, cognitive problems, aggressive behavior, hyperactivity, problems paying attention and problems at school. If you suspect that your child has OSA you should consider consulting an otolaryngologist. The diagnosis may also be made by performing an overnight sleep study or polysomnogram (PSG). Most often in children, sleep apnea may be cured by removal of enlarged tonsils and adenoids. My child has a lump in the neck that does not change. Should I be concerned? Most neck masses in children are enlarged lymph nodes. Some neck masses may be congenital cysts or sinus tracts representing a fusion defect left over from fetal development. Rarely, lumps in the neck in children represent malignancies. If your child has an enlarging neck mass, they should be seen urgently by the pediatrician or otolaryngologist for evaluation. Following a thorough medical history and physical examination, laboratory or imaging studies may be obtained. Occasionally, a small amount of tissue may be aspirated from the mass with or without ultrasound guidance and examined under the microscope. This may be the only intervention required other than observation at intervals for changes. In other instances, surgical removal of the mass may be required for diagnosis or to prevent future complications such as infection. The prudent course is to determine what the mass is, not only to relieve anxiety but more importantly to prevent future serious complications. I have been told my child has a severe congenital hearing loss. What should I do? Unquestionably, the earlier treatment is undertaken to address congenital hearing loss the better the outcome for the affected child. Congenital hearing loss may be of two forms: conductive or sensorineural. Conductive hearing loss occurs when there is a disruption of the anatomy of any part of the external or middle ear that conducts sound waves from the environment to the fluids in the inner ear. Sensorineural hearing loss may be due to the incomplete development of the inner ear or the specialized nerve cells that conduct nerve impulses representing the vibrations of sound waves to the brain. Approximately half of congenital sensorineural hearing losses are due to genetic or inherited factors. Regardless of the cause, a child with a congenital hearing loss should be evaluated as soon as a hearing loss is suspected. Conductive hearing losses may in some instances be reversed when the child is older by reconstructive surgery. Sensorineural hearing losses are usually not reversible and must be treated with amplification with hearing aids or cochlear implantation. Currently, the FDA approves cochlear implantation for children as young as 12 months. Children who are profoundly hearing impaired in both ears and are implanted earliest may develop better language skills than those children implanted later. Cohen Children’s Medical Center Division of Pediatric Otolaryngology 430 Lakeville Road New Hyde Park, NY 11040 Phone (516) 470-7550 Office Hours Monday - Friday 9:00AM - 5:00 PM Most Insurance plans accepted Physicians Lee Smith, MD Chief, Pediatric Otolaryngology Gerald Zahtz, MD Pediatric ENT Visit our website at: www.cohenchildrens.com