Pediatric ENT in Tampa and Spring Hill, FL
Children and teenagers in Tampa, Spring Hill and nearby communities in Florida require specialized pediatric ENT care and treatment. For some children, symptoms that appear benign may lead to more complex problems that jeopardize your child’s hearing, speech, balance and overall quality of life. The board-certified Otolaryngology/Head and Neck Surgeons of Suncoast ENT Surgical Specialists have the expertise to recognize, diagnose and treat pediatric ENT conditions.
Children and teenagers require specialized ears, nose and throat treatments. Unlike adults, younger people are still developing and growing in stature, immune system, weight, and other emotional and physical aspects. As such, children and adolescents require special consideration and care. The most important aspects of care for young patients are
- Use and dosing of medications prescription and over-the-counter medications
- Monitoring for chronic and acute ailments
- Recognition of non-verbal cues that indicate symptoms or conditions
Suncoast ENT Surgical Specialists has the trained staff, equipment and facilities required to provide treatment for children of all ages, starting from birth. We work close with the families and pediatricians of young patients to ensure that they are well and healthy.
Made of the same tissue as the tonsils, the adenoids sit at the back of the nose next to the opening of the Eustachian tubes that serve to equalize the ears. The lymphoid tissue is a source of bacteria for the nose and ears. When the adenoids become enlarged or infected, children may experience nasal congestion, chronic rhinorrhea, sinus infection and ear infections. The adenoids could be part of the reason a child has recurrent sinus infections or is a chronic mouth breather. With chronic infection or enlargement, the Eustachian tubes become congested. As a result, the middle ear does not equalize, and the negative pressure results in recurrent ear infections.
Indications for Adenoid Surgery
- Recurrent sinus infections
- Chronic nasal congestion
- Recurrent ear infections
- Snoring and Apnea
Adenoidectomy or Surgery to Remove the Adenoids
An adenoidectomy is an outpatient surgery to remove of the adenoids. Before the operation, children are given a medication that makes them feel a little silly and helps them not remember what happens during the procedure. A good way to explain it to children is like falling asleep in a car, and the trip is over when they wake up.
Inside the operating room, the surgeon starts an IV, and general anesthesia is administered so that your child is asleep throughout the surgery. The surgeon removes the adenoids through the mouth, and the area is cauterized to avoid bleeding.
Afterward, your child is taken to a recovery room for around an hour. Some children become confused and a little upset for a short while as they come out of the anesthesia. They are more likely to be fussy because they are unsure about what is happening rather than because they are in pain. Other children, however, wake up normally as if they had just taken a nap.
It takes about two weeks for the surgical area to heal. Most children do not feel very much pain after the operation, but parents can give them Tylenol if needed.
Children who need pain medication to relieve discomfort can take Tylenol every four to six hours during the first 24 to 48 hours following an adenoidectomy. We recommend that parents follow dosing instructions that are listed on the medication bottle or package. The dosing is based on weight and age. The surgeon also prescribes antibiotics to reduce the risk of infection after the operation.
For the first five days after the procedure, your child should remain at home under the care of family or friends who can watch for signs of complications. Complications rarely occur and typically appear during the first five days.
Decreased participation in activities is also recommended for the remaining two weeks following surgery to promote healing. While children should not participate in gymnastics, sports or band activities, they do not have to be confined to bed.
Nasal congestion and recurrent ear and sinus infections in children may be caused by other factors, so all aspects must be evaluated. However, at least 50% of patients experience a big improvement in nasal-related symptoms when assessing adenoidectomy cases alone. Having the adenoids removed could also completely resolve nasal symptoms. Although an adenoidectomy is very beneficial for many people, our ENTs review each situation independently and determine all of the medical and surgical options available for each patient.
What is a Eustachian tube?
The Eustachian tube is a tube structure running from the middle ear to the rear of the nose. The tube is highly dynamic in nature — opening and closing when you eat, yawn, or talk. The design of your Eustachian tube explains why you can pop your ears when you hold your nose. The middle ear equalizes the pressure in the middle ear. Fluid and pressure may build up if the middle ear fails to equalize properly, which can cause poor hearing or lasting damage to an ear. Additionally, young children are prone to developing infections the middle ear. Some children experience frequent middle ear infections.
The Eustachian tube is under-developed in infants and very young children, the tubes are shorter and less angled than those of older children and adults. As children mature, the Eustachian tube develops and maintains equalization in the middle ear more effectively, resulting in less pressure, infections, and fluid buildup. The rate at which the Eustachian tube matures varies. At around the age of six or seven, most children have completely developed Eustachian tubes that do not cause problems. Basically, they have outgrown Eustachian tube dysfunction. Children between one and three years old often experience frequent ear infections. Due to the correlation with speech development, parents should seek medical care for any ear infections.
Pressure Equalization Tubes (PE tubes) Placement
The procedure begins with the administration of general anesthesia with the use of a mask. No IV is necessary. After your child falls asleep, the eardrum is examined using an operating microscope. A tiny incision is made along the eardrum. Any fluid present inside the middle ear is then suctioned out. The PE tube is then put into position. Once this tube is in place, the ear does not need the Eustachian tube and is able to equalize pressure by means of the inserted tube. Normally, the tube will remain in place for up to 12 months. Your child has follow-up appointments every six months to ensure the tube comes out, and the eardrum hole heals properly. The surgeon also examines the ears to ensure that the Eustachian tube is mature enough to work properly without further intervention.
Causes of Eustachian Tube Dysfunction
Immature development is one of the most common causes of dysfunction of the Eustachian tube. Congestion in the Eustachian tube can also be caused by anything that promotes swelling or congestion in the rear of the throat or within the nose. Allergies, large adenoids, sinus infection, exposure to second-hand smoke, or reflux can also lead to congestion. Children who are in daycare can also have frequent inflammation caused by bacterial or viral infections that create Eustachian tube dysfunction.
Most Common Causes of Ear Infections
- Exposure to second-hand smoke
- Exposure at daycare
Serous Otitis Media
The condition of Serous Otitis Media occurs when children have non-infected fluid buildup within the middle ear. Children who have inflamed eardrums accompanied by a fever are of great concern to their parents and doctors. Children who have persistent fluid in the middle ear are also of concern. The child may not complain of pain in their ear, or they may only occasionally complain. The child may suffer hearing loss because the condition goes undetected. The child may indicate that they can hear but fail to reveal they do not hear as well as they once did. The condition can lead to speech delay during the critical period of life that the ear dysfunction is occurring.
Types of Treatment For Ear Infections
Treating ear infections usually involves antibiotics. The length of the treatment and type of antibiotic used varies, depending upon the frequency of the child’s ear infections, the child’s age, and any allergies they have involving medications. Reflux or allergy treatment may lower the chances of an infection.
Pressure Equalization tubes (PE tubes) are indicated when treatment is unsuccessful due to factors such as the length of the infections, the number of infections, the severity of the infections, the time it takes to resolve infections, infection complications such as febrile seizure and ruptured eardrum, speech delay, hearing impairment, and if fluid remains following treatment.
Overview of Ear Tube Treatment and Surgery
- The surgery takes around 10 minutes
- It involves outpatient surgery
- General anesthesia is given using a mask. No breathing tube of IV placement is needed.
Your child may go home after spending up to two hours in the recovery room. Your child may be somewhat irritable at arriving home, and Tylenol normally relieves any discomfort. For one or two days after surgery, your child may have difficulties with coordination and balance, so we advise parents to watch their children closely for the first couple days. Children are also required to wear ear plugs when swimming or bathing during the first month. If no drainage is present after one month passes, your child can be bathed without ear plugs.
The tonsils and adenoids are two components of the immune system that work as the first line of defense against infections. The glands are especially large in growing children. Naturally large or swollen adenoids and tonsils may block the air passage and cause a variety of problems for your child, such as sleep apnea, a higher risk of infections, difficulty eating, and general discomfort. Tonsillectomies and adenectomies are common procedures for children that are dealing with these issues. The removal of the tonsils and adenoids will prevent many common medical problems in the future. The child’s immune system will adapt and continue to fight off infections even without tonsils and adenoids.
Medical Treatment for Tonsillitis
Tonsillectomies are highly successful, but the first line of defense against tonsillitis is the use of antibiotics. Some studies have shown that certain medications such as xylitol and low-dose antibiotics may be beneficial, but there is no way to permanently ward off tonsillitis. Until the tonsils and adenoids are removed, the child will continue to be at risk.
Tonsillectomies remain one of the most common procedures for children and can be performed in as little as 30 minutes. The child is first given medication that will put them to sleep, and they will not remember the surgery whatsoever. After removing the tonsils and adenoids, the child is taken to the post-op recovery room where we will monitor them for anywhere from one to four hours before being released to go home.
Tonsillitis Procedure Overview
Tonsillitis surgery involves removing the tonsils from the tonsillar fossa so that there will be no future infections. The tonsils and adenoids are both removed from the child’s mouth after they have been administered general anesthesia.
Tonsillitis Surgery Recovery
- We will prescribe pain medication as well as antibiotics for your child to take in the following days. Parents should ensure that their children take the antibiotics for as long as they are prescribed.
- Children can typically eat whatever they want besides foods that will scratch their throat such as chips and popcorn. Most find it best to eat cold and soft foods that will numb the tissue. Children should also drink as much water as possible to keep food debris from collecting in their mouth. Soda should generally be avoided as the carbonation may cause discomfort.
- If you would like to avoid prescription medication, then Tylenol can be given every 4 hours for the first two days. Prescription painkillers and Tylenol should never be mixed as it can cause permanent liver damage.
- Your child should stay at home for anywhere from 7 to 10 days while the bleeding goes down.
- Your child should avoid physical activities and travel for two weeks.
Tonsillitis Surgery Outcomes
Tonsillectomies and adenoidectomies have a high rate of success and will almost always improve issues such as snoring, sleep apnea, and other obstructive sleep problems.
Children’s sinuses develop at different rates, and some do not develop fully until well into the teen years. As such, conditions such as rhinosinusitis, a condition in which the nasal mucosa becomes inflamed and infected, is much more common in children with underdeveloped sinuses. Because children experience severe sinusitis very rarely, several factors determine the course of treatment, such as allergies, immune system development, reflux disorders, adenoid development, and even the anatomy of the sinuses themselves. Secondary exposure to things such as secondhand smoke is also a consideration.
A three-week treatment with antibiotics is the best course of treatment for some children. In others, aggressive nasal steroids and saline flushes are also effective. Patients who have certain allergies also receive allergy treatments. Maintaining the sinuses to prevent recurring problems is the focus once the infection is under control.
When CT scans show severe sinusitis, or if other medical treatment options fail, surgery is the best treatment option. Options include adenoidectomy, balloon sinuplasty, and functional endoscopic sinus surgery. These surgeries require general anesthesia, but they are typically performed on an outpatient basis.
What to Expect During Recovery
Following sinus surgery, your child should stay home for a period of about one week. You will need to restrict your child’s activities for a period of two weeks, and avoid flying for three weeks. Pressure and congestion similar to that experienced with a severe head cold often persist for three to four days following surgery, but prescription pain medications can relieve the symptoms.
A postoperative evaluation is scheduled for one week after surgery. Splints are normally not used for children, but if splints are placed during surgery, the surgeon removes them during the appointment.
Another postoperative visit is scheduled two weeks after surgery. During this time, a scope is used to evaluate the nose and remove any debris that may remain in the nasal cavity. Following the visit, you will need to help your child with a saline flush to clean the nose and remove debris as your nose continues to heal.
Additional follow-up appointments may be necessary depending on findings related to allergies, healing, and any other potential considerations during surgery.
Most children start feeling better about a week after surgery, but the healing process can take up to a month or even longer depending on your child’s overall health.
What to Expect After Surgery/Recovery
Children who have surgery to alleviate frequent sinus infections report 80% fewer infections on average following sinus surgery. As a whole, the surgery benefits an average of 95% of children.
Success rates vary amongst children who undergo surgery for other reasons. However, according to research, a vast majority of children experience a significant improvement in symptoms following surgery.
Severe complications associated with sinus surgery are very rare and occur only in about 1% to 2% of adult and younger patients. Reported complications include cerebral spinal fluid leaks, blindness, double vision, and issues with tear ducts. Excessive bleeding requiring re-operation or re-hospitalization is also rare, but minor bleeding is common after sinus surgery.
Snoring & Sleep Apnea
Overview of Sleep Disordered Breathing
Many common breathing difficulties that take place while a child is sleeping are referred to as SDB, or sleep-disordered breathing. For most children, SDB presents as mild snoring, especially when they are sick or have allergies. When the airways are almost completely blocked, however, the condition is referred to as OSA, or obstructive sleep apnea. Children with OSA may face a wide variety of medical issues without treatment, including elevated blood pressure, increased heart rate, and difficulty entering the restorative stage of the sleep cycle. Recent studies show that around 10% of children frequently snore while nearly 4% of children have OSA.
Symptoms of Obstructive Sleep Apnea
Occasional snoring is not typically a serious problem for children, but those with OSA snore almost any time they are sleeping. Instead of steady and even breathing, the child may make irregular sounds such as gasps, coughs, and snorts. Parents may also notice that their children’s grades are suffering or that they have problems concentrating. Additionally, parents may note changes in their energy level or swings between the extremes of being hyperactive or chronically fatigued. Another common side effect of OSA is frequent bed-wetting.
OSA can be the result of almost any excess tissue that is covering a child’s breathing passage. Therefore, overweight children are much more likely to develop OSA and SDB due to fat deposits in their neck. Children with enlarged tonsils and adenoids are also at increased risk for OSA and SDB. Other common issues that may result in OSA include abnormalities of the tongue, neck, skull, and jaw.
Potential Consequences of Untreated Pediatric Sleep Disordered Breathing
- Behavior and learning: Children with OSA cannot get as much restorative sleep, so they often show signs of fatigue throughout the day. Children may also experience mood swings and attention problems.
- Enuresis (bed-wetting): SDB has been associated with an increased production of urine during the night, so bed-wetting a very common side effect.
- Growth: Children produce growth hormones while sleeping, and children that are unable to achieve the REM stage of sleep may experience a reduced production of growth hormones.
- Obesity: SBD not only lowers a child’s energy levels, but may also increase their resistance to insulin, increasing their risk for obesity.
- Cardiovascular: Patients with any type of sleep apnea are at increased risk for high blood pressure and other heart problems.
- Social: The effects of OSA and SDB often create anxiety in children.
Diagnosis of Sleep Apnea
Snoring may be nothing more than allergies or illness, but chronic and especially loud snoring is often the result of some form of sleep apnea. Children may begin to wet their bed unexpectedly or may lose interest in activities that they once enjoyed. Other children may experience difficulty concentrating in school or demonstrate peculiar mood swings. While each of these conditions may have other causes, we advise parents to have their children evaluated for sleep disorders if any of the signs are noted.
Parents should first discuss these symptoms with their child’s pediatrician or an otolaryngologist. These specialists will be able to explore the child’s medical history and carry out a number of simple examinations in order to make an accurate diagnosis. If further testing is needed or the results are inconclusive, then the doctor may suggest a polysomnography, or sleep study. For these studies, your child will sleep in a laboratory or the hospital and have their heart rate, airflow, muscle movement, and brain waves monitored.
Treatment for Sleep Disordered Breathing
For most children, sleep apnea is caused by enlarged tonsils and adenoids. If this is the case, your doctor may recommend a tonsillectomy, adenoidectomy, or both. These treatments have very high rates of success and recovery times are minimal. Any discomfort that the child experiences can almost always be treated with over-the-counter medicines such as acetaminophen. Children generally go home within a few hours of the procedure.
If the sleep apnea has not gotten better, the doctor may suggest lifestyle changes such as the use of a continuous positive airway pressure (CPAP) machine or changes to their diet to maintain a healthy weight.
Children and adolescents require specialized care for conditions affecting the ears, nose and throat. Our ENTs specialize in pediatric ENT, so you feel confident about their care. Contact our Tampa or Spring Hill office to schedule a consultation.