Pediatric Otolaryngology

What is Pediatric Otolaryngology?

If your child has a problem with his or her head or neck, your doctor may advise you to consult a pediatric otolaryngologist. That is someone who treats problems with the ears, nose, and throat, as well as other parts of the head and neck. They are abbreviated as ENTs.

A pediatric otolaryngologist has the skills and qualifications to treat your kid if he or she requires surgery or intensive medical therapy for diseases or disorders involving the ear, nose, or throat. Many general otolaryngologists treat children surgically. However, children can get more specialized otolaryngology care.

Pediatric otolaryngologists work with children from infancy through adolescence. They choose to focus their medical practice on pediatrics, and the particular nature of medical and surgical treatment for children is acquired via extensive training and practice.

 

What other sub-specialties does pediatric Otolaryngology include?

Pediatric otolaryngologists attend medical school for four years. They then receive at least five years of specialized training.

Some also get 1 or 2 years of training in a subspecialty:

• Allergy: These doctors use drugs or a series of injections termed immunotherapy to treat environmental allergies (such as pollen or pet dander). They can also assist you in determining whether your child has a food allergy.
• Facial and reconstructive surgery: These doctors assist patients whose face has been altered by an accident or who were born with abnormalities that must be addressed.
• Head and neck: This type of specialist can help if the child has a tumor in the nose, sinuses, mouth, throat, voice box, or upper esophagus.
• Laryngology: These specialists treat disorders and injuries of the larynx and vocal cords. They can also aid in the diagnosis and treatment of swallowing disorders.
• Otology and neurotology: These professionals can assist the youngster if he or she has an ear problem. Infections, hearing loss, dizziness, and ringing or buzzing in the ears (tinnitus) are all ailments they address.
• Rhinology: These specialists concentrate on the nose and sinuses. Sinusitis, nasal bleeding, loss of smell, stuffy nose, and abnormal growths are all treated.
• Sleep medicine: Some pediatric ENTs specialize on sleep disorders involving breathing, such as snoring or sleep apnea. A sleep study may be ordered by the doctor if the child has difficulty breathing at times during the night.

 

When your child needs to see a pediatric ENT specialist?

A primary care physician can frequently assist with issues affecting your ears, nose, and throat. This is usually the case if you have an acute (short-term) disease such as a sinus infection, ear infection, or sore throat.

However, it is occasionally preferable to consult an otolaryngologist instead. Examples include:

• Frequent episodes of runny nose, nasal congestion, or sinus pressure
• Recurrent infections, such as sinusitis, ear infections, or strep throat
• Frequent attacks of dizziness or vertigo
• Changes in hearing
• Persistent hoarseness of voice or wheezing
• Difficulty swallowing
• A visible lump or bump that appears in your face or neck and does not go away or grows in size
• Sleep-related conditions, such as snoring or sleep apnea

 

What conditions are treated under pediatric Otolaryngology?

Pediatric otolaryngologists can perform surgery and treat a wide range of medical issues. If your child is experiencing an issue involving:

• An ear condition, such as an infection, hearing loss, or trouble with balance
• Nose and nasal issues like allergies, sinusitis, or growths
• Throat problems like tonsillitis, difficulty swallowing, and voice issues
• Sleep trouble like snoring or obstructive sleep apnea, in which the airway is narrow or blocked and it interrupts breathing during sleep
• Infections or tumors (cancerous or not) of the head or neck

Other types of physicians address certain parts of the head. Neurologists, for example, treat disorders with the brain or neurological system, whereas ophthalmologists care for your eyes and eyesight.

Seromucinous otitis, often known as glue ear, is the leading cause of hospitalization for surgery and the leading cause of hearing loss or deafness in children.

Tonsil problems are also a fairly prevalent reason for pediatric ENT visits. The tonsils are positioned in the back of the throat and are the body's first line of defense against infections.

Hearing loss in children is also fairly prevalent. Children might be more challenging to examine and treat since they are unable to express their problems in the same way that adults can.

 

Pediatric Middle Ear Infection (Otitis Media)

Otitis media (middle ear infection) is an inflammation of the middle ear. The area behind the eardrum is known as the middle ear. Otitis media can be caused by a cold, sore throat, or respiratory infection.

 

What are the types of otitis media?

The following are the types of middle ear infection:

• Acute otitis media (AOM) - The middle ear infection might occur quickly. Fluid and mucus become trapped inside the ear, producing fever, ear pain, and hearing loss in the children.
• Otitis media with effusion (OME) - After an initial infection, fluid (effusion) and mucus persist in the middle ear. The child may have ear fullness as well as hearing loss.
• Chronic suppurative otitis media - If the doctor diagnoses chronic suppurative otitis media, he or she has discovered that a long-term ear infection has resulted in eardrum tears. Typically, this is linked with pus flowing from the ear.

 

What are the symptoms of Otitis Media? 

Each child may experience symptoms in a unique way. Some children may have no symptoms. Symptoms may include:

• Irritability
• Difficulty sleeping or staying asleep
• Tugging or pulling at one or both ears
• Fever
• Fluid draining from ear(s)
• Loss of balance
• Hearing difficulties
• Ear pain
• Nausea and vomiting
• Diarrhea
• Decreased appetite
• Congestion

 

What are the causes of acute Otitis Media?

Middle ear infections are typically caused by a malfunctioning eustachian tube, a canal that connects the middle ear to the throat. When this tube is correctly functioning, it:

• Allows air to enter the middle ear.
• Enables fluid outflow from the middle ear.
• Prevents germs and viruses from entering the middle ear.

Fluid is more prone to accumulate behind the eardrum when the eustachian tube is not functioning properly. When this fluid cannot drain, bacteria and viruses can proliferate in the ear, leading to an ear infection. Some of the reasons why the eustachian tube may not function adequately are as follows:

• A cold or allergy that causes swelling and congestion of the nose, throat, and eustachian tube lining (this swelling prevents the normal flow of fluids).
• A malformation of the eustachian tube

Inadequate immunization against the microorganisms that cause ear infections is another cause of ear infections. Other risk factors include a family history of ear infections, day care attendance, and cigarette smoke exposure.

 

Treatment of Otitis Media:

• Pain medication. To ease pain, the doctor may suggest to give the child over-the-counter acetaminophen or ibuprofen.
• Possible antibiotic therapy. Even if your symptoms have subsided, continue to take the antibiotic as advised. Failure to take all of the prescription may result in recurrent illness and bacterial resistance to antibiotics. 
• Ear tubes. Your child's doctor may suggest a procedure to drain fluid from the middle ear if he or she has specific disorders.

 

Foreign bodies in the ear, nose, and airway

Foreign bodies in the ear, nose, and respiratory tract (airway) are common in youngsters. Foreign bodies are any objects that are inserted in the ear, nose, or mouth that are not intended to be there and might cause injury if not treated immediately.

Facts about foreign bodies in the ear, nose, and airway:

• Foreign bodies in the ear, nose, and airway are most prevalent in children younger than five years old. These situations necessitate immediate medical intervention. Foreign bodies in the airway are a medical emergency that must be treated right away.
• Foreign bodies in the respiratory tract can lead to suffocation and death. This is one of the main causes of accidental home death, particularly among children under the age of five.
• Foreign bodies in the ear canal are most commonly encountered in children aged 2 to 4 years.

 

Foreign bodies in the ear:

Foreign bodies can lodge in either the ear lobe or the ear canal. Earrings are commonly discovered in the ear lobe, either lodged in the lobe due to infection or pushed too deeply during insertion. Foreign bodies in the ear canal might be anything that a child can insert into the ear canal. Parents should be aware that children can do serious injury to themselves or other children by inserting things into their ears.

Some particles in the ear may not create symptoms, however others, such as food and insects, may cause ear pain, redness, or discharge. Hearing loss may occur if an object blocks the ear canal.

Foreign bodies in the ear are treated by having the object removed by your child's ENT doctor as soon as possible. The following are some of the procedures that otolaryngologist may use to remove the item from the ear canal:

• Instruments may be inserted in the ear
• Magnets are sometimes used if the object is metal
• Cleaning the ear canal with water
• A machine with suction to help pull the object out

Some objects which are deep in the ear canal may need to be removed in the operating room.

• Suction machines with tubes attached
• Instruments may be inserted in the nose

After the object has been removed, your child's ENT doctor may prescribe drops or antibiotic ointments to treat any probable infections.

 

Foreign bodies in the airway:

Foreign bodies in the airway are a medical emergency that must be treated right away. The foreign body might become lodged in a variety of locations throughout the airway. Foreign bodies in the airway are responsible for roughly 9% of all home unintentional fatalities in children under the age of five.

Ingestion of foreign bodies need rapid medical treatment. The following are the most prevalent signs of choking in children. However, each child may experience symptoms in a different way. Symptoms could include:

• Choking or gagging upon initially inhaling the item
• Coughing at first
• Wheezing (a whistling sound, usually made when the child breathes out)

Although the above-mentioned symptoms may subside, the foreign body may still be restricting the airway. The following symptoms may suggest that the foreign body is still obstructing the airway:

• Stridor (a high-pitched sound made by the child when he or she breathes)
• A worsening cough
• Inability to speak
• Chest or throat pain
• Hoarse voice
• Cyanosis around the lips
• Inability to breathe
• The child may become unconscious

The severity of the obstruction determines the treatment. If the item totally blocks the airway, the child will be unable to breathe or speak, and his or her lips will become blue. This is a medical emergency, and you should seek immediate medical attention. Surgical removal of the item is sometimes required. Children who are still talking and breathing but exhibit other symptoms should be checked by an ENT immediately.

 

Acute Sinusitis in children

Acute sinusitis causes inflammation and swelling of the spaces within your nose (sinuses). This obstructs drainage and causes mucus to accumulate. It may be difficult to breathe through your nose if you have severe sinusitis. You may notice swelling around your eyes and face, as well as throbbing facial pain or a headache.

The common cold is the most prevalent cause of acute sinusitis. Most instances, unless a bacterial infection develops, subside within a week to ten days. Home treatments may enough to treat acute sinusitis. Chronic sinusitis is defined as sinusitis that lasts more than 12 weeks despite medical therapy.

Acute sinusitis signs and symptoms often include:

• Thick, yellow or greenish mucus coming from the nose (runny nose) or down the back of the throat (postnasal discharge)
• Tenderness, swelling, and pressure around your eyes, cheekbones, nose, or forehead, which intensifies when you lean over
• Ear pressure
• Headache
• Aching in your teeth
• Altered sense of smell
• Cough
• Bad breath
• Fatigue
• Fever

Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

• Saline nasal spray, which you spray several times a day into your nose to cleanse your nasal passages.
• Nasal corticosteroids. These nasal sprays aid in the prevention and treatment of inflammation. Fluticasone, budesonide, mometasone, and beclomethasone are a few examples.
• Decongestants. These drugs are available as over-the-counter (OTC) and prescription liquids, pills, and nasal sprays. Use nasal decongestants just for a few days. Otherwise, they may bring back more severe congestion (rebound congestion).
• Allergy medications. Allergy medicines may help reduce allergy symptoms if your sinusitis is caused by allergies.
• OTC pain relievers, such as acetaminophen, ibuprofen, or aspirin.
• Antibiotics. They are typically not required to treat acute sinusitis since it is caused by a virus rather than bacteria. Even if your acute sinusitis is bacterial, it may resolve on its own. Before prescribing antibiotics, your doctor may decide to wait and observe whether your acute sinusitis worsens.

 

Pediatric Tonsillectomy

Tonsillectomy refers to the surgical removal of the tonsils while under general anesthesia. Tonsils may be seen through the mouth and are positioned at the back of the throat. If you have sleep apnea, snoring, or recurring tonsil infections (tonsillitis), surgery may be indicated. If a doctor decides to remove both tonsils and adenoids, a single surgery to remove both is frequently suggested.

Tonsil removal is performed under general anesthesia by an Ear, Nose, and Throat Specialist. Tonsils are extracted through the mouth using specialized equipment, and the procedure lasts roughly 30 to 45 minutes. If your kid has sleep apnea, is under the age of three, or lives more than 45 minutes away, you may be requested to remain overnight following surgery.

Tonsil removal recuperation time ranges between one and two weeks. During this period, a kid may encounter the following:

• Severe throat pain
• Throat pain referred to the ears
• Scabs where tonsils have been removed
• Bad breath
• Nausea and vomiting
• Low grade temperatures
• Up to 3% of children may experience bleeding from the site where their tonsils were removed.

Following surgery, patients should expect moderate to severe pain. Acetaminophen and ibuprofen are the most often used pain relievers. If the other pain medications are ineffective, your surgeon may prescribe oxycodone, a liquid opioid.

 

Other Pediatric Otolaryngology disorders

Hearing disorders in children (loss):

Sensorineural hearing loss and conductive hearing loss are the two most common kinds of hearing loss. Sensorineural hearing loss occurs when the auditory nerve or inner ear is destroyed. This is a permanent hearing impairment. When sound waves cannot reach the inner ear, the child has conductive hearing loss. This might be due to earwax accumulation, fluid in the ear, or a hole in the eardrum.

Addressing the possible underlying disease that causes hearing loss is the first step in the treatment but, most of the time, the cause of a child's hearing loss cannot be reversed, and therapy consists of using a hearing aid to compensate for the impairment to the greatest extent feasible.

 

Speech, language and voice disorders:

children with voice disturbances which impact their breathing and/or voice. Conditions treated include:

• Voice abnormalities
• Vocal fold disorders include:
• Abnormal closure (also called paradoxical vocal fold dysfunction)
• Nodules
• Paralysis
• Voice box disorders (also called Laryngomalacia)

 

Swallowing disorders:

Dysphagia is another term for swallowing difficulties. The issue can arise at any point throughout the regular swallowing process when food and drink pass from the mouth, down the back of the throat, and into the stomach. Difficulties include difficulty swallowing and coughing due to food or liquid entering the trachea (aspiration).

 

Facial and neck masses:

Infants and children frequently have facial and neck lumps. Some of the neck tumors we treat are congenital (existing at birth) and are the product of aberrant fetal development. A neck mass may first arise as a result of an upper respiratory illness, such as a cold or sinus infection; the infection causes the neck mass to expand and become uncomfortable.

Although a neck tumor may include other tissues in the head and neck region, the vast majority are benign (non-cancerous). Cancerous neck masses are uncommon in newborns and children.

• Wryneck (also called congenital muscular torticollis)
• Neck mass abnormalities (also called branchial cleft abnormalities)
• Head and neck cysts (including thyroglossal duct cyst, Dermoid Cyst, pilomatrixoma)
• Lymphatic malformations
• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma
• Neck Abscess

 

Craniofacial irregularities:

Craniofacial irregularities (or anomalies) are birth malformations in the development of the head and facial bones. Some are minor, whilst others are serious and necessitate surgery. The most prevalent forms of craniofacial diseases are as follows:

• Cleft lip and /or cleft palate
• Premature closure of an infant’s soft spots (also called craniosynostosis)
• Underdeveloped facial tissues 
• Birthmarks made up of blood vessels (also called vascular malformation and lymphangiomas)
• Port wine stains (also called hemangioma)
• Misshapen head (also called deformational plagiocephaly)

 

Facial trauma:

Physical injury to the face is referred to as facial trauma. The many problems that come under the area of facial trauma are treated by the pediatric ENT doctors.

• Facial soft tissue injuries:
  • Burns
  • Lacerations
  • Bruises
• Bone fractures:
  • Facial
  • Nose
  • Jaw
• Eye injuries

 

Tracheal disorders:

The trachea includes all structures used for breathing including the trachea, esophagus and lungs. Many trachea disorders are considered birth defects.

Conditions include:

• Narrowing of the trachea (also called tracheal stenosis)
• Abnormal esophageal-tracheal connections (also called tracheoesophageal fistula)
• Deformed esophagus (also called esophageal atresia) – a birth defect
• Tracheomalacia – Chest rings are inadequate to keep your child's airways open when exhaling.
• Esophageal compression by pulmonary arteries (also called pulmonary artery sling) – rare birth defect
• Deformed traches (also called complete tracheal rings) – rare birth defect
• Airway tumors

 

Tracheostomy dependent children:

A tracheostomy is a surgical hole through the neck and into the trachea that allows a newborn or child to breathe through a specific tube. The tube is sometimes connected to a ventilator.

 

Conclusion

Pediatric Otolaryngologists are doctors specializing in conditions of the ears, nose, and throat. They’re the same thing as pediatric ENT doctors. In addition to diagnosing and treating these conditions, otolaryngologists can also perform surgery.

Common conditions that affect pediatric age group and require pediatric otolaryngology consultation include:

• Child ear infections (Middle ear infection)
• Foreign bodies in the ear, nose, and airway
• Sinusitis
• Tonsillitis
• Deviated septum
• Nosebleeds
• Hearing disorders
• Speech disorders
• Swallowing disorders
• Facial and neck masses 
• Craniofacial anomalies
• Facial trauma
• Tracheal disorders