PEDIATRIC OTOLARYNGOLOGY
(Pediatric Ear, Nose and
Throat Specialists)
All of our
Physicians, are fully trained and Board
Certified for treating Medical and Surgical pediatric ENT conditions. A
significant portion of each doctor's five to six years of Specialty Training
(beyond medical school) was devoted to Pediatric patients. Currently a high
percentage of our patients are pediatric patients. Our office is the only one
in Wake County that offers all aspects of Pediatric ENT evaluation and
treatment, including:
- Medical Pediatric ENT evaluation and treatment.
- Surgical Pediatric ENT treatment.
- Speech Evaluation and treatment.
- All techniques of hearing testing for infants and
children
In addition, our audiologists run the Rex Hospital
Newborn Hearing Screening Program.
Our Physicians,
Audiologists, and Speech Therapists take pride in working closely
with our patients and their pediatricians or family physicians to provide the
very best pediatric ENT care available in the area.
Children experience the same ear, nose
and throat problems as adults do. Highlighted in this web page are descriptions
of the most common pediatric ear, nose, and throat disorders and medical or
surgical management of these problems.
Otitis Media (Ear
Infection)
Otitis media, otherwise known as a
middle ear infection, is the most frequent pediatric illness treated by
otolaryngologists, occurring in three out of four children by the time they are
three years old. While well-known as a common ailment, otitis media can be much
more serious if the infection in the ear reaches nearby structures in the head,
sometimes causing mastoiditis and/or meningitis. Also, because it affects
important parts of the ear that help us hear, otitis media can cause temporary
hearing problems and, if left untreated, permanent ones. Hearing loss,
particularly in children, can hinder learning capacity and even impede speech
development. The pain produced by an ear infection can be severe, resulting in
serious distress for the child. Fortunately, timely and effective treatment
will almost always restore a child's hearing to normal.
There are two
types of otitis media: acute otitis media and otitis media with effusion (or
serous otitis media).
Acute otitis media most often
occurs when a virus and/or bacteria enters the ear and causes an infection
(usually from upper respiratory infections like the common cold or allergies)
resulting in an accumulation of infected fluid (pus and mucus) behind the ear
drum. Usually the upper respiratory infection causes swelling and inflammation
of the Eustachian tube (a tube that leads from the middle ear to the back of
the nose and works to regulate pressure in and drain mucus from the middle ear)
and its surrounding tissues. With normal Eustachian tube functioning
compromised, pressure and fluids build up in the middle ear, creating earache,
swelling, and redness. In severe or untreated cases the eardrum ruptures,
allowing pus to drain from the ear. But most often the pus and mucus remain in
the middle ear for some time. If, even several months after the infection has
cleared, fluid remains in the middle ear and stays trapped there, the condition
is known as serous otitis media. Serous otitis media makes it more
difficult to fight new infections, resulting in a frequent reoccurrence of
acute otitis media. Also, because the fluid remains in the middle ear, serous
otitis media further impairs the child's hearing.
Generally both acute
otitis media and serous otitis media respond well to antibiotics and/or
antihistamines/decongestants. Bacterial infections are treated and cured with
antibiotics, while viral infections may have treatable symptoms, but typically
resolve themselves on their own. In severe cases of persistent infection and
fluid build up, further treatment may be required. This is most often a
surgical procedure called a Myringotomy. The procedure involves making a
small opening in the eardrum and inserting tiny tubes to stent it open. The
tubes work to relieve pressure and drain fluid from the middle ear while the
eardrum heals. Usually the tubes stay in place for a few months and fall out on
their own. The child can't feel the tubes in the eardrum and will notice a
significant relief of pressure, improvement in hearing and decrease in the
frequency of ear infections.
Infection and Enlargement of Tonsils and Adenoids
Tonsils and adenoids are masses of
lymphoid tissue in the throat and nose. Tonsils are the two lumps located on
the sides of the back of the throat and are visible through the mouth. Adenoids
are located high in the throat at the back of the nose, above the soft palate.
Adenoids cannot be seen without special instruments.
Tonsils and
adenoids are part of the immune system. Like all lymph tissues that form the
immune system, they trap infectious agents like viruses and bacteria and
produce antibodies to better fight them in the future. Positioned at the back
of the throat, the tonsils help to fight against infected substances entering
through the mouth, while the adenoids, because of their location at the back of
the nasal airway, fight against substances inhaled through the nose. Typically,
the tonsils and adenoids enlarge during early childhood, when infections of the
nose and throat are most common. Both reach their largest size (relative to the
diameter of the throat and airways) in young children.
Problems most
often occur when, while protecting against germs and infection, the tonsils and
adenoids are themselves infected. More serious attention is commonly required
when recurrent infections and significant enlargement or throat/airway
obstruction cause breathing and swallowing problems.
Bacterial
infections of the tonsils and adenoids, especially those caused by
streptococcus (strep throat), initially receive antibiotic treatment. However,
removal of the tonsils and/or adenoids, referred to respectively as
tonsillectomy and adenoidectomy, is sometimes recommended. The two main
instances necessitating removal are (1) persistent viral infection or recurrent
infection despite antibiotic treatment and (2) enlargement of the tonsils
and/or adenoids that causes difficulty breathing and/or swallowing. Some recent
studies also point to an adenoidectomy as effective treatment for some children
with chronic earaches and fluid in the middle ear. Removal of the tonsils
and/or adenoids has no major effect on disease resistance or immune system
function.
Nosebleeds
Though incredibly common in
children, nosebleeds often create unnecessary confusion and anxiety for
parents. Most cases resolve themselves quickly and have no further health
implications for the child, generally resulting from dry nasal linings and
excessive picking or scratching. Occasionally a persistent case or serious
damage to the nasal lining may require specific treatment. In extremely rare
cases, it may be the presenting symptom of a serious local or generalized
disease.
The most common causes of nosebleeds are dry, irritated mucus
membranes in the nose (usually the result of dry, heated, indoor air), severe
colds or allergies (with lots of sneezing, coughing, nose blowing, etc),
excessive picking and scratching and bleeding disorders. Any of these slight
traumas can irritate the fragile blood vessels of the nasal lining and cause
bleeding. Nosebleeds are most common in the winter, when the air from central
heating combines with increase in colds to inflame, dry and crack the nasal
lining.
You'll get the best results in stopping a nosebleed by calming
the child and following these steps:
1. Have the child lean forward
slightly, being sure the head is higher than the heart. Leaning back may make
the child swallow the blood (causing nausea) or cough or choke on the blood.
2. Pinch the soft parts of the nose (the tip and portion of the
nostrils just below the bone) together between your thumb and the side of your
index finger OR soak a cotton ball with Afrin, Neo-Synephrine, or Dura-Vent
spray and place this into the nostril.
3. Maintaining the hold on the
soft parts of the nose, press firmly but gently, compressing the pinched parts
of the nose against the bones of the face.
4. Hold that position
faithfully for a full eight to ten minutes. Avoid releasing the pressure
intermittently to check to see if the bleeding has stopped. Continue for
another eight to ten minutes if the bleeding hasn't stopped.
5. Do Not
pick, rub or blow the nose once the bleeding has stopped. This could dislodge
the newly formed blood clot and cause the bleeding to start all over again.
6. Apply an icepack to the bridge of the nose and cheeks.
7.
Contact a doctor, if bleeding doesn't stop or is accompanied by dizziness,
weakness or fainting, or other unusual symptoms, or if there has been a
significant loss of blood.
Severe cases with recurrent bleeding and
considerable blood loss, or those caused by injuries to the outside of the
nose, face or head, may require a doctor's attention. In such rare cases,
doctors commonly employ a chemical cauterization (burning, usually with silver
nitrate) of the enlarged blood vessels. If bleeding persists, more aggressive
treatments may be necessary, including electrical cautery or surgery to tie off
the injured blood vessel. Surgery is very rarely necessary in children.
