Otolaryngology Conditions & Treatments

The Otolaryngology team diagnoses and treats a broad range of pediatric ENT conditions, from ear infections and tonsillitis to larynx reconstruction or hemangiomas.

Chronic otitis media (ear infection)

Ear infections occur when fluid builds up in the inner ear and becomes infected. This can cause:

  • Pain
  • Fever
  • Temporary hearing loss
  • Loss of appetite
  • Irritability

Sometimes children get repeated ear infections because their inner ears cannot fully drain fluid build-up.

Treatments include:

Surgery to improve hearing by reshaping the inner ear bones or removing damaged tissue

Sleep Apnea

The most common cause of sleep apnea in children is enlarged tonsils and/or adenoids. When larger than normal, these tissues can partially blocking the airway, causing snoring and disturbed sleep.

Sleep apnea can lead to or be related to other health conditions, such as:

  • Daytime sleepiness
  • Bed-wetting
  • Sleep-walking
  • Delayed growth
  • Hormonal and metabolic problems
  • Failure to thrive
  • Childhood obesity
  • Behavioral or school performance problems

Treatments include surgery to remove the adenoids and tonsils and positive airway pressure (PAP) therapy to improve breathing during sleep.

Chronic upper respiratory illnesses

Many children experience frequent respiratory tract infections during their preschool and school years. Respiratory illnesses can be caused by allergies, asthma and exposure to secondary smoke at home. The condition is often viral and mainly affects the upper respiratory tract. Symptoms include:

  • Fever
  • Cough
  • Sore throat
  • Rhinitis

Treatments include:

  • Making sure the child drinks plenty of fluids
  • Medicine for fever
  • Saline nose drops

Because these infections are usually viral, antibiotics are not used unless bacteria are present.

Tonsillitis and adenoiditis

The adenoids and tonsils are the body’s first defense against many viruses and bacteria. When these tissues detect possible threats, they release white blood cells and antibodies into the lymphatic system to fight infections. Sometimes the adenoids and tonsils get infected and inflamed. Symptoms include:

  • A white or yellow coating on the tonsils
  • Voice change due to swelling
  • Sore throat
  • Uncomfortable or painful swallowing
  • Ear pain
  • Swollen lymph nodes (glands) in the neck
  • Fever 
  • Bad breath

Treatments include antibiotics for bacterial infections, especially streptococcus. If a child gets repeated infections despite using antibiotics, removal of the tonsils and adenoids may be recommended.

Sinusitis/nasal/allergy

Sinuses are spaces in the bones of the face around the nose. When a child has a cold or allergies, the sinus tissues become swollen and fill with mucus. The same symptoms also affect the nasal passages. This can cause the drainage system for the sinuses to get blocked. If mucus becomes trapped in the sinuses, bacteria, viruses and fungi can grow and cause a sinus infection.

In younger children, symptoms mimic a cold with a stuffy or a runny nose and a slight fever. If fever appears about a week after the cold symptoms, an infection could be present.

In older children and teens, sinusitis symptoms include:

  • A cough that doesn't improve after the first 7 days of cold symptoms
  • Fever
  • Worsening congestion
  • Foul breath
  • Dental pain
  • Ear pain
  • Tenderness in the face

Treatments include antibiotics, pain medicines and using a humidifier.

Laryngomalacia and pediatric airway concerns

Laryngomalacia is a congenital condition where the tissues of the larynx (voice box) get soft. This is the most common cause of noisy breathing in infants, because the floppy tissues partially block the airway. The softer tissues can also lead to gastroesophageal reflux disease. In 90 percent of cases, laryngomalacia is not serious and the condition resolves without treatment by 18 to 20 months old. In severe cases, treatment may include medication for GERD or surgery to strengthen or repair the larynx.

Other pediatric airway conditions include:

  • Laryngopharyngeal reflux is when stomach contents travel to the aero-digestive tract, causing cough, hoarseness and wheezing. Medicines and surgery are the treatment options.
  • Subglottic stenosis is a narrowing of the windpipe below the vocal folds. Treatments include surgery to widen or reshape the windpipe.
  • Vocal fold paralysis happens when the nerve signals to the laryngeal muscles are abnormal. Treatments include voice therapy and phonosurgery, a procedure to reshape or reposition the vocal cords.

Speech

Many children may experience speech disorders as they learn to talk. Most times the issues are minor, but in more serious cases, the cause can be related to:

  • Irregular amount of air coming through the mouth and nose
  • Hearing problems
  • Problems with the tongue or palate
  • Oral motor issues

Speech therapy is the most common treatment. If other conditions, like hearing problems, are present, addressing those disorders can also help to improve speech.

Swallowing Disorders

Swallowing disorders are when an infant or young child has trouble sucking, gathering food in the mouth and swallowing it properly. Children who cannot eat or drink normally may be at risk for other problems, such as:

  • Dehydration
  • Poor nutrition
  • Food or liquid entering the airway
  • Pneumonia
  • Repeated upper respiratory infections
  • Embarrassment in social eating situations

Signs and symptoms of swallowing disorders include:

  • Difficulty breastfeeding
  • Arching or stiffening during feeding
  • Irritability during feeding
  • Coughing or gagging when eating
  • Difficulty breathing while eating and drinking
  • Excessive drooling
  • Food/liquid coming out of the mouth or nose
  • Long feeding times
  • Difficulty chewing
  • Frequent spitting up or vomiting
  • Recurring pneumonia or respiratory infections
  • Less than normal weight gain or growth

Treatment for swallowing disorders depends on the specific condition and can include:

  • Medicines
  • Swallowing therapy
  • Changes in seating positions
  • Behavior management

Hemangiomas

Hemangiomas are a type of vascular abnormality. They are noncancerous tumors created by an abnormal cluster of blood vessels. Hemangiomas can form on any part of the body but usually appear on the neck and face. They can also grow on internal organs, which can interfere with important functions.

Hemangiomas on the skin:

  • Appear as red marks
  • Can be raised above the skin
  • Usually disappear by age 10

Hemangiomas on internal organs can cause:

  • Abdominal discomfort
  • Loss of appetite
  • Nausea
  • Vomiting
  • Weight loss

Treatments for hemangiomas include:

  • Laser therapy to lighten red marks
  • Surgery to remove the mass
  • Scarring of the hemangioma to stop its growth

Hearing loss

Hearing loss in children can be caused by a wide variety of conditions, such as:

  • Otitis media
  • Genetic factors
  • Prenatal infections
  • Toxins consumed by the mother during pregnancy
  • Prematurity
  • Noise exposure
  • Lack of oxygen
  • Head injury

A child’s hearing loss can be mild to severe, depending on the specific cause. Treatments may include:

  • Speech therapy with an audiologist or speech-language pathologist
  • Hearing aids or assistive listening devices 
  • Cochlear implants

Neck masses/bumps

There are many kinds of neck masses and bumps that can be present in children from birth. Most are just inflammatory and are not cancerous. They can be large or small and often are not noticed until the child gets a cold or sinus infection. Types of more common masses and bumps include:

  • Thyroglossal duct cyst. This mass is a small area of fluid or mucus in the neck. It usually goes unnoticed until an infection causes it to swell.
  • Branchial cleft cyst. This type of cysts occurs when tissues in the neck and collarbone area do not develop normally, causing spaces of air to form. These can fill with fluid and become infected.
  • Dermoid cyst. This is a pocket under the skin that contains tissues normally located in the outer skin layers. The mass may be visible at birth or early infancy, but often is not found until later in childhood.
  • Inflammatory Lymphadenitis. Also known as swollen glands, this condition occurs when the glands in the neck become enlarged and inflamed, usually in response to a bacterial or viral infection.
  • SCM Tumor of infancy. This is a benign lesion of the cells inside the sternocleidomastoid muscle (SCM). It is the most common neck mass in infants and usually appears between 2 and 4 weeks of age.
  • Salivary gland infection. A mass can form when the salivary glands become inflamed and infected. 
  • Benign tumors. These masses and bumps are noncancerous growths and do not spread to other parts of the body. 

Rare kinds of neck masses and bumps include:

  • Lymphoma, a cancer of the lymph system
  • Rhabdomypsarcoma, a cancer of the soft tissues
  • Thyroid nodules or thyroid cancer, which forms on the thyroid gland at the base of the neck

Treatments involve treating any infections. Surgery is often recommended to remove a bump or mass if it is impacting function or other nearby tissues or structures.

Subglottic and tracheal stenosis

This type of stenosis refers to a narrowing of the airway or windpipe. The condition creates breathing difficulties and can be caused by scarring of the larynx or the vocal cords. The voice can be affected. There are two kinds of subglottic and tracheal stenosis:

Acquired subglottic stenosis can happen after long periods of intubation and ventilation for respiratory problems.

Congenital subglottic stenosis is a rare birth defect where the airway cartilage did not properly form. This creates a narrow space and causes:

  • Noisy breathing
  • Respiratory distress
  • Recurring croup
  • Inability to breathe without a tracheostomy tube

Treatment depends on the severity of narrowing and other existing conditions. Most treatments deliver excellent outcomes. Options include:

  • Endoscopic surgery to widen the narrowed area with a balloon and remove scar tissue
  • Tracheostomy tube to assist breathing
  • Surgery to repair and rebuild the airway (laryngotracheal reconstruction)

Vascular anomalies (birthmarks)

Vascular anomalies are abnormal clusters of veins, arteries or lymphatic vessels. They can be found on the skin or on internal organs and they vary in size. Vascular anomalies develop before birth, but symptoms may not appear until later in life. Many of these birthmarks are harmless, but some grow quickly and can cause problems with function and appearance.

Vascular anomalies on the skin are usually pink, blue or purple spots that are flat or raised. There are five main types of these abnormalities:

  • Venous malformations are clusters of large veins that appear as red or purple spots on the skin or bumps under the skin. Venous malformations can be painful and can bleed.
  • Arteriovenous malformations are direct connections between arteries and veins. These abnormal masses harm the blood's ability to bring oxygen to tissues and remove waste products from the body.
  • Lymphatic malformations are lumps in the skin or other areas that develop in the lymphatic system, which carries white blood cells and antibodies to fight infection and removes germs and waste from the body. These malformations can cause infections.
  • Port wine stains are usually present at birth and often appear on the face or neck but can occur anywhere. They are red or purple birthmarks created by enlarged capillaries in the skin. These birthmarks can become thicker as your child gets older.
  • Hemangiomas are abnormal clusters of blood vessels. (See description above.)

Treatments include laser therapy to lighten red marks, surgery to remove or repair the malformation and scarring to stop the birthmark from growing.

Cleft lip and palate

Cleft lip and cleft palate are among the most common birth defects. Babies with these conditions are born with an opening in the lip and/or roof of the mouth because parts of the lip and mouth did not completely fuse together during fetal development.

The abnormality can occur on one or both sides of the mouth. Children with cleft lip and palate have trouble with:

  • Feeding
  • Hearing
  • Teeth
  • Speech

Treatment involves surgery to repair the lip and roof of the mouth and close the gaps:

  • Children with a cleft lip can get surgery between 3 to 6 months old. 
  • Children with cleft palate can have the procedure between 9 and 12 months old.
  • Follow-up care may include dental treatment and speech therapy.

Velopharyngeal insufficiencies

This condition occurs when the soft palate does not properly close the nasopharynx, which separates the oral and nasal cavities. The nasopharynx is used to make consonant sounds during speech. When it does not close completely, symptoms include:

  • Hypernasal speech
  • Inability to generate pressure for speech sounds
  • Inability to form speech sounds correctly

The condition occurs with:

  • Cleft palate
  • Genetic disorders such as neurofibromatosis
  • Enlarged adenoids and tonsils

Treatments include surgical repair, speech therapy and psychosocial support.

Facial plastics and reconstruction

Many acquired and congenital otolaryngology conditions affect the appearance of the face, neck and skin on other parts of the body.

Facial plastic surgery and reconstruction repairs and corrects conditions including:

  • Cleft lip
  • Cleft palate
  • Skull or nasal deformities
  • Birthmarks
  • Trauma to the face (cuts, scars or broken facial bones)

Facial plastic surgeons ensure that repairs also address appearance and may include cosmetic elements to improve a child’s self-esteem and confidence.