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Ear, Nose & Throat Associates |
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Pediatric Otolaryngology
INTRODUCTION
One of the many factors that appeals to medical students about becoming an otolaryngologist is the chance to participate in the care of children and their families. There are numerous conditions that children develop that require attention from doctors in our field. Some common conditions for which we are consulted follow.
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MIDDLE EAR PROBLEMS
Children often have problems with Eustachian tube function. As a result, they may be bothered by recurrent acute ear infections and/or chronic middle ear fluid which can interfere with hearing and speech development. Often treatment involves diagnosing and managing the underlying cause of the problem, such as allergies or chronic infection. On occasion, preventive antibiotic treatment is necessary. Myringotomies and tubes are sometimes preferred treatment.
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Additional information:
Myringotomy Tubes (University of Virgina Health System)
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TONSIL & ADENOID CONDITIONS
Not infrequently, children suffer airway compromise related to enlargement of the tonsils and adenoids. This can lead to snoring and sleep apnea, with associated problems such as daytime tiredness and impaired learning ability or behavior problems. Recurrent tonsillitis can also be problematic. Sometimes treatment involves medicines, and sometimes tonsillectomy and adenoidectomy are required. In the last five years, coblation tonsillectomy and adenoidectomy has been a major advance when this surgery is necessary. Our anesthesiologists have pediatric expertise, and Mills-Peninsula provides a warm and friendly environment with nurses skilled in the care of children undergoing outpatient surgery.
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Additional information:
Pediatric Basics (about.com)
Coblation (ArthroCare)
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HEARING LOSS
While hearing loss can be secondary to middle ear fluid and correctable, children on occasion also have nerve loss which can be either congenital or acquired. Major advances in the management of these problems have been made in recent years. Our audiology team includes people with expertise in the diagnosis and management of children with sensorineural hearing loss.
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Additional information:
Hearing Evaluation in Children (KidsHealth.org)
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OTHER PEDIATRIC CONDITIONS
Children can develop numerous other conditions that affect the ears, nose and throat. Examples of such conditions include epistaxis (nose bleeds), ankyloglossia (tongue-tied), speech disorders, nasal and sinus infections, nasal obstructon, allergies, and acid reflux. Other, less common conditions include cholesteatoma (congenital or acquired), cleft lip and palate, and congenital abnormalities. While certain conditions are rare and therefore best managed in tertiary care centers, we believe that the common otolaryngology problems that children experience can be handled efficiently and by a caring and competent team within our community, and we remain committed to providing such care.
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A photo journal of one child's tonsillectomy experience at Mills Hospital Surgery Center
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| Robert*, a four year old boy, is getting ready for his tonsillectomy at Mills Hospital Surgery Center. He has already visited the surgery center with his parents several days prior to his operation; as a result, he is comfortable with the nursing staff and the center. He also had a preoperative appointment with Dr. Bock to discuss how to care for his throat after surgery and has recieved medical clearance to proceed with surgery from his pediatrician. | |  |
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| The anesthesiologist, Dr. Wilk, listens to Robert's heart, reviews the anesthesia plan, and answers the parents' questions. | | A relaxed patient is carried to the operating room by Dr. Wilk.
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 | | Dr. Wilk places an oxygen saturation monitor on Robert's toe while the scrub nurse and Dr. Bock are present to reassure the child. |
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| After Robert is asleep, Dr. Bock places sterile surgical drapes around his face and gently inserts a retractor into his mouth to visualize the tonsils. |
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| A child may bring a familiar stuffed animal or blanket to the operating room. Here's "Leo" watching over the procedure. |
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| Dr. Bock uses an Arthrocare Coblation wand to gently remove the tonsils while minimizing the amount of heat applied to Robert's throat. This technique will reduce postop discomfort. | | When Robert wakes in the recovery room, he is comfortable and his father is present to greet him. |
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 | | After surgery, Robert stays in the Recovery Care Inn (RCI) for the afternoon so that the nursing staff can be certain that he is drinking fluids and that any discomfort is managed with pain medications. If he is doing well, then at the end of the day, Dr. Bock will examine him and discharge him to home. Otherwise, he will stay overnight at the RCI with his parents until he is well enough to go home.
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| One week after surgery, Robert and his mother visit Dr. Bock. She asks about his progress at home and takes a look at his throat. | | Robert's mother and Dr. Bock review any postoperative concerns.
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| Here is a big smile from the patient: he is well enough to resume a regular diet and activities. He is looking forward to swimming with his friends over the weekend. | |  |
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| *Our patient's name is changed to protect his privacy. We would like to thank him and his parents for helping us put together this journal which will help other families prepare for surgery. |
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Coblator Coblation is a technique developed to deliver radiofrequency to tissues through saline to either incise or dissolve tissue. Coblation is preferred over electrocautery because less heat is delivered to the tissues and therefore there is less thermal damage to the surrounding areas, resulting in less patient discomfort. While applying coblation to tissues, there is a coagulative effect as well, so blood loss during coblation procedures is negligible.
Coblation can be used for tonsillectomy and adenoidectomy, as is being done by Dr. Ellison in the accompanying picture. Coblation is also used for turbinate reduction and base of tongue procedures. Studies have reported, and our group’s experience confirms, that patients have smoother postoperative courses and quicker recoveries since the assimilation of coblation into our practice several years ago.
More Coblator information:
Coblation Assisted Tonsillectomy Brochure
Coblation Turbinate Reduction Brochure
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Pediatric Journal Two:
Myringotomys with Tube Insertions
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| Katrina* is a 7 year old girl with a history of chronic middle ear infections requiring treatment with frequent courses of antibiotics. Her pediatrician recommended evaluation by an ENT specialist to determine if the placement of ear tubes would help Katrina's situation. Dr. Bock reviewed the patient's history and determined that Katrina was a good candidate for tube insertions (myringotomys with tubes); therefore, she was scheduled for surgery and had a preoperative consultation with Dr. Bock, her pediatrician and the Mills Hospital Surgery Center in preparation for this procedure. |
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On the day of surgery, Katrina and her mother (not shown in photo), meet with the anesthesiologist, Dr. Wilk, who reviews his anesthetic plan and answers any questions prior to surgery. |
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 After Katrina is asleep using a light, general anesthetic, Dr. Bock examines Katrina's ear under a microscope. Wax is removed from the ear canal, then once the ear drum is clearly visualized, Dr. Bock makes a small, painless incision in the ear drum (myringotomy). Accumulated fluid or pus in the middle ear space is removed with a tiny suction. Next, a tube is inserted into Katrina's ear drum. The tube is very small and can only be seen be an examiner using a special light, called an otoscope. The tube will remain in place for 12 to 18 months and should reduce Katrina's frequent ear infections. Katrina will see Dr. Bock one week after surgery and then every 3-4 months until the tubes extrude. |
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Here is a closeup view of the
myringotomy procedure. | | Shortly after surgery, Katrina recovers from her procedure in the postop recovery area (PACU). Her mother and Dr. Bock are present to check on her progress and to make certain she is comfortable.
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*Our patient's name is changed to protect her privacy. We would like to thank her and her parents for helping us put together this journal which will help other families prepare for surgery.
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100 South Ellsworth Avenue, Suite 308, San Mateo CA 94401
tel 650/344 6896 fax 650/344 2794
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805 Veterans Boulevard, Suite 115, Redwood City CA 94063
tel 650/369 1619 fax 650/474 2997
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