At Virginia ENT, we provide complete pediatric care for ear, nose and throat problems. From ear infections to otoplasty for protruding ears, tonsillitis, hearing loss, noisy breathing and nosebleeds Virginia ENT is the clear choice for pediatrics. In addition to our highly qualified team of doctors and audiologists we have in office MiniCAT CT scanners which are a truly beneficial option for many patients, particularly our pediatric patients.
Pediatric Ear Infections (Otitis Media)
Middle ear infections typically occur in infants and toddlers. Many children outgrow these infections by the age of 3. However, 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. When the Eustachian tube (a small area 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. The fluid can cause pressure in the ear, mild to moderate temporary hearing loss, and viral or bacterial infections.
Symptoms of a Middle Ear Infection in Children
Symptoms may include:
- Irritability (you might see them tugging at their ear to address the pain)
- Difficulty hearing
- Fluid draining from the ear
- Changes in dietary and sleep habits
- Problems with hearing and balance
Occasionally, the fluid and the infection will quickly resolve with intervention, but typically examination and treatment by a doctor are needed. The onset of symptoms is usually rapid.
Treating a Middle Ear Infection
The first line of therapy for otitis media is typically antibiotics and treatment of the nasal congestion. No matter what 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, or are repetitively painful, or the fluid is persistent and the hearing loss not improving, then more intervention is usually needed.
An alternative to medical management of otitis media is a procedure called tube insertion. This is where a small 3mm soft silicone coated plastic tube is inserted through the ear canal, into the eardrum allowing air to get into the middle ear space and fluid to drain outward. The procedure only takes about five to 10 minutes, it’s done under a light general anesthetic in a carefully monitored operating room. The children experience no discomfort during the procedure and only mild irritation for a few hours afterwards. The tubes last for about six to 12 months and they usually do not need to be reinserted, and the children can still enjoy a chlorinated swimming pool without concern.
Outer Ear Infections/Swimmer’s Ear
Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, bathing or showering or moisture from earplugs or even hearing aids may also cause this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply. This may cause infection and irritation of the ear canal. If the infection progresses it may involve the outer ear.
Symptoms of Outer Ear Infections/Swimmer’s Ear
Symptoms may include:
- Ear canal discomfort
- Ear canal itchiness
- Muffled hearing
- Occasionally fever
Treatment for Outer Ear Infections/Swimmer’s Ear
The treatment for mild infections can include drying of the canal, and applications of slightly acidic drops or even antibiotic drops that are prescribed. More significant infections usually require an ENT physician to clean the canal, occasionally applying suction or placing a tiny sponge in the canal for 24 or 48 hours soaked in special medication. Advanced infections may require even more assistance and medical intervention.
Tonsils & Adenoids
Millions of children are evaluated yearly for large tonsils and adenoids, which can cause problems ranging from obstructive sleep apnea to recurrent throat infections and even ear infections. Symptoms usually include snoring and loud or open-mouthed breathing, restless sleep, and pauses in breathing during sleep. Obstructive sleep apnea can lead to daytime sleepiness and crankiness. Sleep apnea may also lead to hyperactivity. In fact, many children diagnosed with behavioral disorders such as attention deficit-hyperactivity disorder, or ADHD, may actually have obstructive sleep apnea.
Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.
The most common problems affecting the tonsils and adenoids are recurrent infections of the throat and/or ear and significant enlargement that typically cause breathing and/or swallowing problems. You should see your doctor when your child suffers the common symptoms of infected or enlarged tonsils or adenoids.
Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. 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.
Surgery for Tonsils and Adenoids
If your surgeon recommends removal of the tonsils and/or adenoids, the surgery can be done safely and effectively as an outpatient procedure at a local hospital. To minimize the discomfort of this procedure, our doctors perform the most up-to-date technique for removing the tonsils, referred to as Coblation tonsillectomy. While still a challenging recovery, Coblation minimizes discomfort, and improves healing time and makes the experience more tolerable.
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.
There are several postoperative symptoms that may arise. These include, but are not limited to:
- Swallowing problems
- Throat pain and ear pain
Occasionally, bleeding may occur after surgery. If the patient has any bleeding, you should notify the surgeon immediately. In addition, any questions or concerns before or after the surgery should be discussed with the surgeon.
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 complex. Symptoms that 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 serious sinus infection is likely. 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.
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. 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. The ENT may recommend medical or surgical treatment of the sinuses.
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. An x-ray called a CT scan may be ordered to help determine how your child’s sinuses are formed, where the blockage has occurred, and the reliability of a sinusitis diagnosis. In many cases the CT scan can be done with the MiniCAT scanners in our offices. These scanners are upright and emit much lower doses of radiation while producing superior quality images making them very child-friendly.
When Is Surgery Necessary For Sinusitis?
Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue (called adenoiditis) or obstruction of the back of the nose, it can cause many of the symptoms that are similar to sinusitis. These symptoms include: runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.
Typically, the first surgical option considered is an adenoidectomy (i.e., removing the adenoid tissue from behind the nose). This type of surgery has a quick recovery time – often, the child is back to being himself or herself by the next day.
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. This can be accomplished in a minimally invasive approach using balloon dilation. Opening the sinuses and allowing air to circulate usually results in a reduction in the number and the severity of sinus infections. During endoscopic sinus surgery, cultures can be taken to help insure the post-operative antibiotic therapy will be specific to the child’s sinus infection.
Newborn Infant Hearing Screening
The Commonwealth of Virginia mandates every infant receive a hearing screening within one month of birth, preferably prior to discharge from the hospital. When a child fails this screening, he/she is referred to a site that has been approved by the state as having the personnel and equipment necessary to perform the recommended additional testing and provide follow-up and the ongoing medical and hearing care that these children may require. Virginia ENT is such an approved site. Our team of physicians and audiologists are committed to the same goals the state had in establishing this program:
- Early diagnosis and full assessment of any hearing difficulties in children
- Immediate care for infants with hearing losses correctable by medical treatment
- Prompt management and early use of hearing aids, if needed, in order to prevent avoidable speech and language delays in any child with a permanent hearing loss
- Care-filled and comprehensive counseling for families of children with hearing loss including the provision of needed resources
- Cooperative participation with other agencies providing early intervention services to children with hearing loss
More than three million American children suffer from hearing loss. An estimated 1.3 million are under the age of three. Good hearing is essential for good language development. If a child is not meeting his/her developmental milestones for speech and language, careful 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 babies because they spend the most time with them. Signs your child may have a hearing loss include:
- Not awakening, startling, moving, crying or reacting in any way to loud noises,
- Not turning his/her head in the direction of your voice, or
- Not freely imitating sound
If 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 Virginia Ear, Nose & Throat Associates.
Temporary Hearing Loss – Hearing loss can be temporary, caused by earwax or middle ear infections. Children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.
Permanent Hearing Loss – Unfortunately, some children have sensorineural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable 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. This means your child will get a head start on speech and language development.
Sudden Hearing Loss – Sudden hearing loss is an urgent concern which requires physician and audiologic evaluation and sometimes medical management.
Noise Induced Hearing Loss – When a child or adult is exposed to harmful sounds (e.g., sounds that are too loud for too long a time) sensitive structures of the inner ear can be damaged causing noise-induced hearing loss (NIHL). NIHL is a hearing disorder characterized by a gradual, progressive loss of high frequency hearing sensitivity over time as a result of exposure to excessive noise levels. According to the National Institute on Deafness and Other Communication Disorders (NIDCD):
- 10 million Americans have already suffered irreversible hearing damage from noise
- 30 to 50 million more are exposed to dangerous noise levels each day.
Noise induced hearing loss is almost always preventable and it is never too early to start protecting your children’s hearing. Click here to learn more about NIHL.
Evaluation and Diagnosis
Proper workup of all hearing loss is important 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 some of the tools utilized to diagnose potential causes of hearing loss. If a CT scan is indicated, in many cases this can be done in our offices on the MiniCAT scanners. These scanners are upright and emit much lower doses of radiation while producing superior quality images making them very child-friendly. Virginia ENT’ physicians and audiologists will work with you to meet your hearing needs.
The airway is comprised of the pathway from the nose to the lungs, and disease can affect any point along this pathway. Most diseases of the airway are manifested by noisy or obstructed breathing, which can be caused by nasal masses, narrowing of the back of the nostrils (otherwise known as choanal atresia), large adenoids and tonsils, floppiness of the larynx and trachea (otherwise known as laryngotracheomalacia), masses on or paralysis of the vocal cords, and narrowing of the airway below the larynx (otherwise known as subglottic stenosis). Evaluation by an ENT usually includes flexible Fiberoptic examination of the airway from the nostrils to the larynx, and treatment includes endoscopic procedures and open neck surgery performed in the operating room.
Neck Masses in Children
Neck masses are fairly common findings and are often the source of significant concern. 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.
Neck masses may occur in children of all ages as well as in adults. There are a variety of possible causes, such as infectious and/or inflammatory diseases, which result in swollen glands. A neck mass may also be a congenital cyst (i.e., present since birth), traumatic in origin (i.e., caused by an injury) or neoplastic disease.
Whatever the cause of the neck mass, a thorough evaluation by an ENT doctor is recommended.
Diagnosing the origin and nature 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 it will be arranged. Once the diagnosis has been obtained, your doctor will discuss appropriate treatment options with you.
Nosebleeds are a condition commonly seen in children. Most cases resolve spontaneously and represent nothing more than a nuisance to the parent and child. Occasionally nosebleeds become persistent and may require specific treatment. In rare instances, 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 the tissue becoming fragile 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 leading to swollen nasal tissues with enlarged blood vessels. In addition, central heating during the winter tends to dry the nasal linings.
When a nosebleed occurs, it is important to help the child to remain calm. Then:
- Pinch all the soft parts of the nose 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
- 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 more aggressive treatment. A chemical cauterization (burning) of the enlarged blood vessels using a silver nitrate stick can be performed in the doctor’s office. If bleeding recurs after an attempt at local cautery, more aggressive measures may be required including electrical cautery or surgery to tie off the bleeding blood vessel is possible. Surgical intervention is extremely rare in children.