Pediatric ENT
At Princeton Eye and Ear, we understand the extra sensitivity that is needed when it comes to evaluating and treating infants and children and for this reason, we make sure to utilize an advanced but minimally-invasive approach. If you have any questions or need any ENT services for your child contact us today to schedule a full evaluation with our experienced doctors.
Pediatric Snoring
Snoring can be troublesome for children because a good night’s sleep is vital for the growth and development of a child. As with adults, the most serious type of snoring is obstructive sleep apnea (OSA), which is identified by gaps in breathing. Parents may notice that the child pauses in between snores, or may gasp, cough or choke while sleeping.
Anatomy:
Snoring in children can be a result of overgrown tonsils and adenoids, both of which block the movement of air while sleeping. The tonsils are usually easily visible on the sides of the throat toward the back. Large tonsils may block nearly the entire back of the throat and cause sleep apnea, however smaller tonsils may also cause symptoms. Adenoids are a tonsil-like tissue that grows above the soft palate near the back of the nose. Large adenoids may contribute to snoring and may also cause nasal obstruction.
Diagnosis:
The size of the tonsils can easily be seen by opening the mouth. The size of the adenoid can be determined by either obtaining a single x-ray of the neck or by passing a small fiberoptic scope through the nostril to the back of the nose. A strong history of sleep apnea and a good physical exam may provide enough information for your doctor to diagnose sleep apnea, however, a more formal sleep study may sometimes need to be obtained. During a sleep study your child will stay overnight (usually at a hospital) and be carefully monitored for pauses in his or her breathing.
Treatment:
Initially, your child’s doctor will take a conservative wait and see approach to determine if the symptoms are minor. If there is significant sleep apnea, your doctor will likely recommend a tonsillectomy and adenoidectomy. Both procedures are done under general anesthesia and can be performed at the same time. Most children will take a week off of school and generally should not travel; they should also limit their physical activities for two weeks. It may be necessary to obtain a new sleep study after the surgery in order to verify that the apnea has resolved. If apnea persists other treatments such as a CPAP machine may be necessary.
References:
Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196
American Academy of Otolaryngology
https://www.enthealth.org/conditions/pediatric-sleep-disordered-breathing/
Ear Infections
Two out of three children will have an experience with an ear infection before their 1st birthday. In fact, ear infections, regarded as one of the most common childhood infections, are very rarely serious and often clear up quickly. A developing immune system along with daycare settings and poor hygiene skills are the main reasons why ear infections are so prevalent in children combined with a developing ear.
Anatomy:
There are two major types of ear infections in children. The first is otitis externa, also known as Swimmer’s Ear. In this condition the ear canal becomes inflamed and infected. Frequently, the ear will be very painful to touch and will drain green or yellow fluid. The second type of ear infection is otitis media which is an infection of the middle ear cavity (which is located behind the ear drum). Because the infection is behind the ear drum, there will rarely be any drainage of fluid or pus into the ear canal.
Diagnosis:
Both types of ear infections can usually be diagnosed using an otoscope to look into the ear.
Treatment:
Otitis externa (Swimmer’s Ear) is typically treated by using antibiotic ear drops. Resolution of pain typically occurs in 24-48 hours. In rare cases, your doctor may place a “wick” which is a special piece of cotton that sits in the ear canal and helps distribute the drops deeper into the ear canal.
Otitis media is typically treated with oral antibiotics. Like otitis externa, the antibiotics may work in 24-48 hours to reduce the pain of the infection, but fluid may remain behind in the middle ear which may cause a temporary hearing loss. This fluid may take days to months to properly drain. In some instances, your doctor may recommend that your child have “tubes” placed. Tubes are recommended if your child has recurring acute otitis media infections or if your child has persistent fluid in the middle ear. Tubes are placed in the operating room under a short general anesthetic. Tubes typically stay in the ear drum 6-18 months are fall out on their own.
References:
https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616
https://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/syc-20351682
https://www.enthealth.org/conditions/swimmers-ear-otitis-externa/
Hearing Loss
Hearing loss in children, like adults, can be caused by many factors and range in severity. Unfortunately, even the mildest form of hearing loss can be of consequence to a child since it will change how they hear the speech of family, friends, and teachers, potentially affecting their ability to properly develop effective communication skills.
Anatomy:
Causes of hearing loss range from genetic and family history, noise trauma, head trauma, and at birth issues such as jaundice. It is important to note hearing loss is not limited to just these causes and it is important to give specific details of factors that may have caused the loss of hearing when visiting a doctor.
Diagnosis:
If a parent suspects that their child may have a hearing loss, they should call an Ear, Nose, and Throat (ENT)) /Otolaryngologist’s office or an Audiologist’s practice as soon as possible. The child will receive age-appropriate testing to determine the type and severity.
Treatment:
One of the most common causes of childhood hearing loss is due to fluid retained in the middle ear behind the eardrum. If the fluid is persistent and causing hearing loss, your doctor may place a tube in order to drain the fluid and prevent it from reaccumulating.
It is important to identify genetic types of hearing loss. You doctor may refer you for further testing and evaluation by other specialists since early hearing loss may be associated with syndromes. Treatment of hearing loss may involve a hearing aid, bone anchored hearing aid or cochlear implant.
References:
https://mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-your-childs-hearing-loss
https://www.enthealth.org/conditions/pediatric-hearing-loss/
Tonsil Infections
Tonsil infections continue to be a common childhood infection. The main signs of tonsillitis are a sore throat and pain in the neck; other symptoms include fever, swollen lymph nodes, and difficulty in swallowing.
Anatomy:
Tonsils are a group of soft tissues located in the back of the throat. Their prime objective is to defend the body from infection by producing antibodies that fight off germs and bacteria. As a result, the tonsils themselves can become irritated causing inflammation and a condition known as tonsillitis.
Diagnosis:
Your doctor can diagnose tonsillitis by examining the tonsil and looking for inflammation and exudates (pus) on the tonsils. Acute infections by the strep bacteria can be diagnosed by swabbing the tonsils and sending for a culture. In some cases tonsillitis may also be caused by a virus known as mononucleosis which can be checked using a blood test.
Treatment:
At home and over-the-counter remedies such as gargling water with salt and lozenges respectively depend on a child’s age. Such remedies should be discussed with a doctor before practicing. In the case of strep throat or other bacterial infections, an antibiotic will be prescribed. Children who have recurrent strep throats may benefit from a tonsillectomy (removal of the tonsils). In general, a tonsillectomy may be offered for a child who has seven episodes of tonsillitis in one year, five episodes per year for two consecutive years, or three episodes per year for three consecutive years.
References:
https://www.enthealth.org/conditions/tonsillitis/
https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479