What are ear tubes, why might my child need them?
Children are more susceptible to upper-respiratory and ear infections, and it’s during cold and flu season that upper-respiratory infections crop up, which can lead to ear infections. Symptoms include fever, pain, fussiness, pulling on the ears, and even vomiting and nausea. These infections can lead to temporary hearing loss, but if they happen very often in the most extreme cases there can be permanent hearing loss. Treatment includes antibiotics plus a decongestant, or numbing and antibiotic eardrops, or surgery.
A typical case would be a child with multiple ear infections we will call Amanda. Antibiotics took care of her first, second and third infections. But four different antibiotics, including antibiotic shots, couldn’t cure her most recent infection. At that point, the pediatrician recommended evaluation by an ear, nose and throat specialist. At the time of the examination, hearing was also tested, and a hearing loss was present due to the infected fluid in the ears. Therefore, Dr. Wyatt recommended that tubes be placed in Amanda’s ears to help ventilate and drain the fluid trapped in her ears. In most cases, this will eliminate the infection, prevent it from returning, and correct the hearing loss. Following the surgery, a number of improvements in the child’s behavior are often seen. Having fluid in the ears can hinder the development of a child’s vocabulary and cause balance problems that slow the progress of learning to walk. Many ear infections, which can be caused by a virus or bacteria, happen in the middle ear. The infection happens when fluid cannot drain from the middle ear and becomes stagnant.
One reason children are more susceptible to recurring infections is because the anatomy of their ears makes it difficult for fluid to drain. The fluid drains out of the Eustachian tube, which connects the middle ear to the throat. The tube also helps ventilate the ear. The angle of the tube is more horizontal in kids than in adults; that can hinder drainage and create a breeding ground for infection. Children’s immune systems aren’t fully developed and have trouble fighting off infections.
The first “peak” in ear infections is in babies 13 to 15 months, and a second peak between 4 and 6 years old. Studies suggest that children who are exposed to cigarette smoke and those who go to day care have a greater risk for ear infections. Children are usually sent to an ear, nose and throat specialist if they have had five or six ear infections in less than 12 months, or if they are becoming resistant to antibiotics or are having overlapping ear infections. Any symptoms of hearing loss also need to be evaluated.
How do you evaluate hearing loss in small children?
Hearing in older children can be evaluated almost as easily as adults, but in small children a technique called “conditioning play audiometry” is used. It requires special equipment that we have in our office. Using robotic toys, the audiologist essentially plays a game with the child. He will make one of the toys move after a tone sounds at a calibrated loudness, and the child will rapidly realize that the robot will move shortly after the tone. So, if the child turns to look at the toy when the tone sounds, the child can hear the tone at that level. The game is repeated at different frequencies and loudness levels until the test is completed, usually in less than 15 minutes. If the child will cooperate with wearing headphones, even more accurate results can be obtained.
What are Tonsils and Adenoids and why do they sometimes cause problems?
The tonsils and adenoids are lumps of lymphatic tissue (like lymph nodes) in the back of the throat. There are two tonsils, one on each side of the throat, and one adenoid located at the very top of the throat at the back of the nose. Their function, like all lymph nodes, is to help fight infection. However, the normal human adult or child has far more than enough lymph tissue in other parts of the body to fight infection and to remain entirely healthy without the tonsils and adenoids. Sometimes, for reasons that are not entirely clear, the tonsils and adenoids get chronically infected. If the infections become frequent or severe, than removal of the tonsils and adenoids is recommended to eliminate the infections. It is not known for certain why some children have this problem and others do not, but the problem does tend to run in families.
Adults can have the same problem, although it is much more common in children. Also, sometimes tonsils and adenoids become so large that they interfere with breathing, especially at night. When this occurs, removal is also recommended. In some cases enlarged tonsils and adenoids can cause difficulty swallowing. Although cancer in the tonsils and adenoids is very rare, sometimes tonsils and adenoids are removed for this reason also.
What can be done for sinus infections in children?
In children, most sinus infections are treated with antibiotics, decongestants and other medicines. In children with frequent or severe infections, removing the adenoids will often help a great deal. In a small number of children with frequent or severe infections removing the adenoids does not solve the problem and other measures may need to be considered. These include extra-long courses of antibiotics and consideration of sinus surgery.
Sinus surgery in children is something we will often do as we specialize in this area, but most children, even those with significant sinus problems, do not need surgery. A special case is children with asthma. In some cases asthma can be very difficult to control due to frequent sinus infections. In these children, when medication fails to help, we will move a little more quickly toward sinus surgery because clearing the sinusitis will help control the asthma most of the time.
Is it normal for my child to snore and is it serious if they stop breathing at night?
It is not normal for children to snore, particularly if the snoring is loud and can be heard easily from outside their room. If the snoring stops by age 2 or so it usually requires no treatment, but if it continues it is associated with significant problems.
Children who snore have a higher rate of attention deficit hyperactivity disorder, and in many children snoring is caused by enlarged tonsils and adenoids. In children with ADHD and enlarged tonsils and adenoids, removal of the tonsils and adenoids often will significantly improve the learning disability. For this reason, the major national organization of pediatricians recommends tonsillectomy and adenoidectomy in children with snoring and enlarged tonsils and adenoids. Snoring with stopping breathing at night is a potentially much more serious problem. Stopping breathing, gasping or choking can be caused by obstructive sleep apnea and will usually need to be corrected by removing the tonsils and adenoids.
Is ear, nose or throat surgery more dangerous or difficult in children?
Ear, nose and throat surgery is no more dangerous or difficult than similar surgeries in adults. In most cases, the decision for surgery involves weighing the risk of surgery against the risks of continuing to be sick. For example, repeated tonsil infections, especially when strep.(+), can be associated with serious health problems such as rheumatic fever and kidney failure. These problems are rare, but if infections are occurring often the risk of not doing surgery becomes greater than the risks involved in removing the tonsils.
However, children are not just little adults, and special attention is required. Dr. Wyatt, Dr. Wyll and Dr. Pero have had extensive training and experience with children’s ENT problems. We work with anesthesiologists who also have extensive training and experience with children and the special issues involved in children’s ENT surgery. The operating rooms at the hospitals and surgery centers we use have the specialized pediatric equipment needed to care for children.
If surgery is needed, will my child need to be in the hospital?
Almost all tonsil, adenoid, ear, and sinus procedures in children can be done on an outpatient basis without hospitalization. This is our preference, as both the child and family are usually much more comfortable at home than in a hospital. In those rare cases where hospitalization is needed it can be arranged.