Pediatrics

Pediatrics

At Midwest Ear, Nose & Throat we love kids and take the best care of them! We can diagnose and treat reflux, allergies, sinusitis, tonsillitis, otitis media and sleep apnea, with a common-sense approach using a single doctor. Our Sinus and Allergy division allows us to treat allergies with medicine, immunotherapy or surgery. Because we are trained in surgery of the ear, nose, sinuses and throat, we are the best choice for pediatric patients. We specialize in the following Pediatric services.

  • Ear tubes
  • Tonsils and adenoids
  • Hearing issues
  • Ear pain
  • Allergies
  • Sinusitis
  • Tongue and mouth problems
  • Obstructive sleep apnea
  • Reflux (GERD)
  • Speech therarpy

Pediatric Allergies

Infants and toddlers have a much more permeable GI tract, and therefore are very susceptible to food allergies. Food allergies and sensitivities may cause a wide range of adverse reactions to the skin, respiratory system, stomach and other physiological functions of the body.

Food allergies can result in vomiting, diarrhea, bloating and colic in children. They can also result in skin symptoms such as atopic dermatitis, or upper respiratory tract symptoms such as nasal congestion, ear and sinus infections. In children, they lead to many sleepless nights for both the child and her parents. Eosinophilic esophagitis is a new and disturbing condition caused by allergies affecting the gastrointestinal tract.

Although there are always exceptions, it is rare in children to have a lot of inhalant allergies. The younger the child, the more likely ingestants such as milk are the allergic culprits. As they get older, inhalants become more prominent, and severely allergic kids seem more likely to develop reactive airways or asthma. Most would agree that early and aggressive treatment is beneficial in preventing this progression.

An infant should have at least a six month delay in consuming solid foods. They should be between 6 and 12 months old before consuming cow’s milk and dairy products, be between 12-24 months old before being offered eggs, and be between 24-28 months of age before peanuts, tree nuts and seafood is introduced. If the infant continues to struggle, they should be tested for other ingestant allergies such as egg and soy. Based on what we find, we can help with avoidance, pharmicotherapy or immunotherapy (such as allergy drops). Pleasa see our allergy section.

Treatment of food allergies

Treatment is mainly through dietary manipulation. Casein and whey are the primary antigenic proteins in cow’’s milk, and dairy is the biggest culprit of pediatric allergies. In children who are not nursing, we often will try a hypoallergenic formula. Goat’’s milk is a good alternative for some. Soy milk is excellent if they are not soy-allergic, and rice milk is also a good option.

In the case of emergency treatment, epinephrine is the drug of choice for an emergency response to reactions. Self-administered epinephrine is readily available, and patients can be trained to self-administer this medication. Antihistamines can be a secondary therapy. It is also good to have an emergency plan in writing, available to schools, spouses, caregivers, mature siblings and friends. We also recommend an emergency identification bracelet.

If the history and testing confirms a cyclic food allergy, you will be asked to abstain from feeding your child this food for a period of 3-6 months. After this time you can slowly reintroduce the food, not to be eaten more frequently than every four days (once or twice a week).

Pediatric Sinus and Ear Infections

Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. The small anatomy combined with the enlarged tonsils and adenoids make for overall tight spaces and may predispose them to blockage and subsequent infections. Allergic rhinitis, either from foods or inhalants, can lead to further congestion, worsening the problem. Once the sinus openings are blocked, the secretions just sit there and can become infected with bacteria.

The middle ear itself is essentially a sinus – that is, an air containing space connected to the nose. Thus, when a child has rhinosinusitis they almost always get ear infections. These infections are especially common in early childhood. They are even more common when children suffer from allergies as well. Allergic inflammation can cause swelling of the adenoids in the nose and around the opening of the Eustachian tube (ear canal). This swelling has the potential to interfere with drainage of the middle ear. When bacterial sinusitis exists, infection can often travel up the Eustachian tube to infect the middle ear.

Tonsils and adenoids become more inflamed with allergies and infections. They not only tend to obstruct the upper airways but also have lots of crevices for viruses, bacteria and fungus to hide. Removal of tonsils and adenoids have repeatedly been shown to reduce the frequency and severity of pediatric upper respiratory infections, including rhinosinusitis. In addition, airway obstruction such as pediatric obstructive sleep apnea and upper airway resistance syndrome are most often cured by tonsillectomy and adenoidectomy.

There is really only one airway, from the tip of the nose to the base of the lungs. This “single airway theory” is even more evident in children. When they are sick they will have a stuffy nose with purulent rhinorhea, pus in the sinuses, fluid behind the ears, pharyngitis and cough.

You can reduce the risk of sinus infections for your child by reducing exposure to known allergens and pollutants such as tobacco smoke, and treating stomach acid reflux disease. Allergic rhinitis can cause enough inflammation to obstruct the openings to the sinuses. Consequently, a bacterial sinus infection occurs. The disease is similar for children and adults. Children may or may not complain of pain. However, in acute sinusitis, they will often have pain and typically have fever and a purulent nasal discharge. In chronic sinusitis, pain and fever are not evident. Some children may have mood or behavior changes. Most will have a runny nose and nasal congestion, even to the point where they must mouth-breathe. The infected sinus drains around the Eustachian tube, and therefore many of the children will also have a middle ear infection.

The following symptoms may indicate a sinus infection in a child:

  • 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, especially in the first several years of life. 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 10 days, a serious sinus infection is likely.

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—, including recurrent episodes of acute sinusitis more than 4-6 times a year, —is an indication that you should seek consultation with an ear, nose and throat (ENT) specialist.

Pediatric Hearing Issues

Approximately 2 – 4 of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. More than 3 million American children have a hearing loss, and an estimated 1.3 million are under age 3.

Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them.

Treatment is most successful if hearing loss is identified early, preferably within the first month of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until age three or older. If at any time 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 (ENT) specialist, which you can find at our clinic. The following questions can be addressed with your ear, nose and throat doctor:

When should a child’’s hearing be tested?

The first opportunity to test a child’’s hearing is in the hospital shortly after birth. If your child’’s hearing is not screened before leaving the hospital, we recommend that screening be done within the first month of life. Should test results indicate a possible hearing loss, seek further evaluation as soon as possible, preferably within the first three to six months of life.

Is early hearing screening mandatory for my child?

In recent years, health organizations across the country, including the American Academy of Otolaryngology –- Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. In 2003, more than 85% of all newborns in the United States were screened for hearing loss.

In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How is early hearing screening conducted?

Two tests are used to screen infants and newborns for hearing loss. They are:

  • Otoacoustic emissions (OAE) involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

  • Auditory brain stem response (ABR) is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’’s brain responds to the sound.

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

What are the signs of hearing loss in children and babies?

Your newborn child may have some degree of hearing loss if he or she:

  • does not startle, move, cry or react in any way to unexpected loud noises
  • does not awaken to loud noises
  • does not turn his/her head in the direction of your voice
  • does not freely imitate sound

Hearing loss can also occur later in childhood after a newborn leaves the hospital. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’’s hearing.

Even if your child’’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss including:

  • not reacting in any way to unexpected loud noises
  • not being awakened by loud noises
  • not turning his/her head in the direction of your voice
  • not being able to follow or understand directions
  • poor language development
  • speaking loudly or not using age-appropriate language skills

If your child exhibits any of these signs, report them to your doctor.

What is normal hearing for children?

The ear consists of three parts that play a vital role in hearing – —the external ear, middle ear and inner ear.

  • Conductive hearing: Sound travels along the ear canal of the external ear, causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the ear drum to the cochlea (auditory chamber) of the inner ear.

  • Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve. It travels through inter-connections to the brain area that recognizes it as sound.

What happens if my child has a hearing loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as middle ear infections, excessive earwax congenital malformations, or a genetic hearing loss.

Many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances.

An inner ear problem can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells in the ear are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage.

For those with this profound hearing loss who will not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by the age six months will prevent subsequent language delays.

Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently. We are fortunate to have Dr. Kenneth Scott, the only neurotologist in the state, on our team.

How will my child handle hearing loss?

Your child with a hearing loss can succeed. It is important to keep this as your focus, whatever your child’s age or degree of hearing loss. While you will have the support of many professionals, ultimately you will make many decisions about what is in the best interest of your child.

As with all children, there is no magic formula for raising a child with a hearing loss. It helps to maintain a positive attitude, educate yourself about hearing loss, seek out the best resources, and take an active role in your child’s education. Most of all, keep in mind that your child is a child first, and a child with a hearing loss second.

Will your child have a “normal” life? While some mild-moderate losses can be surgically or medically corrected, most hearing loss is a permanent condition. Thus, your child’s life will have its challenges. However, these challenges sometimes turn into advantages.

For example, the ability to work hard and concentrate more, coupled with the routines of audiologic and language therapy, frequently produces children who are self-disciplined and focused. Moreover, the outcomes for children with hearing loss have greatly improved in the last two decades due to major advances in technology and emphasis on programs of early detection and early intervention.

What are cochlear implants?

A cochlear implant is an electronic device that restores partial hearing to the deaf. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing-impaired to receive sound.

How do cochlear implants work?

Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve.

The implant consists of a small electronic device, which is surgically implanted under the skin behind the ear and an external speech processor, which is usually worn on a belt or in a pocket. A microphone is also worn outside the body as a headpiece behind the ear to capture incoming sound.

The speech processor translates the sound into distinctive electrical signals. These ‘codes’ travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes’ signals stimulate the auditory nerve fibers to send information to the brain where it is interpreted as meaningful sound.

How is a child evaluated for implants?

Implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be 12 months of age or older (unless childhood meningitis is responsible for deafness). The evaluation will be done by an implant team (an otolaryngologist, audiologist, nurse and others) that will give you a series of tests:

  • Ear (otologic) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery.
  • Hearing (audiologic) evaluation: The audiologist performs an extensive hearing test to find out how much you can hear with and without a hearing aid.
  • X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear bone.
  • Psychological evaluation: Some patients may need a psychological evaluation to learn if they can cope with the implant.
  • Physical examination: Your otolaryngologist also gives a physical examination to identify any potential problems with the general anesthesia needed for the implant procedure.

How is the implant surgery performed?

Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Ideally, an otolaryngologist who has extra years of ear training is available. Fortunately, we have the only fellowship-trained neurotologist in the region, Dr. Kenneth Scott.

Implant surgery is performed under general anesthesia and lasts from two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure may be done as an outpatient, or may require a stay in the hospital, overnight or for several days, depending on the device used and the anatomy of the inner ear.

What happens after implant surgery?

About one month after surgery, your team places the signal processor, microphone and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant.

Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

What can I expect from implants?

Cochlear implants do not restore normal hearing, and benefits vary from one individual to another. Most users find that cochlear implants help them communicate better through improved lip-reading, and over half are able to discriminate speech without the use of visual cues. Many factors contribute to the degree of benefit a user receives from a cochlear implant, including:

  • how long a person has been deaf.
  • the number of surviving auditory nerve fibers.
  • the patient’’s motivation to learn to hear.

Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. A few patients do not benefit from implants.

Are implants FDA-approved?

The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults and children, and approves them only after thorough clinical investigation. Be sure to ask your otolaryngologist for written information, including brochures provided by the implant manufacturers.

You need to be fully informed about the benefits and risks of cochlear implants, including how much is known about how safe, reliable and effective a device is, how often you must come back to the clinic for checkups, and whether your insurance company pays for the procedure.

How much do implants cost?

More expensive than a hearing aid, the total cost of a cochlear implant including evaluation, surgery, the device and rehabilitation is around $40,000. Most insurance companies provide benefits that cover the cost. (This is true whether or not the device has received FDA clearance or is still in trial.)