Transcription:
Does Your Child Snore or Get Recurrent Ear Infections? Look for a Pediatric Otolaryngologist

Melanie Cole (Host): Ear, nose, and throat problems are extremely common in kids, and if you're a parent you know how frustrating some of these things can be. My guest today is Dr. Christopher Azbell. He's a Pediatric Otolaryngologist with UK Healthcare. Dr. Azbell, first tell us a little bit about the field about Otolaryngology or ENT, and what's the difference in training for a Pediatric ENT?

Dr. Christopher Azbell (Guest): First, Melanie, thank you so much for having me on. Otolaryngologists take care of all kinds of problems from all ages with the ears, nose, and throats. All ENTs go through specific five-year training to become a general ENT. Pediatric Otolaryngologists have an additional one to two years of training focusing just on kids, and specifically, on complex problems within kids.

Host: What are some of the most common conditions that you see every single day with kids?

Dr. Azbell: The most common things we see are recurrent ear infections, hearing problems, snoring, and recurrent tonsil infections.

Host: All right, then. And as a parent, Dr. Azbell, I have had all of those things with my children. Let's start with recurrent ear infections. Parents worry that if their child has ear infections even from when they're little babies that they could suffer hearing loss. Tell us about ear infections, and when is it that you take action with these?

Dr. Azbell: Well, that concern is certainly true. Long-term ear infections or even long-term fluid in the ears can lead to a type of hearing loss we call conductive hearing loss that does dampen the child's hearing. Ear infections tend to happen starting in the first year of life when it's extremely important for a young child who is just hearing and developing speech to be able to hear. When we see a kid with ear infections, we start to recommend tubes when we either have more than three infections in six months, more than four infections in a year or when we have persistent fluid in the ear that we worry about affecting a child's hearing negatively.

Host: What is that tube implant like for children, and is it a permanent situation? What is it like when they get those tubes put in?

Dr. Azbell: Doing tubes, unfortunately, does mean surgery. That can be scary for many parents. However, it's a very quick outpatient surgery that just lasts five or ten minutes. Once the child is asleep with the help of a trained Anesthesiologist, we clean out the ears, make a small cut in the eardrum, and clean out any infection and any fluid that's there. Then we place a small, plastic tube, place some drops, and then the procedure is done. The surgery is quick, and the child gets to go home the same day. It is a temporary solution, which is a good thing because most children will eventually outgrow ear infections. With tubes, we just want to give the child a little bit of help for a year or two to help those infections drain on their own and prevent them from causing any further problems. The tubes eventually do fall out, and after that, we follow up with the child and the family to make sure that the infections do not come back.

Host: One question, sticking with ear infections for a minute, that parents have is the whole watching and waiting. Dr. Azbell, when a child gets those ear infections when are antibiotics or antibiotic drops the appropriate treatment?

Dr. Azbell: We want to make sure that there's a true infection rather than just fluid in the ears before giving antibiotics. Additionally, we don't want to confuse a bacterial ear infection that does need antibiotics with a cold or a virus that would not be helped with antibiotics. If you're concerned about an ear infection, the first thing to do is to go to your Pediatric ENT or your Pediatrician to look in the ear. If we just see some simple fluid that doesn't look infected or if symptoms have been temporary, we may watch to try to avoid unnecessary antibiotic administration to the kid.

Host: On to strep throat — none of us like to get that letter from the school saying strep throat is going around the school — but some kids seem to be more susceptible. Tell us about tonsillitis and strep throat, and are you still taking out tonsils?

Dr. Azbell: Absolutely. It's still, unfortunately, a common problem. Many kids get recurrent strep throat. It can be very painful and very frustrating, not just for the kids, but for the entire family. It leads to missed school; it leads to lost productivity for the parents, and it can be a big burden on the entire family. The short answer is yes, we do have to take out tonsils sometimes for recurrent strep throat. Some children are just strep carriers. They may not have symptoms of severe pain, and fever, and drainage from their tonsils. Those kinds of kids we can wait because they'll probably outgrow the strep and not need surgery.

Kids that have multiple infections a year or multiple infections over several years are candidates for tonsillectomy. We try to be judicious in choosing these patients because sometimes things do get better with time without surgery.

Host: To what age, Dr. Azbell? Some kids carry that strep throat thing all the way through high school, and I've heard that the older you get, the harder it is to remove your tonsils.

Dr. Azbell: It's absolutely true. Although the tonsillectomy is painful no matter when you have it, it is especially painful for teenagers and adults. If we have children that are getting up there in their early teen years, they're still having strep problems, we would go ahead and recommend tonsillectomy before they become an adult.

Host: Wow. So, on to sinus issues, allergies, and children — even children snore sometimes. When does a parent worry about a child's snoring, and when do they think well, they've got some kind of sinus issue or chronic allergies? What should parents be looking for?

Dr. Azbell: Interestingly, up to 10% of children have simple, benign snoring — basically, noisy breathing at night, but without other concerning, negative effects. But 1-4% of children can have sleep apnea. That means they're not just snoring, but at night when they're breathing, they're actually temporarily stopping airflow while they breathe. That means their Oxygen level can drop. That means they get poor sleep. It can have long-term, negative effects on both their behavior and actions during the day along with heart and lung problems later in life if sleep apnea goes untreated.

For those patients, if they have snoring and the parents witness pauses, or gasping, or choking during the night, and they have large tonsils, we would recommend taking out the tonsils and adenoids. If we're not sure, sometimes we will order a sleep study just like an adult sleep study. That would mean the child would spend the night with the parent in a pediatric sleep lab to be observed and to be measured so we can know for sure whether or not this is a simple snoring problem that won't have any negative, long-term consequences or if this is obstructive sleep apnea that would need to be taken care of with surgery.

There is a large overlap with adenoid problems. The adenoids are like tonsil tissue, but they sit in the back of the nose, so they can't be seen easily from an outside, physical exam in the clinic, especially in a child. However, the adenoids can become large and can obstruct breathing in the nose specifically. Not only do they obstruct nasal breathing, but they also lead to chronic drainage, chronic pain, and even chronic sinus infections. This is not uncommon, especially in younger kids. For kids that have chronic nasal obstruction or chronic sinus issues, sometimes adenoidectomy is recommended.

Host: Tell us about some of the more complex issues that a pediatric ENT might see.

Dr. Azbell: Absolutely. Some of the sickest patients we have to treat are actually newborns and sometimes even patients — babies that were born weeks or even months early. These babies often have a long, difficult first few months of life in the Neonatal ICU. They have noisy breathing problems; they often need help making their airways bigger. They often need help swallowing, and pediatric ENTs deal with these problems. Our goal is to get every baby breathing comfortably and able to eat and drink well.

Additionally, we see lots of patients with hearing loss that they were born with. Sometimes, hearing loss is simple, and we know the reason, and it can be treated with something like a hearing aid. However, other times, children end up needing cochlear implants to help them hear. These are complicated surgeries, but they allow a child born deaf to be able to hear and interact in the world.

Host: As we close, Dr. Azbell —and what an interesting topic — many parents have a question about ENT for their children. Please tell us the importance of choosing a pediatric-trained ENT for children with these types of issues and your best advice for parents that worry all the time about tonsillitis, strep throat, ear infections, any of these things that we've discussed today.

Dr. Azbell: Absolutely. I strongly recommend any parent with a child with an ear, nose, or throat issue go to a pediatric ENT. These ENTs, whether at UK or elsewhere, have specific training in dealing with the most complex problem with kids and can focus their expertise just on treating the children. Additionally, parents that worry about ear infections, or tonsillitis, or if the child may need surgery should seek out a referral to a pediatric ENT to at least be evaluated. Sometimes, surgery is not necessary, but it can at least give the parent a piece of mind that we're doing all possible to treat their child.

Host: That's perfect. Thank you so much, Dr. Azbell, for joining us today and sharing your expertise so that parents don't worry all the time about ear infections and strep throat. Thank you for being with us. This is UK Health Cast with the University of Kentucky Healthcare. For more information, you can go to UKHealthcare.uky.edu, that's UKHealthcare.uky.edu. I'm Melanie Cole. Thanks so much for listening.