Pediatric ENT

Snoring and Sleep Apnea are two common ENT problems in children. Snoring is caused by obstruction in the nose and throat. It is essentially noise. If the nose is congested by swollen tissue due to allergy or infection there is a resistance to air flow that causes noise – snoring.

Sleep apnea is a serious condition that causes physiologic changes.  Because of severe airflow compromise there is breath holding, gasping, and choking, mouth breathing in addition to snoring.  Sleep apnea unlike snoring is characterized by a decrease in oxygen content that can stress the heart and cause changes in blood pressure. In severe cases of oxygen deprivation, the child can turn blue (cyanosis).  In milder cases there can be changes in the child’s behavior (depression, hyperactivity, aggressive behavior), problems with concentration and performance in school, daytime sleepiness, and bedwetting.

Enlarged tonsils and adenoids must be ruled out as a cause of snoring and sleep apnea.  They are part of the immune system and become enlarged when the child has recurrent infections and/or untreated allergy.  When they become enlarged they block movement of air through the nose and upper throat.

Treatment of snoring usually involves medical management with:

  1. Avoidance of things that cause allergy with nasal congestion such as dust pet dander, dairy products (milk, cheese and yogurt) and wheat
  2. Use of nasal steroid sprays, decongestants and/or antihistamines

If medical management fails surgery Adenoidectomy and/or Tonsillectomy please hyperlink to the bold text http://www.tonsil.org/ is the treatment of choice. Coblation  http://www.arthrocare.com/ent/ent_pat_patients.htm is a minimally invasive technique that uses radiofrequency surgery to remove the tonsil and adenoid tissue.  There is minimal heat and no charring of tissue.  This results in a faster recovery with less pain. 

Ear Infection (Otitis Media) is prevalent in children until age 7.  Prior to that time the anatomy of a child predisposes him/her to ear infection.  The connection between the middle ear and the nose (eustachian tube) is short and can allow mucous/infection to enter into the middle ear.  Because of this it is important to treat runny nose and chronic nasal congestion.  Nasal saline and humidification in addition to dust control and avoidance of dairy are effective.  In those children who do not respond decongestants and nasal steroid sprays can be added.

If middle ear fluid does not resolve with the above mentioned medical management ventilation tube placement http://www.petube.org/ is an effective treatment to clear the fluid and return hearing to normal.

Chronic Cough/Vomiting in children is commonly caused by gastro esophageal reflux disease (GERD) http://www.entnet.org/KidsENT/GERD.cfm treatment includes keeping the child upright for at least 30 minutes after meals and avoiding letting the child have a bottle when he/she is lying down. In severe cases medication to reduce stomach acid production is recommended.  An alternative is the use of a powdered enzyme with meals to aid in digestion.

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