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Pediatrics

Children face many of the same health problems that adults do; however, symptoms may show themselves differently and treatment methods that work well in adults may not be appropriate for children. This page identifies common pediatric ear, nose, throat, head, and neck ailments, and what you should ask your child's doctor about diagnosis and treatment.

Child's Hearing Loss

At birth, one in 1,000 children have significant permanent hearing loss. When mild hearing loss is included, six in 1,000 children are affected. By age 18, 17 in 1,000 people have some degree of permanent hearing loss.

What are the symptoms of pediatric hearing loss?

  • Speech and language delay
  • Not babbling, or babbling has stopped
  • By 12 months, does not understand simple phrases such as “wave bye-bye” or “clap hands"
  • Not turning head in direction of sound
  • Difficulties in school

What causes pediatric hearing loss? 

Nerve hearing loss, also called sensorineural hearing loss, is permanent. This is caused by genetic factors in half of cases. The other half of cases may be due to infection (such as meningitis or congenital cytomegalovirus), head trauma, noise trauma, anatomic abnormalities, or certain medications. Sometimes, a cause can’t be identified.

Conductive hearing loss is usually temporary and caused by fluid in the middle ear, or an abnormality of the eardrum or hearing bones.  The middle ear is the area where ear infections occur. Ear infections can leave fluid in the middle ear after the infection is gone, causing conductive hearing loss. 

What are the treatment options for pediatric hearing loss?

The earlier that hearing loss is diagnosed, the sooner appropriate treatment can be discussed and implemented to help your child hear and speak as well as possible. To make a diagnosis of hearing loss, different types of tests can be done depending on the age of your child. These include the AE (otoacoustic emission) test, the ABR (auditory brainstem response) test, an audiogram (standard hearing test), and tympanometry (checks eardrum function).

For temporary hearing loss, sometimes a simple visit to your doctor to remove earwax, perform an outpatient ear tube placement, or other medical treatment can correct the hearing loss.

For permanent hearing loss, hearing aids, bone anchored hearing aids, FM systems, and/or cochlear implants may be recommended depending on the type and severity of hearing loss. It is important to also consider speech therapy as soon as a diagnosis is made.

Child's Allergies

The symptoms of allergic rhinitis, a physiological response to specific allergens such as pet dander or ragweed, are fairly simple. They include a runny nose, watery eyes, and some periodic sneezing.  Administration of the proper over-the-counter antihistamines may alleviate the symptoms, and seasonal allergic rhinitis may resolve after a short period.  

However, if your child suffers from year round allergic rhinitis, an examination by a ENT specialist will assist in preventing other ear, nose, and throat problems from occurring. You can learn more about potential ear, nose, and throat problems related to allergies below. 

Ear Infections:

One of children's most common medical problems is otitis media, or middle ear infection. These infections are especially common in early childhood. They are even more common when children suffer from allergic rhinitis (hay fever). Allergic inflammation can cause swelling in the nose and around the opening of the Eustachian tube (ear canal). This swelling has the potential to interfere with drainage of the middle ear. When bacteria laden discharge clogs the tube, infection is more likely.

Sore Throats:

Hay fever allergens may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to "post-nasal drip." It can cause a cough, a sore throat, and a husky voice. Air conditioning, winter heating, and dehydration can aggravate the condition. 

Snoring:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis and perennial allergic rhinitis. This allergic condition may have a debilitating effect on the nasal turbinates: the small, shelf-like, bony structures covered by mucous membranes. The turbinates protrude into the nasal airway and help to warm, humidify, and cleanse air before it reaches the lungs. When exposed to allergens, the mucosa can become inflamed. The blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose. This inflammation, or rhinitis, can cause chronic nasal obstruction that affects individuals during the day and night. Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea. 

Pediatric Sinusitis:

Allergic rhinitis can cause enough inflammation to obstruct the openings to the sinuses. Consequently, a bacterial sinus infection occurs. The disease is similar for children and adults. Children may or may not complain of pain; however, in acute sinusitis, they will often have pain, a fever, and nasal discharge. In chronic sinusitis, pain and fever are not evident. Most will have a purulent, runny nose and nasal congestion to the point where they must mouth breathe. The infected sinus drains around the Eustachian tube, and therefore many children will also have a middle ear infection.

Child's Sleep Apnea and Sleep Disordered Breathing

Approximately ten percent of children snore regularly, and about two to four percent of children experience obstructive sleep apnea (OSA). When a child’s breathing is disrupted during sleep due to OSA, the body thinks the child is choking.  The child's heart rate increases, their blood pressure rises, the brain is aroused, and sleep is disrupted.  Recent studies indicate that mild sleep disordered breathing (SDB) or snoring may cause many of the same problems as OSA in children.

What causes pediatric sleep disordered breathing?

A common physical cause of airway narrowing contributing to sleep disordered breathing is enlarged tonsils and adenoids. Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue, or neuromuscular deficits such as cerebral palsy, have a higher risk of developing sleep disordered breathing. 

What are the symptoms of pediatric sleep disordered breathing?

  • Snoring — The most obvious symptom of SDB is loud snoring that is present on most nights. The snoring can be interrupted by a complete blockage of breathing, with gasping noises associated with waking up from sleep. 
  • Irritability — A child with SDB may become irritable, sleepy during the day, or have difficulty concentrating in school. He or she may also display busy or hyperactive behavior.
  • Bedwetting — SDB can cause increased urine production at night, which may lead to bedwetting.
  • Learning Difficulties — Children with SDB may become moody and disruptive, or not pay attention, both at home and at school. 
  • Slow Growth — Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development. 
  • Cardiovascular Difficulties — OSA can be associated with an increased risk of high blood pressure, or other heart and lung problems.
  • Obesity — SDB may cause the body to have increased resistance to insulin, and daytime fatigue can lead to decreased physical activity. These factors can contribute to obesity.

How is sleep apnea diagnosed?

If you notice any of the symptoms described here, have your child checked by an ENT specialist. Sometimes physicians will make a diagnosis of SDB based on history and physical examination. In other cases, like children suspected of having severe OSA due to craniofacial syndromes, morbid obesity, neuromuscular disorders, or for children less than three-years-old, additional testing such as a sleep test may be recommended.

A sleep study, or polysomnography (PSG), is an objective test for SDB. Wires are attached to the head and body to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and is generally performed in a sleep laboratory or hospital. Sleep tests occasionally produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observations and clinical evaluation.


What are the treatment options? 

Surgical removal of the tonsils and adenoids, called tonsillectomy and adenoidectomy (T&A), is generally considered the first line of treatment for pediatric SDB if the symptoms are significant, and the tonsils and adenoids are enlarged. Many children with OSA show both short- and long-term improvement in their sleep and behavior after T&A.

Not every child with snoring needs to undergo a tonsillectomy and adenoidectomy . If the SDB symptoms are mild or intermittent, academic performance and behavior are not an issue, the tonsils are small, or the child is near puberty, your physician may recommend that you wait and treat surgically only if symptoms worsen.

Recent studies have shown that some children have persistent sleep disordered breathing after T&A. A post-operative sleep study may be necessary, especially in children with persistent symptoms or increased risk factors for persistent apnea after T&A.  Additional treatments such as weight loss, the use of continuous positive airway pressure (CPAP), or additional surgical procedures may sometimes be required.

Child's Head and Neck Cancer

Tumors or growths in the head and neck region can be divided into those that are benign (not cancerous) and those that are malignant (i.e., cancer). Fortunately, most growths in the head and neck region in children are benign. These benign growths can be related to infection, inflammation, fluid collections, swellings, or neoplasms (tumors) that are non life-threatening. On the other hand,  malignant growths may be life-threatening and cause other problems. Even malignant growths in the head and neck are usually treatable.

Benign Tumors

It is very common for children to have enlarged tonsils and adenoids. These are almost always from an infection or inflammation. It is very rare that children develop cancer, lymphoma, or sarcoma of these areas. When the tonsils, adenoids, or other areas of the mouth or throat remain enlarged or are enlarged on only one side, it is important to have an evaluation by an ENT specialist.

The lymph nodes of the neck region may become enlarged during childhood. Most of the time, this is related to inflammation or infection. However, if the lymph nodes remain enlarged for a period of time without going away, it is important to visit an ENT to evaluate the problem.

Other benign growths in the face and neck include cysts. These often require removal due to their continued growth and potential for infection. 

Sinus and Nose Growths

Although most children have nose bleeds, occasional allergies, and sinus infections, sometimes tumors of the nose and sinus present with similar symptoms. It is generally recommended that a child with continuous sinus problems or nose bleeds be evaluated by an otolaryngologist to be sure it is not a tumor or other treatable condition.

Salivary Gland Tumors

There are three paired sets of salivary glands in the head and neck region. These include the ones in front of the ears (parotid), below the jaw (submandibular), and underneath the tongue (sublingual). Additionally, there are numerous very small salivary glands throughout the mouth and throat. Although tumors can arise in these areas, they are rare. Thus, any child with a growth in these areas should be seen by an otolaryngologist.

Thyroid Tumors

The thyroid gland is found in the front of the lower part of the neck just above the chest area but below the Adam's apple. Although tumors can arise in this area, they are rare. Any child with a growth in this area should be seen by an ENT specialist.

Pediatric thyroid cancer occurs four times more often in females than males, and has similar characteristics as adult thyroid cancer. Surgery is the preferred treatment for this cancer. Although the procedure is typically uncomplicated, risks of thyroid surgery include vocal cord paralysis and low blood calcium (hypocalcemia). An ENT specialist or a head and neck surgeon who is experienced with head and neck issues should be consulted.

Symptoms of thyroid cancer vary. Your child may experience:

  • A lump in the neck
  • Persistent swollen lymph nodes
  • A tight or full feeling in the neck
  • Trouble with breathing or swallowing
  • Hoarseness

If any of these symptoms occur, consult your child’s physician for an evaluation. The evaluation will consist of a head and neck examination to determine if unusual lumps are present. A blood test may be ordered to determine how the thyroid is functioning. Ultrasonography uses sound waves to create an image of the thyroid gland and neck contents such as lymph nodes.

Other tests that may be warranted include a radioactive iodine scan, which provides information about the thyroid shape and function by identifying areas in the thyroid that do not absorb iodine in the normal way. Another test is a fine needle aspiration (FNA), or a fine needle biopsy. In this test a needle is inserted into a lump or mass to collect a sample of cells. Sometimes it is necessary to remove a part of the tumor or one of the lobes of the thyroid gland, known as a thyroid lobectomy, for analysis to help establish a diagnosis and plan for management.


What are the types of pediatric thyroid cancer?

  • Papillary —This form of thyroid cancer occurs in cells that produce thyroid hormones containing iodine. This is the most common form of thyroid cancer in children and it grows very slowly. This form can spread to the lymph nodes via lymphatics in the neck and occasionally spreads to more distant sites.
  • Follicular—This type of thyroid cancer also develops in cells that produce thyroid hormones containing iodine. The disease afflicts a slightly older age group and is less common in children. This type of thyroid cancer is more likely to spread to the neck via blood vessels, causing the cancer to spread to other parts of the body.
  • Medullary—This rare form of thyroid cancer develops in cells that produce calcitonin, a hormone that does not contain iodine. This cancer tends to spread to other parts of the body and constitutes about five to ten percent of all thyroid malignancies. 

What are the treatment options for pediatric thyroid cancer? 

If the tumor is found to be malignant, then surgery is recommended. Surgery may consist of a partial removal or a total thyroidectomy. In children with papillary or follicular thyroid cancer, total or near-total thyroidectomy is currently the standard of practice, as children typically have more extensive disease when diagnosed. This reduces the risk of recurrence. In children, there is an increased need for repeat surgery when less than a total thyroidectomy is performed. Lymph nodes in the neck may need to be removed as part of the treatment for thyroid cancer if there is a suspicion the cancer has spread to the lymph nodes.

Surgery may be followed by radioactive iodine therapy to destroy cancer cells that are left after surgery. Thyroid hormone therapy may need to be administered throughout your child’s life to replace normal hormones and slow the growth of any residual cancer cells.

If cancer has spread to other parts of the body, chemotherapy may be given. This therapy interferes with the cancer cell’s ability to grow and reproduce. Radiation treatment may also be required for treatment of some forms of thyroid cancer.

In general, treatment outcomes for this type of cancer in children tend to be excellent. The best outcomes are seen in teenage girls, papillary type cancer, and tumors localized to the thyroid gland.

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