The doctors at Huntington Ear Nose Throat Head & Neck specialize in treating pediatric otolaryngology and can help treat a wide range of pediatric conditions including tonsillitis, sinusitis and ear infections.


Breastfeeding difficulties

Research has shown that breastmilk has superior health benefits than formula. However, poor latch or supply can make breastfeeding challenging for many mothers. A careful evaluation of the breastfeeding issue with an experienced professional can often lead to resolution of the difficulty. Anatomic limitations like tethered oral tissue (tongue or lip tie) may need to be addressed either with stretching or surgical release. Sometimes an underlying medical condition like acid reflux or breathing difficulties in the infant needs to be treated for improvement. Dr. Rieber is a Certified Lactation Counselor and fellowship-trained Pediatric Otolaryngologist who is uniquely trained to help address your breastfeeding issues.


Adenoidectomy

An adenoidectomy is the surgical removal of the adenoids, glands located behind the nose above the roof of the mouth. The function of the adenoids is to help fight ear, nose and throat infections by screening bacteria as they enter the body. At times, however, the adenoids themselves may become chronically infected and require removal; this condition is known as adenoiditis.

The majority of adenoidectomies are performed in children, frequently in combination with tonsillectomies. In such cases, the procedure is called an adenotonsillectomy. The adenoids usually shrink by adolescence, so adults rarely undergo the procedure.

Reasons for an Adenoidectomy

When adenoids become infected and swollen, they may block the nose and make it difficult to breathe. To compensate, patients with adenoiditis frequently breathe through their mouths. Because mouth-breathing may produce its own set of symptoms, including dry mouth, bad breath, cracked lips and nasal congestion, an adenoidectomy may be required. Other problems caused by infected and swollen adenoids that can be corrected by adenoidectomy include:

  • Chronic ear infections
  • Chronic sinus infections
  • Difficulty swallowing
  • Difficulty sleeping
  • Nasal speech
  • Swollen glands in the neck

An adenoidectomy may also help to alleviate persistent snoring and sleep apnea

Diagnosis of Diseased Adenoids

While the tonsils can be seen by physical examination, the adenoids cannot. However, diseased adenoids have certain telltale signs, including yellow or white spots near the tonsils or tongue, swollen lymph nodes, or irritated red spots in the mouth, that enable their diagnosis. The adenoids themselves may be seen through the use of a special mirror in the mouth, or through a tube called an endoscope, which is inserted through the nose. Other tests to diagnose problems with the adenoids may include sleep studies or X-rays of the area.

The Adenoidectomy Procedure

Because an adenoidectomy is performed through the mouth, no incision is necessary and the only cutting involves removal of infected tissue. Sometimes surgeons use techniques other than traditional surgery to remove the adenoids. The two primary methods used in such procedures are electrocautery, which uses electricity to heat and remove the glands, and radiofrequency energy (RFB), which uses unheated radiofrequency energy for the same purpose. Adenoidectomies are normally performed as outpatient procedures under general anesthesia, but patients usually remain in the clinical setting under observation for about five hours to prevent complications.

Patients may experience sore throats or earaches, for up to two weeks after an adenoidectomy, and they may be treated with analgesics. There may also be swelling in the mouth, which causes residual mouth-breathing or snoring. White scabs in the mouth are normal after surgery and should not be picked because they will fall off naturally. It is important for a patient who has undergone an adenoidectomy to maintain hydration after surgery, and to be aware of complications signified by high or persistent fever, nausea and vomiting, headache, stiff neck or difficulty breathing.

Risks of an Adenoidectomy

While an adenoidectomy is a safe procedure, there are risks involved in any surgery. These risks may include:

  • Excessive bleeding
  • Blood clots
  • Adverse reactions to anesthesia or medications

Post-surgical infection and breathing problems are also possible complications of an adenoidectomy.
After an adenoidectomy most patients experience increased breathing through the nose, fewer sore throats and ear infections.

 


Frenectomy

A frenectomy is a simple surgical procedure that is often used to treat an exceptionally short or tight frenulum. The frenulum, also known as the frenum, is the band of tissue that connects the tongue to the floor of the mouth. In some cases a short frenulum may cause a gap between the two front bottom teeth. This condition can restrict movement of the tongue and can affect a patient's ability to eat and speak with ease, causing a common condition informally known as being "tongue-tied".

In cases where a short or tight frenulum is adversely affecting the speech and eating habits of a patient, a doctor may recommend a frenectomy. A frenectomy is a procedure that surgically removes the frenulum. The frenectomy procedure is performed under local anesthesia and using a scalpel or a laser, the surgeon removes the frenulum from beneath the tongue. This procedure usually takes less than 15 minutes. If necessary, the doctor may use dissolvable stitches to close the wound. Most patients recover well from the frenectomy procedure, only experiencing minor soreness afterwards. While it is considered a safe and non-invasive procedure, risks of a frenectomy may include bleeding and infection.

After surgery, most patients experience restored full movement of the tongue and problems with eating and speech are greatly reduced. In some cases, tongue exercises may be recommended to improve the movement of the tongue after a frenectomy.

 


Frenuloplasty

Some children are born with an inherited birth defect in which the lingual frenulum, the tissue that connects the tongue to the bottom of the mouth, is abnormally short, which can restrict movement of the tongue. This condition is commonly referred to as "tongue-tied". While this condition does not always cause symptoms, some children may experience difficulty nursing, eating, speech problems or social obstacles because of their condition.

Because a shortened frenulum restricts the range of motion of the tongue, a frenuloplasty may be recommended. A frenuloplasty is a surgical procedure performed to clip the frenulum and release the tongue. This procedure is used for children over a year old, and is usually performed under general anesthesia. Stitches are used to close the wound after this procedure, and most patients can resume their regular diet immediately after treatment. Although it is considered a safe and simple procedure, risks of a frenuloplasty may include infection, scarring and excessive bleeding.

This procedure results in increased tongue mobility and problems with eating and speech are greatly improved. After surgery, most patients experience effective symptom relief and restored full movement to the tongue. In some cases, tongue exercises may be recommended to improve the movement of the tongue after a frenuloplasty.


Pediatric Allergies

Children suffer with allergies in many of the same ways adults do, although since they are often less verbal, particularly when they are very young, they may not be able to describe their symptoms as accurately. Children may simply present as fussy, irritable or angry when suffering pain or discomfort they can't describe. Parents and other caregivers should be aware that children suffering from ear, nose and throat allergies are much more likely than adults to develop ear infections because of anatomical differences in the structure of their ears.

Causes of Pediatric Allergies

Allergies are not present at birth, but certain children are predisposed by hereditary factors to develop them. As children are exposed to particular allergens, such as pollen, mold, pet dander, specific foods or medications, they may reach a threshold and develop allergic reactions. Allergies are an abnormal reaction of the immune system to normally harmless substances. When a susceptible child is exposed to an allergen, the body releases a variety of chemicals, including histamine. Histamine is the precipitating cause of the allergic reaction.

Symptoms of Pediatric Allergies

As in adults, symptoms of allergies in children are varied. They may be allergic to substances that are inhaled, that come into contact with the skin, or that are ingested as food or medication. Children, like adults, may also have severe allergic reactions to the bites or stings of insects or other creatures. Symptoms of pediatric allergies may include:

  • Chronic cold-like symptoms, particularly during certain seasons
  • Itchy or watery eyes
  • Asthmatic coughing, wheezing, chest tightness, difficulty breathing
  • Rashes or itchy patches on the skin, eczema, hives
  • Repeated gagging, vomiting or abdominal pain
  • Itchy sensations in the mouth, throat or ears

Anaphylaxis, the most severe allergic reaction, occurs in a child or adult after the body has already been exposed to the allergen at least once before. Anaphylaxis is a systemic, life-threatening allergic reaction and must always be treated as an emergency. When a child is in danger of this type of systemic reaction, most often to a bee sting, food or medication, an epinephrine autoinjector must be carried by the child or caregiver at all times.

Diagnosis of Pediatric Allergies

Apart from observation and physical examination by a physician, allergies are diagnosed by various allergy tests, the skin test being the most common. During a skin patch test, the physician applies various potential allergens to the skin, usually of the arm and then scratches the skin so that the substance enters the bloodstream. The child is examined after a certain period of time to see if there is any reaction, mild to severe, on the skin where the allergen has been applied.

Common Allergens

There are many allergens in the household or outdoor environment that can cause allergic reactions in sensitive children. Among these are the following:

  • Dust mites
  • Fur-covered animals
  • Insect bites or stings
  • Pests, like cockroaches or mice
    Pollen
  • Molds and fungi, including microscopic ones

Foods, commonly cow's milk, eggs, nuts, soy, wheat and shellfish are also common allergens.

Treatment of Pediatric Allergies

No way has yet been discovered to prevent allergies, so the best help for children with allergies is to avoid contact with allergens wherever possible. This may mean strict avoidance of certain foods, medications, perfumes, detergents, or plants. Treatments for allergy symptoms once they occur may include:

  • Antihistamines
  • Decongestants
  • Corticosteroids administered as nasal drops or cream
  • Allergy shots to desensitize the child to the allergen

As previously mentioned, once a child suffers, or has previously suffered, an anaphylactic allergic reaction, it is essential that an epinephrine autoinjector be kept available at all times.


Tonsillectomy

A tonsillectomy is the surgical removal of the tonsils, the two pads located at either side of the back of the throat. The tonsils serve as part of the immune system, a first line of defense for pathogens entering the mouth or nose. Because of their function, they may become infected or inflamed and, in some cases, may require surgical removal. Tonsillectomies are more commonly performed on children than adults. A tonsillectomy may be necessary when an individual has recurring episodes of tonsillitis or an ongoing infection that has not healed with other treatment. Surgery may also be required if enlarged tonsils block airways, leading to sleep apnea, swallowing problems or difficulty eating. Rarely, a tonsillectomy may be performed to treat a malignancy of the tonsils.

Tonsillectomy Procedures

Traditionally, tonsillectomies have been performed with a scalpel under general anesthesia during a procedure which usually takes approximately an hour. In recent decades, many types of surgical procedures have become available for use in tonsillectomies. General or local anesthetics may be used, depending upon the method employed. Most patients return home several hours after the operation and are expected to heal within about 2 weeks.

Cold Knife Dissection

During a cold knife tonsillectomy, the doctor uses a snare, a knife curved like a circle, to remove the tonsils. This method requires general anesthesia, and approximately 2 weeks of recovery time.

Electrocautery

Using the electrocautery method, the surgeon burns the tonsillar tissue, stemming blood loss through cauterization. While this technique greatly reduces the risk of excessive bleeding, research has shown that the heat employed can damage surrounding tissue and may lead to a more painful recovery.

Coblation

During a coblation tonsillectomy, radio waves are used to ionize a saline solution, energizing the ions enough to enable them to cut through tissue and remove the tonsils. Because this procedure is performed without heat, less postsurgical pain and more efficient healing has been reported.

Microdebrider

This technique is used for a partial tonsillectomy. The microdebrider is a powered rotary shaving device with suction, eliminating the enlarged portion of the tonsil while preserving some tonsillar tissue. A natural biologic dressing is placed over the tonsil in order to prevent inflammation and infection. This procedure has been shown to result in less pain, dehydration and bleeding and a more rapid recovery. Because this procedure leaves part of the tonsil intact, however, it is recommended as a treatment for enlarged tonsils rather than infected ones.

Harmonic Scalpel

In this technique, ultrasonic vibrations are used to simultaneously cut tissue and cauterize the wound. An advantage of this technique is minimal damage to the surrounding tissue since sound waves, rather than heat, are responsible for excision.
Some types of tonsillectomy procedures result in shorter recovery times and less postsurgical soreness, but not all types of surgery are appropriate for all patients.

Risks of a Tonsillectomy

Although a tonsillectomy is a safe procedure, there are risks involved in any surgery. While a painful sore throat and some bleeding are expected after a tonsillectomy, more serious complications, though rare, may occur. These include:

  • Excessive bleeding
  • Blood clots
  • Adverse reactions to anesthesia or medications
  • Postsurgical infection
  • Breathing problems

While a tonsillectomy will greatly reduce the number of throat infections, it is possible for throat infections to recur after surgery. Additionally, the tonsils may partially grow back after a tonsillectomy, especially if some tonsillar tissue is left at the site.


Tonsillitis

Tonsillitis is an inflammation of the tonsils, the two pads of lymphoid tissue at the back of the throat. The tonsils are part of the immune system, functioning as the first line of defense against pathogens entering the body through the nose or mouth. Because of their role is protecting the body against infections, they can easily become infected or inflamed themselves. The immune function of the tonsils diminishes after puberty, so tonsillitis, a common ailment in children, is not usually found in adults. Tonsillitis is most often caused by a virus or a bacteria, usually a type of Streptococcus, but may also result from a fungal or parasitic infection. Although usually not considered a serious disorder, severe or untreated tonsillitis may result in complications.

Symptoms of Tonsillitis

Many of the symptoms of tonsillitis are similar to those of a strep throat or a common cold. Symptoms of tonsillitis may include:

  • Sore throat
  • Nasal congestion
  • Red, swollen tonsils with white or yellow spots
  • Fever
  • Headache
  • Laryngitis
  • Tender, swollen lymph nodes
  • Mouth breathing or bad breath
  • Stiff neck
  • Difficult or painful swallowing

Young children with tonsillitis may also experience stomach pain.

Diagnosis of Tonsillitis

Tonsillitis is typically diagnosed easily by physical examination since the tonsils are visibly red, swollen and covered with spots or sores. Tests for strep or cultures for other bacteria may be taken to ensure that the appropriate antibiotic is prescribed. If mononucleosis is suspected, a diagnostic test for that illness may also be administered.

Treatment of Tonsillitis

Tonsillitis caused by a virus can usually be treated at home through rest, gargling salt water and drinking plenty of warm liquids. Throat pain can be alleviated with over-the-counter pain medication and sucking on lozenges. When tonsillitis is caused by a bacterial infection, usually Streptococcus, antibiotics are prescribed.

In the past, it was common to surgically remove the tonsils as a treatment for tonsillitis. At present, a tonsillectomy, is only considered necessary if the patient has had several infections in a short period of time, or is suffering an ongoing case of tonsillitis that does not respond to treatment with medication. A tonsillectomy may be performed in a variety of ways and is often combined with the removal of the adenoids. The surgical method chosen is dependent on the patient's overall medical condition and the severity of the infection.

Complications of Tonsillitis

Left untreated, tonsillitis can result in serious medical problems, either from the obstructive enlargement of the tonsils or from the systemic spread of bacteria. These may include:

  • Respiratory difficulty
  • Sleep apnea
  • Tonsillar cellulitis
  • Tonsillar abscess

If tonsillitis caused by a strep infection is left untreated, the following complications may occur:

  • Rheumatic fever
  • Kidney disorders

Because of the dangerous consequences of untreated tonsillitis, it is important to have severe sore throats examined, diagnosed and treated promptly.


Pharyngitis

Commonly known as a sore throat, pharyngitis is usually the result of a viral infection, such as the common cold, or a bacterial infection, most often Streptococcus. Pharyngitis is characterized by rawness, scratchiness, and often swelling in the throat, sometimes accompanied by painful swallowing. On occasion, pharyngitis may be caused by a fungal infection or be a symptom of other diseases. Although usually not serious, pharyngitis that is accompanied by a fever, swollen lymph nodes, a rash, body aches or breathing difficulties should be diagnosed by a physician. Sometimes when a patient has pharyngitis, the tonsils or adenoids are also inflamed.

Symptoms of Pharyngitis

Depending on the cause of the condition, symptoms of pharyngitis may include:

  • Fever
  • Headache
  • Swollen lymph nodes
  • Runny nose or nasal congestion
  • Painful swallowing
  • Difficulty breathing
  • Skin rash
  • Joint or muscle pain
  • Ear pain

Causes of Pharyngitis

Pharyngitis is most frequently caused by the common cold or flu. It often occurs seasonally during the colder months, and frequently spreads among family members. Pharyngitis may also be caused by any of the following conditions:

  • Strep throat
  • Oral candidiasis (oral thrush)
  • Infectious mononucleosis
  • Coxsackie virus
  • Herpes simplex virus, or cold sores
  • Tonsillar abscess
  • Allergic reaction
  • Insect or spider bite

Rarely, pharyngitis may be caused by other bacteria, such as those that cause gonorrhea or chlamydia. In the case of the latter, the bacteria causing the sore throat is not necessarily been sexually transmitted.

Treatment of Pharyngitis

Pharyngitis associated with the common cold requires no treatment other than bed rest, increased fluid intake and over-the-counter analgesics. Hot drinks and lozenges may provide alleviation of symptoms. When pharyngitis is caused by a bacterial infection, antibiotic treatment is necessary. A throat culture may be administered to pinpoint the pathogen causing the problem. If the sore throat results from a fungal infection, antifungal medication will be prescribed. Pharyngitis that is resistant to treatment or that becomes chronic requires further investigation, diagnosis and treatment.


Strep Throat

Strep throat is a bacterial infection of the throat caused by the group A Streptococcus bacteria. This condition is highly contagious and may be spread easily from person to person, especially among family members, in schools and in child care settings. Children between the ages of 5 and 15 years old are commonly affected, however, strep throat can affect people of all ages. Strep throat is commonly treated with antibiotics, but left untreated it may lead to serious complications such as kidney inflammation or rheumatic fever.

Symptoms of Strep Throat

The most common symptoms of strep throat are a painful sore throat and fever, however additional symptoms may include:

  • Red and swollen tonsils
  • Red spots on the mouth palate
  • Rash
  • Fatigue
  • White patches in the back of the throat
  • Headache
  • Swollen glands in the neck
  • Difficulty swallowing

Young children may also experience stomach pain and vomiting when they have strep throat.

Diagnosis of Strep Throat

Strep throat is diagnosed after a physical examination and a review of symptoms. A throat culture is often performed to get a sample of the throat secretions. The sample is then sent to a lab to confirm whether the infection is viral or bacterial. The results of these test often take up to 24 hours, therefore the doctor may perform a rapid antigen test on the swab sample. This test can detect strep bacteria in minutes by detecting antigens in the throat. Since the results of the rapid strep antigen test are not always completely reliable, doctors may still use a traditional throat culture to confirm a strep diagnosis if the results of the rapid antigen test are negative.

Treatment of Strep Throat

Strep throat is commonly treated with antibiotics to clear the body of infection. Treatment for symptoms may include ibuprofen or acetaminophen to reduce fever and ease the pain of the sore throat. Patients are also advised to get plenty of rest and to drink fluids to stay hydrated. Gargling with warm salt water may also help to relieve throat pain. Most individuals start to feel better about 2 days after starting the antibiotics.


Sleep Apnea

Sleep apnea is a common sleep disorder that involves repeated breathing interruptions during sleep. These interruptions may occur hundred of times each night, and may be the result of structural abnormalities or brain malfunctions. During normal breathing, air passes through the nose, past the flexible structures in the back of the throat, including the soft palate, uvula and tongue. When a person is awake, the muscles hold this airway open. When they are asleep, these muscles relax and the airway usually stays open. Sleep apnea occurs when the upper airway and airflow are blocked, causing the oxygen levels to drop in both in the brain and the blood, resulting in shallow breathing or breathing pauses during sleep.

Causes of Sleep Apnea

Sleep apnea occurs as a result of a partial or fully blocked airway passage in the throat. Certain factors may put certain people at risk for developing sleep apnea, which include:

  • Enlarged tonsils or adenoids
  • Obesity
  • Cardiovascular problems
  • Smoking
  • Family history
  • Nasal congestion
  • Throat and tongue muscles that are more relaxed than normal

Adults over the age of 60 may be more at risk of developing sleep apnea because the aging process may limit the brain's ability to keep the throat muscles stiff during sleep. Heavy use of alcohol or sedatives may also contribute to sleep apnea because these substances may relax the muscles of the throat.

Types of Sleep Apnea

There are different types of sleep apnea that have different causes.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the soft tissue at the back of the throat closes, blocking or obstructing the airway.

Central Sleep Apnea

In patients with central sleep apnea the airway remains open but the brain does not send signals to the muscles involved in breathing. Patients with heart-related conditions may suffer from central sleep apnea.

Mixed Sleep Apnea

Mixed sleep apnea combines aspects of the obstructive and central types of apnea. A common warning sign of mixed sleep apnea is snoring, especially interspersed with gasps or lack of breathing.

Patients who are overweight, have high blood pressure, are older, smoke or have a family history of sleep apnea may have an increased risk of developing obstructive sleep apnea, while those with heart disease or a stroke are at an increased risk for central sleep apnea.

Symptoms of Sleep Apnea

Patients with sleep apnea may wake up with a headache in the morning and experience excessive daytime sleepiness. Additional symptoms may include:

  • Loud snoring
  • Waking up with a dry mouth or sore throat
  • Insomnia
  • Abrupt awakenings during the night
  • Bedwetting
  • Restless sleep
  • Concentration difficulties

Individuals with sleep apnea may experience shortness of breath that awakens them from sleep.

Diagnosis of Sleep Apnea

Sleep Apnea is diagnosed through a physical examination and a review of symptoms. Individuals may be referred to a sleep specialist who performs various diagnostic tests to confirm a diagnosis of sleep apnea or another sleep disorder. Some evaluations often involve overnight monitoring of breathing and other body functions during sleep. Additional diagnostic tests may include home sleep tests and a nocturnal polysomnography, which monitors heart and lung function, brain activity, breathing patterns, and blood oxygen levels during sleep.

Treatment of Sleep Apnea

Sleep apnea may be treated with lifestyle changes such as losing weight, cutting down on alcohol consumption and quitting smoking. Nasal training devices are also commonly used to treat sleep apnea. Other treatment for sleep apnea may include continuous positive airway pressure, or CPAP, which involves the patient wearing a pressurized mask over their nose while they sleep. The mask pumps air through the airway to keep it open.

If conservative treatment is unsuccessful in treating sleep apnea, there are other options available. Individuals who suffer from severe cases of sleep apnea that may lead to serious medical conditions, may benefit from surgery. The goal of most surgical procedures is to remove the excess tissue from the nose or throat and open upper air passages to facilitate breathing.

Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty surgery treats obstructive sleep apnea by tightening the tissue in the throat and palate to expand the passageways. It may also include the removal of the tonsils and adenoids.

Lingual Tonsillectomy

Sometimes the tonsils located on the base of the tongue can be enlarged. Reducing these with ablative technologies can open the airway and improve breathing

Genioglossus and Hyoid Advancement

Genioglossus and hyoid advancement procedures are frequently used to treat sleep apnea. The surgical procedure prevents the collapse of the lower throat by pulling the tongue muscles forward, which opens the obstructed airway.

Septoplasty and Turbinate Surgery

Nasal septoplasty reduces resistance to air flow through the nose. It repairs and straightens the bone and tissue separating the two nasal passages, as well as the layers of spongy horizontal bones, or turbinate, which are located inside the nasal cavity.
Custom made oral appliances may also be used to treat sleep apnea. Some devices are designed to open the throat by bringing the jaw forward, which can help to relieve snoring and mild obstructive sleep apnea. Left untreated, sleep apnea may cause serious problems. Patients with sleep apnea have a higher risk of developing high blood pressure, heart failure and stroke.

Tracheostomy

Often performed after other treatments have failed, a tracheostomy involves inserting a metal or plastic tube into the throat to help the patient breathe during sleep. The opening remains covered during the day but helps air pass directly in and out of the lungs during sleep. Tracheostomy is reserved for severe,life-threatening cases of sleep apnea.

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