Acute and Chronic Otitis Media

ENT doctor examining young child's ear

What is Otitis Media?

Ear infections, also known as otitis media, are one of the most common conditions affecting up to 75 percent of children in the US. This condition develops as a result of a buildup of fluid in the space behind the ear drum, typically caused by decreased function of the eustachian tubes (tubes that connect the middle ear to the nose). Patients with an ear infection may experience earache, fever, ear discharge, headache and dizziness. Ear infections rarely affect adults as the eustachian tube develops and improves its function as kids grow.

How are ear infections treated?

Most ear infections go away on their own within two or three days. Treatment for these cases aims to relieve pain and other symptoms, although your doctor may not recommend any treatment at all. Some patients may experience recurrent or chronic ear infections leading to persistent fluid behind the ear drum that may ultimately impact hearing, speech, and/or long-term damage to the middle ear. In these cases, treatment options may include antibiotics, steroids and potential placement of ventilation tubes, depending on the severity of the condition.

Nasal Congestion in Children

What is nasal congestion?

Nasal congestion, or a "stuffy nose," is a common condition in pediatric patients and is often caused by inflammation and swelling of the nasal tissues due to viral infections (like the common cold), allergies, or irritants. Nasal breathing is vital in both infants and children as congestion can significantly impact feeding, sleep, overall comfort, as well as facial growth. While most cases are mild and self-limiting, prolonged or severe congestion may indicate underlying issues such as adenoid hypertrophy, allergic rhinitis/chronic sinusitis or other anatomical abnormalities.

How is nasal congestion in children treated?

First line management typically includes use of nasal saline sprays/rinses, humidification and potentially medicated nasal sprays such as intranasal steroids or antihistamines. If symptoms persist then surgical options may be available, such as adenoidectomy and/or inferior turbinate reduction.

Tonsillitis and Tonsillar Hypertrophy

ENT doctor checking young boy's mouth and throat with mother

What is tonsillitis?

Tonsillitis is an inflammation and swelling of the tonsils, which are located in the back of the throat.

Symptoms may include:

  • sore throat
  • painful swallowing
  • fever
  • chills
  • swollen lymph nodes

The most common cause is viral infections that will typically be self-limited over the span of 5-7 days. Other causes include bacterial infections, such as Strep throat.

How is tonsillitis in children treated?

Supportive care with rest, hydration and pain control are initial management options with antibiotics reserved for bacterial infections. In the event of recurrent episodes of tonsillitis, particularly strep tonsillitis, surgery is sometimes indicated to help prevent future occurrences and limit symptoms and time away from school.

Recurrent inflammation of the tonsils, can lead to tonsillar hypertrophy (i.e. big tonsils). When tonsils are enlarged in pediatric patients, it can cause discomfort/sore throat, swallowing difficulties, voice changes, and airway obstruction. To learn more about the impact of tonsillar hypertrophy, please see the Pediatric Sleep Disorders (Obstructive Sleep Apnea) section below.

Tongue Tie (Ankyloglossia)

What is Ankyloglossia?

Ankyloglossia (i.e. tongue tie) is a congenital condition in which the lingual frenulum (a band of tissue connecting the underside of the tongue to the floor of the mouth) is thickened or shortened causing decreased mobility of the tongue. This is especially important in the newborn period and may affect the ability for the child to effectively latch and nurse while breastfeeding leading. This may cause prolonged feeding times, inability to receive adequate nutrition/weight loss and maternal nipple pain/discomfort. Furthermore, the ineffective latch can result in more air intake during feeding leading to bloating and/or reflux and discomfort. As the child grows, it can further impact speech, oral hygiene and facial growth/open mouth posturing.

How is Tongue Tie treated?

Diagnosis is made clinically with parent history and physical exam. A minor procedure may be recommended in order to release the band of tissue and improve mobility of the tongue (lingual frenulectomy). It can be done in the office typically in children under the age of 7 months with a rapid recovery and minimal complications.

Pediatric Sleep Disorders (Obstructive Sleep Apnea)

Young child sleeping with pediatric obstructive sleep apnea

What is Pediatric OSA?

Pediatric obstructive sleep apnea (OSA) is a sleep-related breathing disorder whereby there are episodes of partial or complete upper airway obstruction during sleep.

Typical symptoms noted by parents include:

  • loud snoring
  • mouth breathing
  • restless sleep or frequent awakenings
  • choking/coughing episodes at night
  • potential witnessed episodes of pauses in breathing

These episodes of obstruction can lead to poor sleep quality, difficulty waking up in the morning, daytime fatigue/tiredness, nightly bedwetting issues and potential behavioral issues such as irritability, inattention, or hyperactivity. In pediatric patients, the most common cause of OSA is enlarged tonsils and adenoids, which leads to a literal roadblock obstructing the airway during sleep. Early identification and treatment are essential to prevent complications such as growth impairment, learning difficulties and cardiovascular strain.

How is OSA treated in children?

When diagnosing OSA in children, history and physical exam may be enough. Sometimes, a sleep study may be recommended, which can be done safely at home or in a sleep lab. For the vast majority of pediatric OSA patients, removing the tonsils and adenoids is curative, however other options may be required, based on the individual child.