Ventilating Ear Tubes
Tympanostomy tubes are tiny tubes that are placed in the eardrum. Also called “ear tubes”, they are usually placed for these reasons:
* If your child has repeated ear infections that do not get better with antibiotics
* If your child has fluid in his or her middle ear space for 3 months or more.
The middle ear space is normally filled with air. If the middle ear is filled with fluid instead of air, hearing is muffled or garbled. This is what happens with ear infections. By draining fluid, tympanostomy tubes allow the middle ear to fill with air again and ventilate properly.
The main concern about fluid in the ear is that it makes sound garbled. This can interfere with your child’s learning to speak because children imitate the sounds they hear. Hearing usually improves soon after the tubes are placed. Your doctor or an audiologist should check to make sure that your child’s hearing is normal.
Tubes are placed during surgery. Most children will go home the same day of the surgery. Your child is briefly put to sleep during the procedure. When you schedule the surgery, we will tell you that your child cannot ear or drink (including water) for a certain number of hours before the surgery. It is very important to have an empty stomach so that he or she doesn’t vomit and inhale it in while asleep.
After your child is asleep, your doctor makes a tiny surgical opening under a microscope in your child’s eardrum. Any fluid present in the middle ear is then suctioned out. Next, the tube is put in the small opening in the eardrum. Most tubes look like a small spool, generally the size of the tip of a pen.
It is normal for your child to be tired, irritable or feel sick to his or her stomach for a few hours after surgery. If your child continues to feel sick or vomits after you go home, call your doctor. There may be persistent watery ear drainage, sometimes blood-tinged, for the next 48 hours. This is normal.
When your child is ready to eat, offer clear liquids such as juice, broth, or popsicles, and if tolerated offer a light diet such as toast, crackers, or applesauce. When your child eats these foods without problems, he or she can resume a normal diet.
Most children resume their normal routine shortly after surgery. Watch for unsteadiness during the first 24 hours after surgery. If your child does seem unsteady or dizzy, encourage quiet activities such as reading, watching TV or coloring. Traveling by airplane or to the mountains (elevation changes) will not hurt your child’s ears.
Although the risk is lowered, ear infections can still happen, usually occurring with a cold. Infections may start with drainage, but generally have little (or no) pain or fever. The drainage is usually thick and sticky with noticeable odor. Call your doctor if this happens. Most infections can be successfully treated with ear drops alone.
After tubes are placed, some children may get ear infections from water entering the ear canal and going through the tube. This seems to happen more often with older children. To protect the ears from water take a piece of cotton, place it snugly in the outer ear, then cover it generously with Vaseline to make it waterproof. We also make custom “????? Plugs” that are comfortable and provide the best protection against water exposure. Please ask your doctor about these if you are interested.
Please schedule a follow up visit for 2-3 weeks after surgery. Further follow up visits are needed for every six months thereafter. Your child’s ears need to be examined regularly for the status of the tube and health of the middle ear.
The tube will work its way out of the eardrum and into the ear canal on its own. This usually happens 6-12 months after surgery. In most children the remaining hole in the ear drum will slowly close. Less than 20% of all children with tympanostomy tubes need a second set of tubes.
- An ear infection develops after surgery and can not be successfully treated by your family doctor or pediatrician.
- If you have any other questions.
Tonsillectomy - Adenoidectomy
The tonsils are located on each side of the back wall of the throat, just above and behind the tongue. The adenoids are found above and behind the soft palate (roof of the mouth) where the nose and mouth join. When they are overcome by chronic infections, or when marked enlargement blocks breathing, tonsils and/or adenoids may need to be removed. During surgery, the tonsils and adenoids are removed from the wall of the throat. The adenoids are reached by lifting the soft palate. The operation takes about 30 minutes.
After this operation, your child may lack energy for several days. Many children are restless and don’t sleep through the night. This will gradually improve over 7-14 days. Constipation may also occur. This is due to less food and fluids taken and/or the use of pain medications with codeine. To avoid nausea, give your child food and drink with this type of medication.
No new bleeding (BRIGHT RED blood) is expected from the nose or mouth after you return home. Please check your child for bleeding during the night after the operation. If fresh bleeding occurs after you have returned home, try gargling with ice water for 10-15 minutes and if it does not resolve, call the surgeon or go to the nearest emergency room. If the adenoids are removed do not allow your child to blow his or her nose for 3 days. This may cause bleeding. It is safe to sniff gently as needed. 5-10 days after the operation your child may spit up a small amount of dark, bloody material. The white membrane that formed across the back of the throat has broken away. If the bleeding does not stop within a few minutes, take your child to the closest emergency room.
Encourage your child to drink clear, cold liquids every waking hour for the first 2 days. Good choices include cold water, fruit juice, Jell-O, popsicles, slush, Gatorade, and Pedialyte. You may advance the diet to soft, the sold foods at any time after surgery. If your child is nauseated and vomits DO NOT provide any food or drink for 30-45 minutes. Then begin with clear liquids again, progressing to solid foods once your child tolerated clear liquids without vomiting.
A slight fever is NORMAL for 24-48 hours after surgery. Giving your child plenty of fluids will help keep the fever down. If the fever rises above 101.5 F, contact your doctor.
Throat pain and/or ear pain can be severe after a tonsillectomy. Expect your child to experience pain in the ears between the 3rd and 7th day after the operation. The nerve that goes to the tonsil also goes to the ear causing pain to be felt in the ear. After the operation give pain medication 4-5 times a day. Do NOT use aspirin, medications containing aspirin, or ibuprofen (Motrin, Advil) – they increase the chance of bleeding. Acetaminophen (Tylenol, Tempra) of a prescription item advised by your physician can be used. Sometimes a short course of prescription steroids may help with pain and swelling. Other ways to decrease throat pain are:
* Give you child cold liquids. They moisten the throat and reduce the swelling.
* Cool compresses and ice collars on the neck.
* Ice chips also moisten the throat.
Bad breath is common after a tonsillectomy. It is caused by the white-yellowish membrane that forms in the throat where the surgery took place. Bad breath may be improved by gargling with a mild salt-water solution. This is made by adding a teaspoon of table salt to 8-ounces (1 Cup) of warm tap water.
Promethazine (Phenergan), or prochlorperazine (Compazine) suppositories may be used to control nausea and vomiting. The dose may be repeated after 4-6 hours. If vomiting continues after the 2nd dose, call your child’s doctor or the local hospital emergency room.
Your child can be up and dressed after going home. But do NOT allow your child to resume normal activity for about one week. Your child may experience alternating “good” and “bad” days for 2 weeks after surgery. It is a good idea to keep your child away from crowds and ill people for 7 days, since the throat is highly susceptible to infections during this period.
Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.
Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems.
The tongue is one of the most important muscles for speech and swallowing. For this reason having tongue-tie can lead to eating or speech problems, which may be serious in some individuals.
When Is Tongue-tie a Problem That Needs Treatment?
Feeding – A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Such feeding problems should be discussed with your child’s pediatrician who may refer you to an otolaryngologist-head and neck surgeon (ear, nose, and throat specialist) for additional treatment.
NOTE: Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie. Although it is often overlooked, tongue tie can be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breast feeding altogether.
Speech – While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the sounds – l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three-year-old child’s speech is not understood outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:
* V-shaped notch at the tip of the tongue
* Inability to stick out the tongue past the upper gums
* Inability to touch the roof of the mouth
* Difficulty moving the tongue from side to side
As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If the answer is no, they cannot, then it may be time to consult a physician.
Appearance – For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth. Your child’s physician can guide you in the diagnosis and treatment of tongue-tie. If he/she recommends surgery, an otolaryngologist-head and neck surgeon (ear, nose, and throat specialist), can perform a surgical procedure called a frenulectomy.
Tongue-tie Surgery Considerations
Tongue-tie surgery is a simple procedure and there are normally no complications. For very young infants (less than six-weeks-old), it may be done in the office of the physician. General anesthesia may be recommended when frenulectomy is performed on older children. But in some cases, it can be done in the physician’s office under local anesthesia. While frenulectomy is relatively simple, it can yield big results. Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.
Foreign Bodies in the Ear, Nose and Airway
Foreign bodies in the ear, nose, and breathing tract (airway) sometimes occur in children. Foreign bodies refer to any object that is placed in the ear, nose, or mouth that is not meant to be there and could cause harm without immediate medical attention.
Foreign bodies can either be in the ear lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into his/her ear. Some of the items that are commonly found in the ear canal include the following:
* pieces of crayon
* small batteries
It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear. The reason children place things in their ears is usually because they are bored, curious, or copying other children. Sometimes, one child may put an object in another child’s ear during play. Insects may also fly into the ear canal, causing potential harm. It has also been noted that children with chronic outer ear infections tend to place things in their ears more often.
Some objects placed in the ear may not cause symptoms, while other objects, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing may be affected if the object is blocking the ear canal.
The treatment for foreign bodies in the ear is prompt removal of the object by your child’s physician. The following are some of the techniques that may be used by your child’s physician to remove the object from the ear canal:
* instruments may be inserted in the ear
* magnets are sometimes used if the object is metal
* cleaning the ear canal with water
* a machine with suction to help pull the object out
After removal of the object, your child’s physician will then re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.
Objects that are put into the child’s nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys, or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious, or copying other children.
The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.
Treatment of a foreign body in the nose involves prompt removal of the object by your child’s physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child’s physician to remove the object from the nose:
* suction machines with tubes attached
* instruments such as small tweezers called forceps
After removal of the object, your child’s physician may prescribe nose drops or antibiotic ointments to treat any possible infections.
Foreign bodies in the airway constitute a medical emergency and require immediate attention. The foreign body can get stuck in many different places within the airway. Foreign bodies in the airway account for nearly 9 percent of all home accidental deaths in children under 5 years of age.
As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the “airway” tube (trachea) instead of the “eating” tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects, including, but not limited to, the following:
* toy parts
* hot dogs
Children need to be watched very closely to avoid a choking emergency.
Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:
* choking or gagging when the object is first inhaled
* coughing at first
* wheezing (a whistling sound, usually made when the child breathes out)
Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:
* stridor (a high pitched sound usually heard when the child breathes)
* cough that gets worse
* child is unable to speak
* pain in the throat area or chest
* hoarse voice
* blueness around the lips
* not breathing
* the child may become unconscious
Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.