Pediatric otolaryngology (or pediatric ENT)

Sometimes it’s cute to see children imitate their parents, but snoring is no laughing matter and it’s rare for children to have it. Children are like miniature adults, and snoring can be an indication of a more serious problem, such as obstructive sleep apnea (OSA). When we enter the deepest phase of sleep, our muscles relax and allow the tonsils to move inward. Enlarged tonsils can interfere with the flow of air during sleep, which leads to arousal, a lighter stage of sleep, and a higher level of consciousness.

Recent studies have shown that children’s academic performance is significantly affected as a result of poor quality sleep patterns and disruptions. Children with OSA have more problems with attention and behavior. Even your best student will suffer if they don’t rest properly at night.

What is the solution?

Firstly, an accurate account of sleep is essential. Children who snore should be evaluated by an ear, nose, and throat specialist, especially if they have hypertrophy of the tonsils. If obstructive sleep apnea is diagnosed, removal of the tonsils and adenoids is recommended as initial treatment. Thanks to new techniques such as Radiofrequency, patients recover faster and are able to resume their regular diet and activities in a shorter period of time. After surgery, children are healthier, sleep better, and grow faster.

Ventilation tubes are small cylinders, 1 mm in diameter, that are placed through the eardrum to allow air to enter the middle ear. They can be called tympanostomy tubes, myringotomy tubes, ear tubes, or pressure equalization (PE) tubes. These tubes can be made of plastic, metal, or Teflon and may have a coating that serves to reduce the possibility of infection.

There are two basic types of ventilation tubes: short-term ventilation tubes and long-term ventilation tubes.

1. 1. Short-term tubes are smaller and usually stay in place for six months to a year before falling out on their own.
   2. Long-term tubes are larger and have flanges that anchor them in place for a longer period of time.

Tubes are frequently recommended when a person experiences repeated middle ear infections (acute otitis media) or hearing loss caused by persistent fluid buildup in the middle ear (otitis media with effusion). These conditions occur more frequently in children, but can also be present in teenagers and adults, and can lead to speech and balance problems, hearing loss, or changes in the structure of the eardrum membrane.

Each year, over half a million ear tube surgeries are performed in children, making it the most common surgery of childhood. The typical age for ear tube insertion is one to three years old. The insertion of tubes in the ears can:

• Inserting ear tubes can restore hearing loss caused by middle ear fluid.
• Prevent ear infections.
• Improve behavior and sleep caused by chronic ear infections.
• Improve speech problems and balance issues.

The ventilation tubes are inserted in a procedure called a myringotomy. A myringotomy is a small incision in the eardrum. This can be done with a small knife or with a laser. If a tube is not inserted in the ear, the hole will close in a few days. To prevent this, the ventilation tube is placed to keep it open and allow air to reach the middle ear space (ventilation).

Young children are given light general anesthesia (laughing gas) during the procedure. Some older children and adults can tolerate the procedure without anesthesia. A myringotomy is performed and the middle ear is cleaned. The ventilation tube is then inserted. Ear drops can be put in after the tube has been inserted. The procedure is quick, and patients wake up shortly afterward.

Sometimes, the ENT doctor may recommend removal of adenoid tissue (lymphoid tissue located in the upper airway behind the nose) when ear tubes are placed. This is typically considered when repeat ear tube placement is required. Current studies suggest that removing the adenoid tissue along with ear tube placement may decrease the risk of recurrent ear infections and the need for repeat surgery.

Patients typically experience little to no postoperative pain, but drowsiness, irritability, or nausea from the anesthesia may occur temporarily. Hearing loss due to the presence of fluid in the middle ear is typically resolved immediately after the surgery. Children hear with much greater clarity, so that normal sounds may seem excessively loud to them.

To prevent bacteria from entering the middle ear, doctors may recommend earplugs or other devices

However, recent research suggests that ear protection is not necessary except when diving or participating in water activities in contaminated waters, such as lakes and rivers. Parents should consult with the doctor regarding ear protection after the surgery.

Should my child have a hearing test before attending school?

Yes. According to the National Institutes of Health, hearing loss affects about 17 out of every 1000 children aged 18 years and under. Many children undergo a hearing test after birth or in the early years to determine if they have hearing problems. Some other causes of hearing loss include infections, trauma, and noise exposure. Sometimes the problem does not present itself until the child is older. In the last 15 years, 30% of American teenagers have experienced mild hearing loss, and 70% have experienced mild or worse hearing loss. In the last 15 years, the proportion of American teenagers with mild hearing loss has increased by 30%, and the number of American teenagers with mild or worse hearing loss has increased by 70%.

One in five teenagers has some degree of hearing loss, which can affect learning, speech perception, social skill development, and self-image; one in twenty has more severe hearing loss. Since hearing loss is cumulative, these teenagers are at high risk of experiencing significant hearing problems as adults. Hearing tests for older children are typically conducted at ages 4, 5, 6, 8, 10, 12, 15, and 18, and at any other time if there is a concern.

Every year it becomes more difficult to get my child out of bed and ready for school. Is he growing or is something else going on?

It could be either one of those things! Although most sleep disorders are associated with adults, children also commonly experience sleep-related health issues.

Obstructive sleep apnea, also known as sleep-disordered breathing, is not uncommon in children, and has various causes, consequences, and treatments. The number one indicator of sleep-disordered breathing is difficulty breathing and sleeping. This includes loud snoring that occurs every night, regardless of the sleeping position; the snoring is followed by a complete or partial obstruction of breathing, with loud gasping and snorting. Recording your child’s snoring may be helpful and consulting with an otolaryngologist to evaluate your child’s problem could be useful.