Pediatric ENT 

Ear Infections

Middle ear infections are very common in infants and young children. Symptoms may include ear tugging or pain, fever, irritability, and hearing loss. The eustachian tube keeps the middle ear healthy by ventilating and draining the middle ear. If it does not do its job, then middle ear infections may occur. Middle ear fluid can persist for weeks or months affecting hearing and speech development. Predisposing conditions for pediatric middle ear infections include daycare exposure, smoking and allergies. Ear tubes will stop recurrent infections and improve hearing.

Swimmer’s Ear

Ear canal infections are more common in summer months when children are outdoors and go swimming. Retained moisture in the ear canal and skin irritation lead to painful and tender ears. Avoid using Q-tips in the ears. Treatment involves staying out of the pool, keeping the ear dry and using antibiotic eardrops. Sometimes a small wick has to be inserted into the ear canal to facilitate drop penetration and expand the ear canal. This is done in an ENT office using a microscope at which time the ear canal can also be cleaned out.

Hearing loss

The most common cause of hearing loss is due to chronic or recurrent ear infections. Hearing loss early in life can delay speech acquisition and development. Ear tubes can greatly help eliminate this and prevent complications later leading to further hearing loss. Congenital hearing loss is another less common cause that needs to be identified. Most children have a screening hearing test after birth. If your child fails that test be sure to follow up with your pediatrician or see an ENT doctor.

Tonsils and Adenoids

Enlarged tonsils, adenoids or both can cause obstructive symptoms such as mouth breathing, snoring, disruptive sleep, daytime sleepiness and cause your child to feel cranky. Prolonged mouth breathing can affect facial development and contribute to malocclusion resulting in more severe orthodontic problems. Sleep disordered breathing or sleep apnea should be addressed and many times is corrected with tonsillectomy and adenoidectomy.

Viral infections, strep or other bacteria may cause recurrent tonsillitis or adenoiditis. It is important to identify strep tonsillitis with a throat swab or culture because untreated infections can harm the kidneys. Some children can be carriers and re-infect themselves. Too many infections are an indication for tonsillectomy and/or adenoidectomy.

Tongue Tie

The bottom portion of the tongue has a small fibrous band called the frenulum that anchors it to the floor of the mouth. Some newborns or young infants may have a tight frenulum that can affect nursing or eating. Rarely does this affect speech. Frenotomy is a simple office procedure to cut this band of tissue allowing greater tongue mobility and easier nursing for the infant and mother.

Allergies

Allergies often occur early in childhood and are associated with other allergic conditions such as eczema and asthma. These may improve as a child ages but can persist or worsen with time. Common symptoms we are all familiar with are sneezing, runny nose, cough, congestion, and increased susceptibility to upper respiratory infections. Allergies often result in enlarged tonsils and adenoids that contribute to breathing and sleeping problems. Medications help alleviate symptoms but do not address the root problem. Allergy drops under the tongue are a great alternative to allergy shots. Make an appointment with Dr. Coppola for allergy evaluation and treatment.

Head and Neck Masses

Lymph nodes are small pea sized structures scattered throughout our body but especially in the head and neck. They may enlarge due to inflammation, infection, or malignancy. Benign reactive lymph nodes usually get smaller after infection is gone but sometimes may persist for some time. A visit with your pediatrician can help reassure everything is fine. Any enlarging lymph node without resolution should prompt an ENT consultation. Other masses in the neck may be congenital cysts. A thyroglossal duct cyst develops in the midline under the chin. A branchial cleft cyst usually appears on the side of the neck. Either of these may be stable in size or continue to grow. Sometimes they become infected and form an abscess that has to be drained. It is better to remove these when they are smaller or before infection occurs.

Nosebleeds

Pediatric nosebleeds or epistaxis are very common. While they may be annoying and inconvenient, they are rarely a serious problem. Allergic rhinitis is a frequent predisposing condition due to inflamed nasal membranes. Septal deviation and cold dry air also aggravate nosebleeds. The use of saline nasal sprays and moisturizing gels can be very helpful. Sometimes the inside of the nose must be cauterized to stop recurrent episodes. This is often done in the office under topical anesthesia, but younger children may require a brief trip to the operating room.

Sinus Infections

The sinus cavities are not fully developed until adolescence. These spaces are easily infected by viruses but are usually self-limiting to seven days. If inflammation persists bacterial infection may occur resulting in longer symptoms of cough, nasal discharge, ear congestion and malaise. Treatment with antibiotics can shorten the time frame of these infections when appropriate. If symptoms persist or keep recurring schedule an evaluation with Dr. Coppola. Allergy evaluation and removal of large adenoids may be extremely helpful.

Pediatric ENT Treatments and Procedures

Tonsillectomy/Adenoidectomy

Tonsillectomy and adenoidectomy are common surgical procedures children may benefit from. One indication for surgery is enlargement of these structures that results in chronic snoring, sleep disordered breathing and sleep apnea. Allergies and chronic infection may lead to progressive and persistent enlargement with obstruction of the upper airway. This surgery is almost always curative for these problems. Children who are overweight or obese may still be at risk for continued breathing disturbances at night. In those situations, a sleep test may be indicated.

Another frequent indication for tonsillectomy and/or adenoidectomy is recurrent tonsillitis caused by viruses or bacteria. Antibiotics are used to treat strep tonsillitis or other bacterial infections. If your child has too many infections in one year or has recurrent infections for two or more years, then surgery may be appropriate. Tonsillectomy and adenoidectomy are short surgical procedures often done in an outpatient surgery center.

Ear Tubes

Ear tubes or tympanostomy tubes should be considered if your child suffers from too many ear infections or has persistent middle ear fluid that does not resolve. Eustachian tube dysfunction is the root cause of ear infections. Normal eustachian tube function may not occur until the age of six or seven before ear infections become less common. Some children may continue to be at risk for ear infections beyond this age. Ear tubes can break the cycle of recurrent infections and give your child time for eustachian tube maturity to occur. Sometimes adenoidectomy is performed with ear tubes under certain conditions.

Tympanostomy tubes are one of the most common surgical procedures performed. It involves a brief gas inhalation anesthetic (no IV) in the operating room. A small incision is made in the eardrum and fluid is drained from the middle ear. An ear tube is inserted into the eardrum to provide ventilation and drainage. Eardrops are often used at the time of surgery and for several days after. Your child will be in the recovery room before you know it and soon you are on your way home. Office follow-up is typically in two weeks. The tubes may last a year or longer before they extrude into the ear canal. If your child has recurrent ear infections in the future, it is possible a second set of tubes may be required.

Frenulectomy

In newborn infants, tongue-tie may prevent adequate breast-feeding. A tight frenulum may restrict tongue mobility and impair latching on to mother’s breast. Frenotomy or frenulectomy is a simple office procedure to release the frenulum and allow immediate breast-feeding. Call right away for an appointment so your baby can breast-feed and nurse successfully.

Nasal Fracture Repair

Children and teenagers are involved with many activities and sports that may result in facial trauma. A broken nose is a common injury that can affect the appearance and function of the nose. Surgery is recommended if the nose looks crooked or breathing is compromised. This should be done within two weeks before the bones have healed in the wrong position. Don’t delay evaluation and treatment because a more complex operation may be required months or years later.

Neck Mass Removal

There are various congenital neck masses that may present in childhood or adolescence. They may present as a painless slow-growing lump or remain stable in size. Thyroglossal duct cysts are benign cysts that occur in the midline under the chin and above the Adam’s apple. Branchial cleft cysts develop on the side of the neck. These often get infected with an upper respiratory infection. Surgery involves removing the cyst and adjacent tissue so they do not recur. It is best to do this before infections occur.

Allergy Drops

Allergies are very common in childhood. Treatment of allergy symptoms includes medications and possibly allergy shots. A great alternative to allergy shots is the use of allergy drops. Instead of injections once or twice a week, specially formulated drops are placed under the tongue several times a day. No needles or injections are required. Allergy drops are extremely safe and effective. Over time your child develops tolerance as desensitization progresses. Symptoms are markedly reduced, much less medication is needed, and fewer upper respiratory illnesses occur. Treatment usually lasts three to four years.