Pediatric Ear Nose and Throat

As part of your lymphatic system, your tonsils are in the back of your throat and your adenoids are higher up, behind your nose.Their purpose is to help fight germs that come in through your mouth or nose before they cause infections in the rest of the body. Tonsillitis occurs when bacteria or viruses get into the tonsils and infect them.

Tonsillitis usually makes your throat hurt, making it hard to eat or even swallow. You may also have a fever.

Other symptoms include:

• Redder-than-normal tonsils
• A yellow or white coating on your tonsils
• A funny-sounding voice
• Fever
• Bad breath

When both your tonsils and adenoids are sore and swollen, this may make it hard to breath and cause ear infections.

To help your throat feel better at home, try the following:

• Drink plenty of fluids
• Eat smooth foods, like jello, soups, popsicles and applesauce.
• Avoid hard, crunchy or spicy foods
• Use a cool-mist vaporizer or humidifier where you spend most of your time.
• Get plenty of rest

Otitis externa is an infection of the ear canal (aka “swimmer’s ear”)

Causes of infection:

• Bacteria and fungi may cause the infection.
• Injury may occur if you use a Q-tip to clean your ear canal.
• Dirty water in your ears (for example, from a lake or ocean).
• Frequent showering or swimming can increase the risk of getting an infection.
• Otitis externa often occurs in the summer from swimming in polluted water.
• The chemicals in hair spray or hair dye may irritate the ear canal as well and increase the risk of infection.
• Some people get otitis externa repeatedly, especially if they clean their ears too vigorously.
• People who have skin allergies also seem particularly prone to otitis externa.

Symptoms include:

• Itching (often the first symptom).
• Pain and swelling in ear canal.
• Discharge from the ear, which may smell bad.
• Crusting around the ear canal opening.
• Sometimes swelling or pus may decrease your hearing.

Your health care provider will examine your ears. He or she may take a sample of pus and culture it to identify the bacteria or fungus.

How is it treated?

Your provider will carefully clean and dry your ear. If your ear is very swollen, he or she may insert a wick soaked with an antibiotic into the ear to get the medicine into the infected area. You may need to put drops in your ear several times a day to keep the wick moist.

Your health care provider may prescribe an oral antibiotic if you have a severe infection. Your provider may suggest a cream or ointment medicine for some types of infection. The pain and swelling will go away gradually as the antibiotics or other medications take effect. Most cases of otitis externa clear up completely in 5 to 7 days.

Follow the treatment plan prescribed by your health care provider. Your health care provider will tell you how to take care of your ear and how to remove the wick. Keep water out of your ears until the infection is completely gone. Take baths instead of showers. Ask your health care provider how you should protect your ears when you wash your hair.

How can I help prevent otitis externa?

• Don’t put anything into your ear canal that should not be put there. This includes Q-tips. Q-tips are for cleaning the outer ear, not the ear canal. Ask your health care provider if it might help to wear earplugs or use something such as lamb’s wool to keep your ears dry when you swim and shower.
• Dry your ears carefully if you get water in them. You can use a hair dryer (on the “warm” setting) at least 6 inches from your ear to help dry the water in the ear canal.
• Avoid any substance that may cause an allergic reaction of the ear canal skin. Read product labels carefully and ask your health care provider before you use chemicals or medications in the area around your ear.

Middle Ear Infections are located in the air-filled space in the ear behind the eardrum and are more common in children less than 8 years old.

Ear infections usually begin with a viral infection of the nose and throat or occur when you have allergies.

• The viral infection or allergic reaction can cause swelling of the tube between your ear and throat (the eustachian tube). The swelling may trap bacteria in your middle ear, resulting in a bacterial infection.
• Pressure from the buildup of pus or fluid in the ear sometimes causes the eardrum to tear (rupture). The eardrum is a thin membrane that separates the delicate parts of the middle ear from the air and moisture in the ear canal.

You may have one or more of these symptoms:

• Earache
• Hearing Loss
• Feeling of blockage in the ear
• Fever
• Dizziness

Your health care provider will ask about your symptoms and look at your eardrum. Your health care provider may check for fluid in the ear.

Antibiotic medicine is a common treatment for ear infections. However, recent studies have shown that the symptoms of ear infections often go away in a couple of days without antibiotics. For these reasons, your health care provider may wait 1 to 3 days to see if the symptoms go away on their own before prescribing an antibiotic.

Your provider may recommend a decongestant (tablets or a nasal spray) to help clear the eustachian tube and decrease pressure in the middle ear. For pain take a nonprescription pain reliever such as acetaminophen (Tylenol) or ibuprofen. Carefully follow the directions for using medicines, even if they are nonprescription.

In most cases you should feel better in 2 to 3 days.

Call your health care provider if you have:

• A temperature over 102 degrees F (38.9 degrees C) that persists even after you take aspirin, acetaminophen, or ibuprofen.
• A severe headache or worsening pain around the ear
• Swelling around the ear
• Increasing dizziness
• Worsening of your hearing
• Weakness of one side of your face.
• Keep all your appointments. Your health care provider may want you to have one or more follow-up exams until signs of inflammation and infection have disappeared.

How can I prevent an ear infection from occurring?

• If you tend to get ear infections often, ask your health care provider if you need to be checked for allergies.
• Getting treatment for allergies may help prevent ear infections.
• Ask if using decongestants when you have a cold may help prevent you from getting ear infections.

A nosebleed occurs when the membranes lining the inner nose are disturbed or irritated enough to cause abnormal bleeding. The medical term for nosebleed is epistaxis.

There are 2 types of nosebleeds: anterior and posterior. If the bleeding is near the front of the nose, it is an anterior nosebleed. If the bleeding is from the back of the nose, it is a posterior nosebleed. An anterior nosebleed is usually not as severe or serious as a posterior nosebleed.

The most common causes of nosebleed are:

• A breakdown in the membranes lining the nose. This can be triggered by dry air or probing, bumping, picking, or rubbing your nose.
• Blowing your nose forcefully can also cause a nosebleed, especially if the nasal membrane is already inflamed because of allergies or an infection, such as a sinus infection.
• Injury to the face or nose.
• Rebleeding from an area of a previous nosebleed.
• High altitude.
• Drug abuse involving the nose, such as cocaine snorting or glue sniffing.
• High blood pressure.
• Medicine to keep your blood from clotting.
• Medical problems that prevent your blood from clotting normally.
• If you have a nosebleed after a head injury, it could mean you have a fractured skull. You should go to the hospital right away.

If you see your health care provider when you have a nosebleed, he or she will have you sit up and lean forward to determine the rate and site of the bleeding. Most nosebleeds are minor and respond to first aid.

First aid for a nosebleed includes these steps:

1. When your nose starts bleeding, sit up and lean forward to prevent blood from passing into your throat.
2. Pinch the nose gently but firmly between the thumb and index finger, just below the nasal bones, and hold it for 5 full minutes.
3. If it continues to bleed, hold it again for another 5 minutes

After the bleeding stops, use a saline nasal spray or saline nose drops to keep the nose moist. Do not blow your nose for several hours after the bleeding stops.

If a nosebleed lasts more than 10 minutes in spite of first aid, see your health care provider.

If you go to your health care provider with a nosebleed, he or she will likely apply a cotton ball soaked in epinephrine, or a nose drop such as Neo-Synephrine or Afrin, to the site of the bleeding for 5 to 10 minutes.

If the bleeding starts again, your provider may apply a cotton ball soaked in stronger medicine for 5 minutes to numb and temporarily reduce the blood supply to the nasal membrane.

Your health care provider might use a procedure called cauterization to cause the blood to clot at the bleeding site. After numbing the area inside the nose, your provider will apply a tiny amount of electricity to the bleeding area. This will help stop it from bleeding again.

To prevent dryness, keep the lining of your nose moist. Gently apply a light coating of petroleum jelly inside your nose or use a saline nose spray twice a day. Avoid injuring the nasal membranes with nose picking, rubbing, or forceful nose-blowing. Keep your home humidified.

What is a congenital neck mass?

A congenital neck mass is a growth that is present at birth and slowly becomes noticeable to the patient or family. Although the neck abnormality is present since birth, the resulting lump may not appear until much later in life.

What are the types of congenital neck masses?

Congenital neck masses can take many forms. The most common congenital masses that are treated by an ear, nose, and throat specialist are:

• Branchial Cleft Anomalies (Abnormalities)
• Thyroglossal duct remnants (like cysts)

 

BRANCHIAL CLEFT ANOMALY

What are Branchial Cleft Anomalies?

Branchial cleft fistulas (tracts) and cysts (called anomalies) are found in the neck and are composed of tissue trapped in the developing neck. These anomalies appear as a soft lump or draining opening on one side of the neck. They can appear in any age group yet are very common in the first decade of life. Because these anomalies develop in the growing embryo, any tract that forms in combination with a cyst follows a fairly predictable pattern. The tracts connect the cyst to the inside of the throat at a specific area. It is important to understand this relationship so that the entire tract can be excised and will not recur.

If your child has been diagnosed with a branchial cleft anomaly, many times the physician will order a CT scan (cat scan). This test will allow us to identify the exact location of the mass and/or tract as well as its relation to blood vessels and nerves in the neck.

Once an anomaly has been identified, treatment consists of surgically removing the cyst before it has a chance to get infected and become an abscess. Surgery is performed under general anesthesia by making an incision over the cyst or draining area. Every effort is made to place the incision in an existing skin crease so that cosmetically the child’s scar will be minimal. Plastic surgery techniques are always used to close the incision. Branchial cleft anomalies are usually removed as an outpatient procedure. These operations usually last between one and two hours. Ear, nose and throat specialists have extensive training in surgery of the neck, making them the most qualified physicians for this type of surgery.

If the cyst has become infected (or formed an abscess) prior to removal, incision and drainage of the abscess may be necessary first, followed by treatment with antibiotics. The cyst and tract can then be safely removed at a later date.

 

THYROGLOSSAL DUCT REMNANTS

What are Thyroglossal Duct Cysts?

Thyroglossal duct cysts are cysts that are left over when the thyroid migrates from the base of the tongue into the neck before birth. The cyst is connected to the back of the tongue by a small tract. The cyst usually lies in the middle of the neck in front of the.

Thyroglossal duct cysts usually show up in the first ten years of life, but may be found in older children or even adults. It is a benign cyst that usually contains mucous or even pus-like fluid. Many times, these cysts will not be evident until your child has an upper respiratory infection (cold). After which, the cyst will suddenly appear in the front of the neck. The sudden appearance or rapid enlargement of these cysts can be alarming. If a cyst is infected, many times antibiotics and/or drainage may be necessary to control the infection prior to definitive removal.

However, if the cyst appears without infection, and you wish to avoid further problems with infection, surgical removal is best performed before the cyst is ever infected.

 

Thyroglossal duct cysts are usually in the middle of the neck and seem to move up and down during swallowing. Because thyroid tissue may be inside the cyst, it is important to make sure that the thyroid gland has developed normally (and that not all the thyroid tissue is within the cyst). Your doctor may order an ultrasound and/or a thyroid scan to make sure the “cyst” is not the only functioning thyroid gland.

Once these tests have been completed, excision of the cyst may be performed as an outpatient procedure. This operation usually takes 45 minutes to an hour. Your child may leave the same day but will require decreased activity in the first week after surgery.