Conditions & Treatments > pediatric ent
Otitis Media + Video
- Tonsillectomy + Video
- Adenoidectomy
- Examining your child
Otitis Media
Otitis media is a condition in which inflammation occurs behind the eardrum (the thin sheet of tissue that passes sound waves between the outer and middle ear). It is usually due to bacteria or viruses, which are often related to a recent cold or allergy problem. In many cases, both ears are affected. Otitis media is most common in young children, whose ear anatomy is not yet fully developed. Children under age 5, boys, bottle-fed infants, and children in daycare run the greatest risk of infection. Although much less common, otitis media can also occur in older children and adults.
Otitis media can be painful and they tend to disrupt sleep- for you as well as for your child. But this isn't the full extent of the problem. Otitis media can also limit the eardrum's flexibility, reducing your child's ability to hear. This could make it harder for your child to learn to talk. Depending on when the hearing problem starts and how long it lasts, your child's learning ability could be affected.
What causes middle ear fluid?
Otitis media results in fluid within the middle ear. Here are some things that may cause middle ear fluid to happen in your child:
Past ear infection. It is common for children to have middle ear infections. And some children with middle ear infection later have:
- Middle ear fluid.
- Blockage of the Eustachian tube.
- Cold or flu
There is no one cause for middle ear fluid. Often, your child's health care provider will not know what caused the middle ear fluid.
How can Middle Ear Fluid be prevented?
Recent studies show that children who live with smokers and who spend time in group child care have more ear infections.
Because some children who have middle ear infections later get middle ear fluid, you might help prevent middle ear fluid by:
- Keeping your child away from cigarette smoke.
- Trying to keep your child away from playmates who are sick.
Medical management
Most children have had at least one middle ear infection by the age of 2. Treatment may depend on whether the problem is acute or chronic, as well as how often it comes back and how long it lasts. The doctor may prescribe medication and then watch to see how healing progresses. For many children, taking antibiotics and reducing risk factors are all the treatment that's needed.
If this is your child's first or second acute infection, the doctor may prescribe antibiotics and suggest a period of "watchful waiting". During this time, your child's ears will probably be retested to look for any eardrum or hearing changes. In most cases, fluid outlasts the acute infection by two or three weeks. If the fluid buildup becomes chronic, however, the doctor may watch your child for up to several months. Why? Because even chronic fluid may go away with time - provided that no new infection occurs.
Some behaviors or surroundings increase your child's risk of ear infection. Reducing such risk factors can be a benefit at any point in treatment. The tips below may help:
- If your child goes to group daycare, he or she runs a greater risk of getting colds or flu. Help prevent these illnesses by teaching your child to wash his or her hands often.
- If food allergies are a problem, identify the food that triggers the reaction and help your child avoid it. In some children, eating or drinking dairy products causes tissues around the Eustachian tube to swell. This may make a blockage more likely
Antibiotics may be used as a short- or long-term treatment, depending on whether the ear problem is acute or chronic. Either way, antibiotics will be effective only in treating bacterial infections. For an acute middle ear infection, the doctor may prescribe 7 to 14 days of antibiotic treatment. In a case of chronic fluid, the doctor may suggest using antibiotics to prevent any new infection while waiting for the fluid to go away. Such antibiotic use may last weeks or months.
Although most children can take antibiotics without problems, side effects can occur. Some children get stomach upset, including vomiting or diarrhea. Some get rashes, hives, puffy eyes, or yeast infections. In rare cases, an allergic reaction may cause breathing problems that require immediate medical care. If your child shows any type of reaction during antibiotic use, call the doctor.
Surgical management
In some cases, medical care alone cannot control middle ear problems. If your child has hearing loss or if fluid still remains after several months, surgery may be recommended to treat the middle ear. An ENT (ear, nose, and throat) specialist (also called an otolaryngologist) will examine your child and talk with you about the surgical procedure. If you decide on surgery, you'll be told how to prepare your child and you'll be informed about the anesthesia.
As a parent, you may find it difficult to consider surgery for your child. You're not alone. Many parents feel this way, despite knowing that the procedure can improve their child's health. If necessary, give yourself a little time before making a decision. This way, emotions are less likely to affect your judgement. A talk with your child's pediatrician or primary care doctor may help. If you decide on surgery, you'll work with the specialist's office to set a date. The doctor may want to see your child a day or two before surgery to make sure he or she doesn't have a cold.
During surgery. the ENT specialist removes the fluid from your child's middle ear and places a tiny tube in the eardrum. This tube creates a very small tunnel between the outer ear canal and the middle ear. This tunnel balances air pressure on both sides of the eardrum and prevents fluid buildup, even if your child's Eustachian tube becomes blocked again. In most cases, surgery can be done on both ears in less than 30 minutes. If adenoid problems are also being treated, surgery takes a little longer.
Once your child is asleep, the ear canal is cleaned. Then, using an operating microscope and special surgical instruments, the ENT specialist makes a small slit in the eardrum (tympanostomy). Next, a hollow instrument is passed through the slit in the eardrum. Using gentle suction, the fluid is withdrawn through the instrument. In some cases, a fluid sample may be sent to a lab. If the infection is still active, the lab may identify whether it is viral or bacterial. After the fluid is removed, the ENT specialist inserts a tiny tube into the same slit in the eardrum (tympanostomy). Once in position, the shape of the tube helps keep it in place. Tubes can be made of plastic or metal, and they vary slightly in size and shape. The ENT specialist chooses the tube most likely to provide the best results for your child.
After surgery is completed, your child will be taken to a recovery area. There, nurses will monitor your child's condition until the anesthesia wears off. Once fully awake, your child should be able to go home. in fact, even after adenoid surgery, most patients go home the same day. Although your child can soon return to normal activities, be aware of the signs that require calling the doctor.
Following surgery, cotton may be placed in your child's ears, and he or she may be given medication for pain relief. Within a half-hour, your child will wake up. You may be allowed into the recovery room at this time, depending on the facility. When you join your child, don't be alarmed if he or she is upset. Anesthesia may reduce self-control, causing some children to cry or scream. You can help calm your child by acting normally and speaking softly.
Although your child is unlikely to have problems after surgery, call the doctor for any of the following:
- The ear bleeds heavily or keeps bleeding after the first 48 hours
- Sticky or discolored fluid drains out of the ear after the first 48 hours.
- Your child has a high fever that does not drop.
- Your child is dizzy, confused, extremely drowsy, or has a change in mental state.
Tonsillectomy
Talk to your child about his or 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 that friend.
If the patient or patient's family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
A blood test and possibly a urine test may be required prior to surgery.
Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.
When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient's history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.Once the patient is put to sleep, a retractor is placed into the oral cavity to allow for proper exposure of the tonsils. Next, each tonsil is dissected using either electrocautery or radiofrequency ablation (See coblation tonsillectomy below) with blood vessels sealed along the way. Once the tonsils are removed, any bleeding areas are sealed and a small amount of anesthetic is injected into the area of dissection. The adenoids are usually visualized thereafter with a mirror and removed if appropriate.
Coblation tonsillectomy is a new technique that uses radiofrequency energy and a salt solution. This requires less heat energy which spares the surrounding tissues from burn injury, thus leading to less post-operative pain. More information is available at http://www.arthrocareent.com/wt/page/index
There are several post-operative symptoms that may arise. These include (but are not limited to ) swallowing problems, vomiting, fever,. throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified.
Adenoidectomy
The adenoid pad is a structure located in the back of the nasal passageway. A retractor is placed into the mouth and used to help visualize the most posterior area of the oral cavity. A mirror is then used to visualize the adenoid pad. A number of techniques are available for adenoidectomy including electrocautery, radiofrequency ablation, and curettage. Care is taken to remain midline to avoid injury to the Eustachian tube openings. Once the back portion of the nasal passageway is clearly visualized, the procedure is complete.
Since the adenoid pads lack nerve endings, the post-operative course is fairly well tolerated. There is minimal pain and bleeding is quite rare. Nasal congestion is commonly encountered after surgery and improves as the swelling gradually subsides over the next several days.
Examining your child
The physical exam helps the doctor determine the specific type of ear problem affecting your child. The exam also helps identify any respiratory illnesses, such as bronchitis, pneumonia, or strep throat.
If the doctor suspects a middle ear problem, otoscopy is almost always performed. Using a special device (otoscope) to look down the ear canal, the doctor views the eardrum and any fluid behind it. If your child can sit still for several minutes, the eardrum and middle ear may be tested to learn how well they are working. Tympanometry and acoustic reflex testing both use a probe to send air and sound through the outer ear. Tympanometry measures the amount of sound bouncing off the eardrum. The purpose is to evaluate the eardrum's flexibility and its response to loud sounds
The nasal passages and throat are also examined. If your child's tonsils (masses of tissue near the back of the throat) are greatly enlarged, the doctor may check the adenoids (pads of tissue in the upper part of the throat) as well. The adenoids are located near the site where the Eustachian tube opens into the throat. Their job is to help filter inhaled germs before they reach the lungs. If the adenoids themselves get infected, they may swell. After repeated infections, the adenoids may remain enlarged, blocking the Eustachian tube opening. In some cases, germs stopped by the adenoids may enter the Eustachian tube and spread to the middle ear. Adenoid-related ear problems happen more often in older children and adults.
To learn if a young child has trouble hearing, the doctor or a hearing specialist may talk or play with the youngster. The child's response to changes in the speaker's voice helps identify hearing loss. Older children and adults may be given an audiometric test. In some cases, young children with chronic fluid may also be tested. During audiometry, sound waves are sent into the outer ear or vibrations are passed through the bones behind the ear. The listener signals every time he or she hears a tone. Test results are used to identify the types of sounds that can and cannot be heard.
If the doctor suspects a problem with the structure of your child's ear, a special test may be done. A computed tomography (CT) scan shows the images of the middle ear bones or bone surrounding the ear. Magnetic resonance imaging (MRI) is used to check for soft tissue problems, such as nerve damage or tumors. To identify an inner ear problem, a sophisticated hearing test may be done to pinpoint any problem with the nerve pathways that send signals to the brain. These tests take time to perform, but they do not cause pain.
