Middle Ear Infections (Otitis Media) Middle ear infections typically occur in infants and toddlers with many children outgrowing the infections by age 3 years old. Eighty percent (80%) of children will have two or more episodes of otitis media by their second birthday. Otitis media is an infection involving the middle ear space, which is behind the eardrum. Usually, this space is dry, but when the Eustachian tube (a small passage that connects the back of the nose to the actual middle ear) doesn’t work well, mucus or thick fluid develops in the middle ear space. This fluid can cause pressure in the ear, mild to moderate temporary hearing loss, and viral or bacterial infections. Symptoms can include fussiness, irritability, fever, changes in dietary and sleep habits and problems with hearing and balance. Occasionally the fluid and the infection will resolve without intervention, but usually examination and treatment by a doctor is needed.
Treatment of Ear Infections
The first line of therapy is typically antibiotics and treatment of the nasal congestion. Whatever treatment is given, it can take more than a few days for the infection to resolve and weeks for the fluid to resolve. When the infections become very frequent, repetitively painful, or the fluid is persistent and the hearing loss not improving, then additional intervention is usually needed and a procedure called tympanostomy tube insertion may be recommended. This is where a small pinhole is made in the eardrum and a 3 mm soft silicone or plastic tube is inserted into the eardrum, allowing air to enter the middle ear space and fluid to drain outward. The procedure only takes about five to 10 minutes and is done under a light general anesthetic in a carefully monitored operating room. The child experiences no discomfort during the procedure and, at most, only mild irritation for a few hours afterwards. A single dose of Tylenol is usually adequate to eliminate this. The tubes last for about six to twelve months, after which they typically fall out by themselves. During the time that the tubes are in place, it is recommended that water exposure to the ears be minimized by using earplugs, ear putty or similar ear protection. Please discuss any specific issues regarding tympanostomy tube insertion with your physician.
Outer Ear Infections/Swimmer’s Ear
Swimmer’s ear is an infection of the outer ear structures. It may occur from water trapped in the ear canal due to swimming, bathing or showering, or moisture from earplugs. Even hearing aids may cause this common infection. It may also be caused by scratching the ear canal (often with a Q-tip). Bacteria that normally inhabit the skin of the ear canal multiply, causing infection and irritation of the skin of the ear canal. If the infection progresses it may involve the outer ear. Symptoms include pain, ear blockage, drainage, and occasionally fever. Infection may be more serious in people who have diabetes.
Treatment of Outer Ear Infections
The treatment for mild infections can include drying of the canal and applications of slightly acidic drops or even antibiotic drops that are prescribed by a medical professional. More significant infections usually require an ENT specialist to clean the canal and, in some cases, suction the infected material out of the canal or put a tiny sponge in the canal soaked with special medication for 24 or 48 hours. Advanced infections may require even more medical intervention.
More than three million American children have hearing loss. An estimated 1.3 million of these children are under the age of three. Good hearing is essential for proper language development. If a child is not meeting his or her developmental milestones for speech and language, accurate diagnosis and timely hearing intervention are critical to ensure that the child has an opportunity for normal speech.Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them.
Signs that your child may have a hearing loss include:
- does not startle, move, cry or react in any way to unexpected loud noises,
- does not awaken to loud noises,
- does not turn his/her head in the direction of your voice, or
- does not freely imitate sound
If at any time you suspect your baby has a hearing loss, discuss it with your doctor. He or she may recommend evaluation by an ear, nose and throat doctor (an Otolaryngologist) such as those with North Shore Ear, Nose & Throat Associates.
Treatment of Hearing Loss in Children
Temporary hearing loss can be caused by ear wax or middle ear infections and many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.
Sudden hearing loss can be urgent and requires physician and audiologic evaluation and sometimes medical management. Proper workup of gradual hearing loss is necessary to identify potentially treatable causes and attempt to restore lost hearing function. Clinical history, audiograms, otoacoustic emissions, tympanometry, auditory brainstem responses, and radiographic imaging are utilized to diagnose potential causes.
Sensorineural hearing loss (sometimes called nerve deafness) is permanent. A medical evaluation should be undertaken to determine the potential cause of the hearing loss and any potential genetic implications. A continuously increasing ability to evaluate the genetic causes of hearing loss is available through laboratory testing. Most children with this type of hearing loss have some remaining hearing and children as young as three months of age can be fitted with hearing aids. Early diagnosis, early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child’s existing hearing to give your child a head start on speech and language development.
All children, including newborns, can be given accurate hearing tests. The physicians and audiologists at North Shore ENT Associates offer comprehensive evaluation of your child’s hearing needs.
Neck masses are fairly common and often the source of significant concern. They may occur in children of all ages as well as in adults. There are a variety of causes for neck masses including infectious and/or inflammatory diseases which result in swollen glands. They may also be due to congenital cysts which have their origins from birth, traumatic in origin (i.e., caused by an injury) or malignant disease. Whatever the cause of the neck mass, a thorough evaluation by a board-certified ear, nose and throat specialist (an otolaryngologist) is recommended.Diagnosing the cause of the neck mass can sometimes be made after a simple history and a complete physical examination has been completed in the physician’s office. If additional testing is required we will be arrange it for you. Once the diagnosis has been obtained, your doctor will discuss treatment options with you.
Fortunately most neck masses are benign (non-cancerous). Nonetheless it is imperative that all persistent neck masses be evaluated by an otolaryngologist for diagnosis and treatment.
The airway is the pathway from the nose to the lungs, and disease can affect any portion of this pathway. Most diseases of the airway are manifested by noisy or obstructed breathing and this can be caused by nasal masses, narrowing of the back of the nostrils (choanal atresia), large adenoids, large tonsils, immaturity of the voice box (larynx) or trachea (laryngo/tracheomalacia), masses or paralysis of the vocal cords, and narrowing of the airway below the larynx (subglottic stenosis). Evaluation in the doctor’s office usually includes flexible fiberoptic examination of the airway from the nostrils to the larynx, and treatment may include endoscopic (through telescopes) procedures and open neck surgery performed in the operating room.
Nosebleeds are commonly seen in children. Most episodes resolve spontaneously and represent nothing more than a nuisance to the parent and child. Occasionally nosebleeds become recurrent or persistent and may require specific treatment. Rarely, a nosebleed may be the presenting symptom of a serious local or generalized disease.Nosebleeds are often the result of extremely dry nasal linings which lose the protective layer of mucus. This leads to fragility of the membranes which then has a tendency to bleed following the slightest trauma. Nosebleeds are most common during the winter because of the increased incidence of colds which leads to swollen nasal membranes with engorged blood vessels. In addition, central heating during the winter months tends to dry the nasal linings.
When a nosebleed occurs, help the child remain calm and then:
- Pinch all the soft part of the nose together, below the bones, between your thumb and the side of your index finger or soak a cotton ball with Afrin or Neo-Synephrine spray and place into the nostril.
- Press firmly but gently with your thumb and the side of your index finger toward the face, compressing the pinched parts of the nose against the bones of the face.
- Hold that position for a full five minutes by the clock.
- Keep the head higher than the level of the heart. Sit up or lie back a little with the head elevated.
- Apply ice – crushed in a plastic bag or washcloth – to the nose and cheeks.
More severe cases with frequent bleeding and significant blood loss may require additional treatment. A chemical cauterization of the enlarged blood vessels using silver nitrate can be performed in the doctor’s office. This is usually done after the application of topical anesthetic. If bleeding recurs after an attempt at chemical cautery, more aggressive measures may be required including electrical cautery or surgery to tie off the bleeding blood vessel, however, surgical intervention is extremely rare in children.
A child’s sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes varied.Symptoms which may indicate a sinus infection include:
- a “cold” lasting more than 10 to 14 days, sometimes with a low-grade fever
- thick yellow-green nasal 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
Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears. 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 week to ten days, a sinus infection should be considered. The occurrence of sinus infections may be decreased by reducing your child’s exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.
Treating Sinus Infections
For 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 suffers from one or more symptoms of sinusitis for at least twelve weeks, he or she may have chronic sinusitis. Although more unusual in children, 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. Appropriate evaluation may reveal the underlying cause of the problem.
If your child sees an ENT specialist, the doctor will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. A computerized x-ray called a CT scan may help to determine how your child’s sinuses are formed, where the blockage has occurred, and the accuracy of the diagnosis.
When Is Surgery Necessary For Sinusitis?
Surgery is considered for the small percentage of children who have severe or persistent sinusitis symptoms despite medical therapy. Typically, the first surgical option considered is an adenoidectomy (i.e., removing the adenoid tissue from behind the nose). This is typically a day surgical procedure and recovery is generally mild with full return to normal in 3-4 days. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue (adenoiditis) or obstruction of the back of the nose can mimic sinusitis with runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.
If allergy treatment and an adenoidectomy fail to control the sinusitis, functional endoscopic sinus surgery would be a second surgical option. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of the child’s sinuses and makes the narrow passages wider. Opening the sinuses and facilitating their drainage usually results in a reduction in the number and the severity of sinus infections.
TONSILS & ADENOIDS
Millions of children are evaluated yearly for enlarged tonsils and/or adenoids which can cause problems ranging from obstructive sleep apnea to recurrent throat infections and even ear infections. Symptoms usually include snoring and loud breathing, open-mouthed breathing, restless sleep, and pauses in breathing during sleep. Obstructive sleep apnea can lead to daytime sleepiness and crankiness, or may paradoxically lead to hyperactivity. In fact, some children diagnosed with behavioral disorders such as attention deficit-hyperactivity disorder, or ADHD, may actually have obstructive sleep apnea underlying this behavior.
Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or “glands” found in the neck and the rest of the body. Tonsils are the two masses on the back of the throat. Adenoids are higher in the throat above the roof of the mouth (soft palate), behind the nose. They are not visible through the mouth without special instruments.
Another common problem affecting the tonsils and adenoids is recurrent infection. Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. If infections become frequent or severe, removal of the tonsils and/or adenoids may be recommended.
Surgery for Tonsils and Adenoids
The two primary reasons for tonsil and/or adenoid removal are:
- Recurrent infection despite antibiotic therapy, and
- Difficulty breathing due to enlarged tonsils and/or adenoids.
If your surgeon recommends removal of the tonsils and/or adenoids, be assured that the surgery can be done safely and effectively, often as an outpatient procedure. In preparing for the surgery, talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with the friend.
Information for Patients and Parents
After Tonsil Surgery
Detailed post-operative instructions will be provided by your surgeon. There are several post-operative symptoms that typically arise. These include, but are not limited to:
- Painful or difficulty swallowing
- Nausea and vomiting
- Throat pain
- White healing tissue in back of throat
- Bad breath
- Ear pain
Occasionally, delayed bleeding may occur after surgery. If this occurs, it is typically between the 5th and 10th day after the procedure. If the patient has any bleeding lasting more than 10 minutes or repeated episodes of brief bleeding, you should notify the surgeon immediately. In addition, any questions or concerns before or after the surgery should be discussed with the surgeon.