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 Ventilation Tubes: If
your child has a history of ear infections that persist or recur
frequently, your doctor may advise placement of ventilation tubes
in your child's ears.
Ventilation tube placement is a common and uneventful procedure
and in young children it
is usually performed in the operating room under general anesthesia.
A small hole is cut in --- the eardrum
and any one variety of tube types are placed into the hole. The
tubes have raised or flanged edges to help hold the tube in place.
The tube allows the passage of air into and fluid out of the
middle ear.
 Many children notice an immediate
difference in pain and hearing postoperatively. If your child
has a history of frequent ear infections,
you may want to discuss this possibility with your doctor. |
Ear Infections: Ear
infections are the 2nd most common reason a child must see his/her
primary care physician. Ear infections can be caused by a number
of bacterial organisms. Some signs that may suggest your child
has an ear infection are fever, irritability, ear pain, tugging
or picking at the ear, lack of balance, lack of hearing or the
presence of fluid from the ear canal.
| There are a variety of treatments
available for this condition. They range from observation without
treatment, to antibiotic therapy, to placement of ventilation
tubes. Although its true some ear infections may resolve without
any intervention, it is important not to let an ear infection
continue long-term. Chronic ear infections have been known to
affect hearing and cause language and speech delays. Consult
your physician if you think your child may have an ear infection. |
Sinus Surgery: It is
extremely common for children to have problems with a runny nose.
Most children below the ages of 5 years will have 6 to 8 colds
a year, and during this time they may have marked mucus production
from the nose. This is usually self-limiting, but if a cold persists
for more than 10 days there may be underlying sinusitis requiring
treatment. Most children with sinusitis respond well to antibiotics
and nasal sprays.
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In a small number of children if the symptoms
do not improve, surgery may be necessary. Not all runny noses
are due to sinusitis. Some children removing their adenoids may
greatly improve their situation. However, in other children sinus
surgery is required, and requires special instrumentation and
particular care in order not to damage any of the surrounding
important structures that lie close to the nose.
In a very small number of children sinus problems
may present abruptly with acute sinusitis with a high fever and
occasionally a lot of swelling around the eyes. If this occurs,
intravenous antibiotics are usually required, and sometimes an
emergency sinus operation is also required.
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Vocal Cord Paralysis: Paralysis
of the vocal cords is a cause of noisy breathing and hoarseness
in some children. Some children are born with this problem, and
in some it may be the result of heart surgery or thyroid surgery.
One or both vocal cords may be paralyzed.
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If one vocal cord is paralyzed the voice is often
much more hoarse than if both of the vocal cords are paralyzed.
However, if both vocal cords are paralyzed there may be a marked
obstruction of the child's breathing causing very noisy breathing,
particularly when running around. Sometimes a vocal cord paralysis
will get better on its own. However, this is not always the case.
Not all children with vocal cord paralysis require
an operation, particularly if it is only one vocal cord that
is affected. However, in some cases it may be necessary to place
a tracheotomy to improve the breathing, or to perform an airway
reconstruction to remove the tracheotomy or to prevent the need
for a tracheotomy. Children with bilateral vocal cord paralysis
who require a tracheotomy usually still speak very well if a
speaking valve such as a Passey Muir valve is used on their tracheotomy
tube.
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Laryngeal Cleft: Laryngeal
clefts are a rare disorder where there is an abnormal communication
between the trachea and esophagus. There may be a minor cleft
just down to the vocal cords, or there can be a more major cleft
connecting the trachea to the esophagus for the whole length
of the trachea.
| Laryngeal clefts often present
with vague symptoms of choking, noisy breathing, and frequent
respiratory infections. This is due to varying degrees of aspiration,
and if left untreated the lungs risk being permanently damaged.
Laryngeal clefts are difficult to diagnose. Occasionally very
small clefts can be fixed endoscopically but the vast majority
of clefts will need to have an open surgery to be repaired. Children
with laryngeal clefts also often have gastroesophageal reflux
disease, and a few children will also have a tracheoesophageal
fistula. Some syndromes, such as Opitz-Friaz, are more prone
to having laryngeal clefts. |
Subglottic Hemangiomas: A
subglottic hemangioma is a benign tumor of blood vessels occurring
in the airway just below the vocal cords that may cause partial
obstruction of the airway. It is an example of the same disorder
that causes strawberry birthmarks on the skin of some children
and behaves in the same way as a strawberry birthmark in that
hemangiomas are not usually present at birth and they rapidly
grow quite large then slowly disappear again. In fact, 50% of
children with subglottic hemangiomas will also have a strawberry
nevus birthmark somewhere else on their body.
| Subglottic hemangiomas usually
do not cause problems at birth but cause increasing respiratory
distress over the first few months of life. If large enough,
they may block the majority of the airway and require intervention.
The treatment options are high-dose steroids, which often will
shrink hemangiomas. Another alternative is placement of a tracheotomy,
which can then be removed one or two years later when the hemangiomas
has disappeared again. Currently, in some children, open resection
of the whole hemangiomas is considered to avoid the need for
a tracheotomy. |
Laryngomalacia: Laryngomalacia
is the most common cause of noisy breathing in a baby. It is
due to the soft tissues and cartilage just above the vocal cords
being to floppy and falling into the airway, partly blocking
the airway when the child breathes in. The noisy breathing is
usually worse when the child is upset or crying, feeding, lying
on the back, and sometimes when sleeping. In these children,
the problem often gets worse before it gets better, particularly
for the first six months of life.
| Most children have out grown the
problem by one year of age. Some children with severe laryngomalcia
may also have problems with reflux and apnea, and occasionally
a child with this condition will require an operation to improve
breathing. |
Subglottic Stenosis: What
is subglottic stenosis? Subglottic stenosis is a narrowing of
the windpipe occurring at the level just below the vocal cords.
The cause of subglottic stenosis can be classified in two main
groups, acquired and congenital.
| Congenital subglottic
stenosis is the least common. Someone with congenital
subglottic stenosis was born with the condition and symptoms
of difficult breathing presenting at or some weeks after birth. |
| A person with acquired
subglottic stenosis, as the name implies, developed stenosis
as a result of an external factor. Some of those external factors
are thermal or chemical burn, blunt trauma to the throat, prolonged
endotracheal intubation, the latter of which is being far the
most common cause of subglottic stenosis. Premature infants very
often must be endotrachealy ventilated for a prolonged period
of time in order for them to survive. Ironically, it is this
life-saving technique that leads to subglottic stenosis in a
small percentage of infants. |
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