The National Institute on Deafness and Other Communication Disorders reports approximately 28 million Americans have lost some or all of their hearing, including 17 in 1,000 children under age 18. Noise exposure is increasingly common in the age of iPods and other personal music players. Overexposure to noise can cause both temporary and permanent hearing loss.

Loudness of common sounds

30 decibels (dBa)         Whisper
60 decibels                    Normal Conversation
60 – 80 decibels            Cars to a close observer
Above 85 decibels        Can cause permanent hearing loss

Although 10 million Americans suffer irreversible noise-induced hearing loss, with 30 million more exposed to dangerous noise levels each day, very little has been reported on the risk of such hearing loss in children.

How does noise exposure cause hearing loss?

Very loud sounds damage the inner ear by damaging the hair cells of the cochlea. When loud sounds are exposed to the ear for a short time, one may experience what’s called a temporary threshold shift, or a temporary hearing loss. This hearing loss may be accompanied by tinnitus (a ringing in the ears). One may recover from the temporary loss. But if the ear is exposed to loud sounds over longer periods of time, the hair cells can be permanently damaged, causing permanent sensorineural hearing loss.

Should MP3 player use be limited?

The maximum sound from an iPod Shuffle has been measured at 115 decibels, a level that can cause hearing loss to listeners of all ages. A survey sponsored by the Australian government found that about 25 percent of people using portable stereos had daily noise exposures high enough to cause hearing damage. Further research from the Netherlands reports that 90 percent of adolescents listened to music through earphones on MP3 players, almost half used high-volume settings, and only 7 percent used a noise limiter. Researchers at Boston Children’s Hospital determined that listening to a portable music player with headphones at 60 percent of their potential volume for one hour a day is relatively safe. The maximum volume limit is adjustable on many current MP3 players.

Why earplugs are important at concerts

Parents should be aware that various medical studies have found sound levels at rock concerts often to be significantly higher than 85 dBA, with some reports suggesting that sound intensity may reach 90 dBA to as high as 122 dBA.

To experience 85 dBA, listen to an electric shaver or a busy urban street. If levels are maintained at values greater than 85 dBA for long periods of time, this may lead to a significant noise exposure. Frequent concertgoers may experience some potentially irreversible hearing loss from their experience.

A research study, “Incidence of spontaneous hearing threshold shifts during modern concert performances” (Opperman, Reifman, Schlauch, Levine; Otol-HNS 2006, 134:4: 667-673), examined sound intensity throughout a well known concert venue, and the effectiveness of earplugs. The findings stated that sound pressure levels appeared equally hazardous in all parts of the concert hall, regardless of the type of music played. Accordingly, you should use earplugs at every type of musical concert, regardless of your distance to the stage.

A good rule of thumb: When a child accompanies a parent to any activity or location with excessive noise, ear protection should be worn by the entire family.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is laryngopharyngeal reflux (LPR)?

Food or liquids that are swallowed travel through the esophagus and into the stomach where acids help digestion. Each end of the esophagus has a sphincter, a ring of muscle, that helps keep the acidic contents of the stomach in the stomach or out of the throat. When these rings of muscle do not work properly, you may get heartburn or gastroesophageal reflux (GER). Chronic GER is often diagnosed as gastroesophageal reflux disease or GERD.

Sometimes, acidic stomach contents will reflux all the way up to the esophagus, past the ring of muscle at the top (upper esophageal sphincter or UES) and into the throat. When this happens, acidic material contacts the sensitive tissue at back of the throat and even the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.

During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat. However, in most infants, it is a normal occurrence caused by the immaturity of both the upper and lower esophageal sphincters, the shorter distance from the stomach to the throat, and the greater amount of time infants spend in the horizontal position. Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.

What are symptoms of LPR?

There are various symptoms of LPR. Adults may be able to identify LPR as a bitter taste in the back of the throat, more commonly in the morning upon awakening, and the sensation of a “lump” or something “stuck” in the throat, which does not go away despite multiple swallowing attempts to clear the lump. Some adults may also experience a burning sensation in the throat. A more uncommon symptom is difficulty breathing, which occurs because the acidic, refluxed material comes in contact with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material into the windpipe (trachea). This event is known as laryngospasm.

Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an otolaryngologist. Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical.

  • Chronic cough
  • Hoarseness
  • Noisy breathing (stridor)
  • Croup
  • Reactive airway disease (asthma)
  • Sleep disordered breathing (SDB)
  • Spit up
  • Feeding difficulty
  • Turning blue (cyanosis)
  • Aspiration
  • Pauses in breathing (apnea)
  • Apparent life threatening event (ALTE)
  • Failure to thrive (a severe deficiency in growth such that an
  • infant or child is less than five percentile compared to the expected norm)

What are the complications of LPR?

In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction causing recurrent ear infections, or persistent middle ear fluid, and even symptoms of “sinusitis’. The direct relationship between LPR and the latter mentioned problems are currently under research investigation.

How is LPR diagnosed?

Currently, there is no good standardized test to identify LPR. If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician a referral to see an otolaryngologist for evaluation. An otolaryngologist may perform a flexible fiber-optic nasopharyngoscopy/laryngoscopy, which involves sliding a 2 mm scope through the infant or child’s nostril, to look directly at the voice box and related structures or a 24-hour pH monitoring of the esophagus. He or she may also decide to perform further evaluation of the child under general anesthesia. This would include looking directly at the voice box and related structures (direct laryngoscopy), a full endoscopic look at the trachea and bronchi (bronchoscopy), and an endoscopic look at the esophagus (esophagoscopy) with a possible biopsy of the esophagus to determine if esophagitis is present. LPR in infants and children remains a diagnosis of clinical judgment based on history given by the parents, the physical exam and endoscopic evaluations.

How is LPR treated?

Since LPR is an extension of GER, successful treatment of LPR is based on successful treatment of GER. In infants and children, basic recommendations may include smaller and more frequent feedings and keeping an infant in a vertical position after feeding for at least 30 minutes. A trial of medications including H2 blockers or proton pump inhibitors may be necessary. Similar to adults, those who fail medical treatment, or have diagnostic evaluations demonstrating anatomical abnormalities may require surgical intervention.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Tinnitus is a condition where the patient hears a ringing or other noise that is not produced by an external source. This disorder can occur in one or both ears, range in pitch from a low roar to a high squeal, and may be continuous or sporadic. This often debilitating condition has been linked to ear injuries, circulatory system problems, noise-induced hearing loss, wax build-up in the ear canal, medications harmful to the ear, ear or sinus infections, misaligned jaw joints, head and neck trauma, Ménière’s disease, or an abnormal growth of bone of the middle ear. In rare cases, slow-growing tumors on auditory, vestibular or facial nerves can cause tinnitus as well as deafness, facial paralysis and balance problems. The American Tinnitus Association estimates that more than 50 million Americans have tinnitus problems to some degree, with approximately 12 million people having symptoms severe enough to seek medical care.

Tinnitus is not uncommon in children. Although it is as common as in adults, children generally do not complain of tinnitus. Researchers believe that a child with tinnitus considers the noise in the ear to be normal, as it has usually been present for a long time. A second explanation of the discrepancy is that the child may not distinguish between the psychological impact of tinnitus and its medical significance.

Continuous tinnitus can be annoying and distracting, and in severe cases can cause psychological distress and interfere with your child’s ability to lead a normal life. The good news is that most children with tinnitus seem to eventually outgrow the symptom. It is unusual to see a child carry the problem into adulthood.

If you think your child has tinnitus, first arrange an appointment with your family physician or pediatrician. If the child does not have a specific problem with the ears such as middle ear inflammation with thick discharge, then it may be necessary to have your child referred to an otolaryngologist (ear, nose and throat specialist).

What treatment may be offered

Most people, including children, who are diagnosed with tinnitus find that there is no specific problem underlying their tinnitus. Consequently, there is no specific medicine or operation to “cure” the problem. However, experts suggest that the following steps be taken with the child diagnosed with tinnitus:

  1. Reassure the child: Explain that this condition is common and they are not alone. Ask your physician to describe the condition to the child in terms and images that they can understand. Depending on the nature of the tinnitus, the doctor may order further testing, such as a hearing test, a CT scan or MRI.
  2. Explain that he/she may feel less distressed by their tinnitus in the future: Many children find it helpful to have their tinnitus explained carefully and to know about ways to manage it. This is partly due to a medical concept known as “neural plasticity”, where children are more able to change their response to all kinds of stimulation. If carefully managed, childhood tinnitus may not be a serious problem.
  3. Use sound generators or provide background noise. Sound therapy, which makes tinnitus less noticeable, has been used to treat adults for some time, and can also be used with children. If tinnitus occurs on a regular basis, with sound therapy the child’s nervous system can adapt to the condition. The sound can be environmental, such as a fan or quiet background music.
  4. Have hearing-impaired children wear hearing aids. A child with tinnitus and hearing loss may find that hearing aids can help improve the tinnitus. Hearing aids can pick up sounds children may not normally hear, which in turn will help their brains filter out their tinnitus. It may also help them by taking the strain out of listening. Straining to hear can make your child’s brain focus on the tinnitus noises.
  5. Help your child to sleep with debilitating tinnitus. Severe tinnitus may lead to sleep difficulties for the young patient. Ask your otolaryngologist the best strategy to adopt if your child cannot sleep.
  6. Finally, help your child relax. Some children believe their tinnitus gets worse when they are under stress. Discuss appropriate stress-relieving techniques with your pediatrician or family physician.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such as viral illness and allergy.

How do I know when my child has sinusitis?

The following symptoms may indicate a sinus infection in your child:

  • a cold lasting more than 10 to 14 days, sometimes with a low-grade fever
  • thick yellow-green nasal drainage
  • post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
  • eadache, usually in children age six or older
  • irritability or fatigue
  • swelling around the eyes

Young children are more prone to infections of the nose, sinus and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, if your child remains ill beyond the usual week to ten days, a sinus infection may be the cause.

You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. Over-the-counter decongestants and antihistamines are not generally effective for viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is not well defined. Such medications should not be given to children younger than two years old.

If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis: If your child suffers from one or more symptoms of sinusitis for at least 12 weeks, he or she may have chronic sinusitis. Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek consultation with an otolaryngologist (an ear, nose and throat – ENT – specialist). The ENT may recommend medical or surgical treatment of the sinuses.

Diagnosis of sinusitis: If your child sees an ENT specialist, the doctor will examine his/her ears, nose and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how completely your child’s sinuses are developed, where any blockage has occurred and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural changes, allergies, and problems with the immune system.

When Is Surgery Necessary for Sinusitis?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child’s sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child’s sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.

Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.

Summary

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy and swelling around the eyes, along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. In the rare child where medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

¿Qué es la otitis media?

Otitis media se refiere a la inflamación del oído medio. Cuando la infección ocurre esta condición es llamada “otitis media aguda”. La otitis media aguda ocurre cuando un resfrío, alergia o infección de las vías respiratorias superiores y la presencia de bacterias o virus llevan a la acumulación de pus y moco detrás de la membrana timpánica bloqueando la trompa de Eustaquio. Esto causa dolor de oído e hinchazón.

Cuando se forma líquido en el oído medio, la condición es conocida como “otitis media con efusión”. Esto sucede en una infección en recuperación o cuando una infección esta por ocurrir. El líquido puede permanecer en el oído por semanas hasta algunos meses. Cuando una descarga del oído persiste o se hace recurrente es llamada a veces infección crónica de oído medio. El líquido puede permanecer en el oído hasta tres semanas después de la infección. Si no es tratada, la infección crónica del oído puede tener consecuencias potenciales serias como pérdida auditiva transitoria o permanente.

¿Como afecta la otitis media la audición del niño?

Todos los chicos con infección de oído medio o líquido tienen un grado de pérdida auditiva. La pérdida promedio en oídos con secreción es de 24 decibeles, equivalente a usar auriculares (24 decibeles es el nivel aproximado de los silbidos leves). Líquidos más espesos pueden causar una pérdida mucho mayor, de hasta 45 decibles (el nivel de la conversación normal)
Su niño puede tener pérdida de la audición si no es capaz de entender ciertas palabras y habla a un volumen mayor del normal. Básicamente, un chico con pérdida auditiva debida a infecciones de oído medio escuchará sonidos poco claros y perderá de entender algunos diálogos en menor medida que aquellos con hipoacusias profundas. De todas formas las consecuencias pueden ser importantes – el paciente joven pueden perder en forma permanente la habilidad de entender en forma concisa el diálogo en ambientes ruidosos (como el aula de la escuela) llevando a un retraso en el aprendizaje de importantes habilidades de lenguaje.

Tipos de hipoacusias

La hipoacusia conductiva es una forma de dificultad auditiva debida a una lesión el en canal auditivo externo o en el oído medio. Esta forma de hipoacusia es generalmente transitoria y se encuentra en personas de 40 años o menos. Infecciones de oído crónicas no tratadas pueden llevar a una hipoacusia conductiva; drenar el oído medio infectado a través de la membrana timpánica lleva de nuevo la audición a la normalidad.

La otra forma de hipoacusia es la neurosensorial, pérdida auditiva debida a una lesión en la rama auditiva del VIII par craneal o del oído interno. Históricamente esta condición es más prevalente en la edad media o pacientes mayores, sin embargo la exposición continua a música a un alto volumen puede llevar a la pérdida auditiva neurosensorial en adolescentes.

¿Cuándo se debe realizar un examen de audición?

Un examen de audición se debe llevar a cabo en chicos que tienen infecciones de oído frecuentes, pérdidas auditivas que duran mas de seis semanas o líquido en el oído medio por mas de tres meses. Hay una amplia gama de instrumentos para evaluar la audición del niño, la función de la trompa de Eustaquio y la movilidad de la membrana del tímpano. Ellos incluyen otoscopía, timpanometría y audiometría.

¿Pierden los niños su audición por otras razones aparte de la otitis media crónica?

Los niños pueden tener pérdidas auditivas temporarias por otras razones más allá de la infección crónica del oído medio y la disfunción de la trompa de Eustaquio. Ellas son:

  • Impactación de cerumen (tapón de cera compresivo)
  • Otitis externa: Inflamación del canal auditivo externo, también llamado oído de nadador.
  • Colesteatoma: Una masa de tejido epitelial escamoso y colesterol en el oído medio, generalmente resultado de una otitis media crónica.
  • Otoesclerosis: Enfermedad del laberinto óseo en el oído que es más común en los adultos y caracterizado por la formación de hueso que lleva a la progresiva hipoacusia conductiva. Ocurre debido a la fijación del estribo (uno de los huesecillos del oído). Hipoacusia neurosensorial puede resultar cuando esta involucrado el conducto coclear.
  • Trauma: Un trauma del oído o la cabeza puede causar una pérdida auditiva transitoria o permanente.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is otitis media and ear infection?

Otitis media refers to inflammation of the middle ear. When an abrupt infection occurs, the condition is called “acute otitis media.” Acute otitis media occurs when a cold, allergy, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This can cause earache and fever.

When fluid sits in the middle ear for weeks, the condition is known as “otitis media with effusion.” This occurs in a recovering ear infection. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss.

Why do children have more ear infections than adults?

To understand earaches and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed.

The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear.

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. A child’s tube is also floppier, with a smaller opening that easily clogs.

How does otitis media affect hearing?

Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels – equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Suspect hearing loss if one is unable to understand certain words and speaks louder than normal.

Types of hearing loss

Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent.

When should a hearing test be performed related to frequent infections or fluid?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function and flexibility of the ear drum. They include the otoscopy, tympanometer and audiometer.

Do people lose their hearing for reasons other than chronic otitis media?

Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

  • Cerumen impaction (compressed earwax)
  • Otitis externa: Inflammation of the external auditory canal, also called swimmer’s ear.
  • Cholesteatoma: A mass of horn-shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media.
  • Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes (bones in the ear). Sensorineural hearing loss may result because of involvement of the cochlear duct.
  • Trauma: A trauma to the ear or head may cause temporary or permanent hearing loss.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it’s your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

What First Aid Supplies Should You Have on Hand in Case of An Emergency?

  • sterile cloth or pads
  • scissors
  • ice pack
  • tape
  • sterile bandages
  • cotton tipped swabs
  • hydrogen peroxide
  • nose drops
  • antibiotic ointment
  • eye pads
  • cotton balls
  • butterfly bandages

Ask “Are you all right?” Determine whether the injured person is breathing and knows who and where they are.

Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.

Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.

Look at the eyes to make sure they move in the same direction and that both pupils are the same size.

If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

  • Call for medical assistance (911).
  • Do not move the victim, or remove helmets or protective gear.
  • Do not give food, drink or medication until the extent of the injury has been determined.
  • Remember HIV…be very careful around body fluids. In an emergency protect your hands with plastic bags.
  • Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.
  • Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.
  • Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

swelling and bruising, such as a black eye
pain or numbness in the face, cheeks or lips
double or blurred vision
nosebleeds
changes in teeth structure or ability to close mouth properly
It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.
If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist – head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face, and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises, cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling, skiing and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

  • deep skin cuts
  • obvious deformity or fracture
  • loss of facial movement
  • persistent bleeding
  • change in vision
  • problems breathing and/or swallowing
  • alterations in consciousness or facial movement

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

  • breathing difficulties
  • deformity of the nose
  • persistent bleeding
  • cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist – head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist – head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voice box), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

  • Be sure the playing areas are large enough that players will not run into walls or other obstructions.
  • Cover unremoveable goal posts and other structures with thick, protective padding.
    Carefully check equipment to be sure it is functioning properly.
  • Require protective equipment – such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.
  • Prepare athletes with warm-up exercises before engaging in intense team activity.
  • In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes – check the path of travel, making sure there are no obstructing fences, wires or other obstacles.
  • Enlist adequate adult supervision for all children’s competitive sports.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

More than three million American children have a hearing loss, and an estimated 1.3 million of them are under three years of age. Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them. If at any time you suspect your baby has a hearing loss, discuss it with your doctor. He or she may recommend evaluation by an otolaryngologist – head and neck surgeon (ear, nose and throat specialist) and additional hearing tests.

Hearing loss can be temporary, caused by ear wax, middle ear fluid,or infections. Many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

However, some children have sensorineural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable hearing, and children as young as three months old can be fitted with hearing aids.

Early diagnosis is crucial in the management of pediatric hearing loss. When diagnosis is delayed, there can be significant impact on speech and language development. Early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child’s existing hearing. This means your child will get a head start on speech and language development.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

As the parent of a child with newly diagnosed hearing loss, you will have many questions and concerns regarding the nature of this problem, its effects on your child’s future, treatment options and resources. This brief guide will give you necessary initial information, and provide guidance about the availability of resources and the respective roles of different care providers.

It is always difficult for parents to receive bad news about any aspect of their child’s health. Reacting with anger, grief and even guilt are not unusual when finding out that your child is hearing-impaired. These feelings are best managed by discussing them with a family member, close friend, clergy or mental health professional. At times, the feeling may also result in a degree of denial. Feel free to seek a second opinion, but it is unadvisable to delay further recommended diagnostic evaluations for your child. The best treatment for hearing loss of any degree is appropriate early intervention. Significant delays may result in irreversible harm to your child’s hearing, speech, language and eventual educational development.

You will come into contact with many healthcare and rehabilitation specialists during the long-term management of your child’s hearing loss. Some of them will be involved early in the journey and again at intervals. Others may step in later on. The following are professionals you will encounter and the role each of them will play in managing your child’s hearing loss.

The Audiologist

The audiologist is likely to be the first professional you encounter, and possibly the one who gives you the initial news regarding your child’s hearing loss. The audiologist will carry out behavioral or objective testing (such as auditory brainstem responses) or a combination of these approaches to determine the degree and type of hearing loss. The audiologist will also eventually recommend appropriate amplification, following a medical consultation. The audiologist will also provide your child with well-fitting ear molds along with the hearing aids, as he or she grows. The audiologist may also be the professional who provides you with information and referral to an early intervention program. Over time, the audiologist will provide periodic follow-ups to chart your child’s progress and to monitor his or her hearing loss.

Otologist, Otolaryngologist or Pediatric Otolaryngologist (ENT Physician)

Upon diagnosis of hearing loss, your child will be referred to an ear, nose and throat specialist (otolaryngologist), or one who specializes in childhood ear and hearing problems. This physician’s initial role is to determine the specific nature of the underlying problem that may be at least partially causing the hearing loss. Additionally, the physician will also determine if the problem is medically or surgically treatable, and if so, provide the necessary medical or surgical treatment. Such treatments could include something relatively simple, like the placement of eardrum ventilation tubes, or more complex surgical procedures. The ENT specialist may also refer your child for additional diagnostic procedures such as imaging studies (X-rays, CT-scans, MRI scans) to further define the type and source of hearing loss. The doctor will also provide clearance for hearing aid fitting, after determining if no other intervention is indicated. If it is determined that your child needs a cochlear implant, the otolaryngologist, along with the audiologist, will carry out further tests and examinations, and will carry out the implant surgery.

Primary Care Physician: Pediatrician or Family Practitioner

Your child’s primary care physician may be either a pediatrician or a family practice doctor. If your child is not diagnosed with a hearing loss in the newborn period but develops hearing loss later in life, it is the responsibility of this doctor to make appropriate referrals to an ear, nose and throat specialist and an audiologist to rule out or diagnose hearing loss. Your child’s primary care doctor may also participate in the treatment of ear infections if they appear, or refer them to an otolaryngologist for treatment. The primary care physician or the otolaryngologist may also provide a referral to a doctor who specializes in medical genetics, to find out if your child’s hearing loss may be hereditary. That may help you determine if a similar hearing loss could occur in your other children.

Early Intervention Specialist

This professional is typically is someone with an education background. He or she can help you find resources in your community, define family members’ roles in early intervention and management of the hearing loss, and can help you deal with questions regarding future educational placement. This specialist will also help you deal with your observations and concerns about your child and give you information and support regarding your child’s educational needs in the future.

Speech/ Language Pathologist (SLP)

This professional will evaluate the impact of your child’s hearing loss on speech/language development, and monitor his/her progress, noting if progress with that development is falling behind. If this happens, the SLP may refer back to the audiologist or otolaryngologist to determine if any changes have occurred in your child’s hearing. The SLP will also help your child to learn proper speech production, including correct articulation of speech sounds. If you choose oral communication for your child, in addition to the speech language pathologist your child may also be treated by an auditory-verbal therapist, who can help your child acquire the full range of speech sounds and guide the family to additional medical or audiological treatments. The auditory-verbal therapist will also help the child’s family become familiar with appropriate speech/language, auditory and cognitive developmental milestones you may expect for a child with hearing loss.

Finally, many other people can provide additional assistance for your hard-of-hearing child. Parents of older hard-of-hearing children and hard-of-hearing adults can share their experiences with you and may have suggestions for educational and recreational resources in the community.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Insight into Bell’s palsy, including:

  • What is Bell’s palsy?
  • How is it treated?
  • What if I don’t fully recover?

What is Bell’s palsy?

Bell’s palsy is a fast change to one side of your face resulting in weakness or complete loss of movement. It happens because of damage to the facial nerve of unknown cause. This makes half of your face seem to droop. Although Bell’s palsy typically goes away on its own, facial droop or weakness may keep you from closing the affected eye, change how things taste, make your smile crooked, and sometimes may make you drool.

Bell’s palsy can affect anyone, but is most common in those 15-45 years old. There are some conditions that put you more at risk such as being overweight, having untreated high blood pressure, diabetes, or upper respiratory illness.

Most people with Bell’s palsy get better without medical attention within 2-3 weeks. Many recover completely within 3-4 months. Even without any treatment, 70 percent with this palsy get better within six months.

How does the facial nerve change facial expression?

While a virus may cause facial palsy, no one really knows how this works. It may be due to facial nerve swelling (inflammation). As the nerve travels through a narrow bony canal within the skull, the pressure of such swelling may lead to temporary or permanent facial nerve damage. The facial nerve not only carries nerve impulses to muscles of the face, but also to the tear glands, salivary glands, muscle of a tiny ear bone, and taste fibers of the tongue. This means that those with Bell’s palsy may have a dry eye or mouth, taste loss, and a sagging eyelid or mouth corner.

How is Bell’s palsy treated? What will my doctor do?

Facial weakness can be caused by many things. The determination of Bell’s palsy is made when the doctor finds no other cause of your facial weakness. The doctor will conduct a thorough history and examination, looking for any clear causes of the drooping. Be sure to tell your doctor about any change or discomfort you notice and when you first noticed a change. Unless a cause of the problem is found, your doctor is unlikely to do any additional tests, like laboratory testing or imaging. If your doctor does identify another cause of the facial weakness, then your condition is not Bell’s palsy.

For those 16 years and older, doctors may prescribe steroid medication to calm the swelling, helping the facial nerve to work better. Studies show that steroids are likely to be helpful. Antiviral treatment may also be of some help for Bell’s palsy when used in addition to steroids.

Protecting your eye

With Bell’s palsy you may have trouble shutting your eye. Not being able to close the eye will cause dryness and may cause pain or eye damage. So if you do, tell you doctor. He or she may suggest you use eye drops, ointment, or wear an eye patch while you heal.

What else can I do?

You will want to do everything you can to speed recovery, but so far doctors do not know if things like physical therapy or acupuncture help. Talk to your doctor about what else might help.

What if I don’t fully recover?

Most people with Bell’s palsy recover completely. For the small percentage of patients who do not fully recover the remaining problems can affect how you feel about yourself and being with others in your day-to-day life. Certain corrective procedures, such as weighting the eyelid or surgery to improve your smile may help your self-esteem and your appearance. Talk to your doctor about what might work for you.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery