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Dust, mites, pet dander and ragweed are not the only allergic threats to your child. Food allergies and sensitivities may cause a wide range of adverse reactions to the skin, respiratory system, stomach and other physiological functions of the body.

Determining what foods are the cause of an allergic reaction is key to treatment. Before you identify the ingestible culprit you must consider what type of food allergy your child has. There are two types, classified as:

  • Fixed (immediate) food allergies: A fixed food allergy may be very apparent, such as the child whose lips swell and throat itches immediately in response to eating peanuts. The cause for this type of food allergy is similar to that of inhalant allergies, so the diagnosis is more easily reached. Blood testing (i.e., RAST test) is typically used to verify fixed food allergies. Approximately 5 to 15 percent of food allergies are of the fixed variety.
  • Cyclic (delayed) food allergies: These allergies are far more common but less understood. Delayed food allergy symptoms can take up to three days to appear. This type of reaction is associated with the body’s immunoglobulin G (IgG) or antibodies. Unlike fixed food allergies, this allergic response is cyclical in nature. As an example, a child may be IgG sensitive to milk. Consequently, symptoms might appear if the child increases the intake and/or frequency of milk consumption.

Both children and adults are susceptible to food allergies. The bad news for children is that they often have more skin reactions, such as eczema, to foods than do adults. But the good news for the young patient is that a child often outgrows his or her food sensitivities over time, even those that are positive on a RAST test. Food allergies may fade, and then inhalant (e.g, dust, ragweed) allergies may begin to manifest themselves.

Diagnosing and treating the cyclic food allergy

If your child is experiencing allergic reactions to food of unknown origin, you should ask yourself, “Are there any foods that my child craves or any food that I avoid offering?” These foods may be the ones that are causing difficulties for the young patient.

Your physician may also suggest the Elimination and Challenge Diet. This dietary test consists of the following steps:

  1. Keep a detailed food diary, tracking what was eaten (including ingredients), when it was eaten, medications taken, and any symptoms that developed. Be honest! Some well-meaning parents or caregivers often create a food diary that looks healthier than it really is. Your child can receive the best diagnosis if the diet records are accurate, timed precisely and truthful. The diet diary can be evaluated by the doctor to identify food items that may be the culprits.
  2. Conduct an elimination and challenge diet at home based upon your physician’s assessment of your child’s diet diary. It is best if you carefully maintain a new diet diary for your child during this period. During this diet, your child must abstain from one, and only one, of the possible food culprits at a time for a period of four days. This can be difficult to carry out if the food is very common, such eggs or cereal, so you need to pay strict attention to your child’s diet during the elimination phase. Any cheating will invalidate the results. On the fifth day, you will be asked to feed your child the suspected culprit food item. This is the challenge! Provide your child an average-sized portion of the food in question to be eaten in five minutes. In one hour the child should eat another half portion if no symptoms have developed. Any symptoms that develop are then timed and recorded. With a true cyclic food allergy, you would expect a significant worsening of the symptoms described in the original diet diary, although the challenge symptoms may vary as well.
  3. If the Elimination and Challenge Diet confirms a cyclic food allergy, then you will be asked to abstain from feeding your child this food for a period of three to six months. After this time you can slowly reintroduce the food on a rotary basis; it is not to be eaten more frequently than every four days (once or twice a week).

For minor, moderate discomfort from the testing, the caregiver may choose to offer one of the following: 1) a child’s laxative to decrease the transit time through the digestive system; 2) Alka Seltzer® Gold; 3) buffered Vitamin C (one gram).

Fixed food allergies should never be deliberately challenged unless under the direct supervision of a physician.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Does your child have allergies? Allergies can cause many ear, nose and throat symptoms in children, but allergies can be difficult to separate from other causes. Here are some clues that allergies may be affecting your child.

Children with nasal allergies often have a history of other allergic tendencies (or atopy). These may include early food allergies or atopic dermatitis in infancy. Children with nasal allergies are at higher risk for developing asthma.

Nasal allergies can cause sneezing, itching, nasal rubbing, nasal congestion and nasal drainage. Usually, allergies are not the primary cause of these symptoms in children under four years old. In allergic children, these symptoms are caused by exposure to allergens (mostly pollens, dust, mold and dander). Observing which time of year or in which environments the symptoms are worse can be important clues to share with your doctor.

Ear infections:

One of childrens’ most common medical problems is otitis media, or middle ear infection. In most cases, allergies are not the main cause of ear infections in children under two years old. But in older children, allergies may play role in ear infections, fluid behind the eardrum, or problems with uncomfortable ear pressure. Diagnosing and treating allergies may be an important part of healthy ears.

Sore throats:

Allergies may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to “post-nasal drip.” It can lead to cough, sore throats and a husky voice.

Sleep disorders:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis and perennial (year-round) allergic rhinitis. Nasal congestion can contribute to sleep disorders such as snoring and obstructive sleep apnea, because the nasal airway is the normal breathing route during sleep. Fatigue is one of the most common, and most debilitating, allergic symptoms. Fatigue not only affects children’s quality of life, but has been shown to affect school performance.

Pediatric sinusitis:

Allergies should be considered in children who have persistent or recurrent sinus disease. Depending on the age of your child, their individual history and an exam, your doctor should be able to help you decide if allergies are likely. Some studies suggest that large adenoids (a tonsil-like tissue in the back of the nose) are more common in allergic children.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Overview of Sleep Disordered Breathing

Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When a child’s breathing is disrupted during sleep, the body perceives this as a choking phenomenon. The heart rate slows, blood pressure rises, the brain is aroused and sleep is disrupted. Oxygen levels in the blood can also drop.

Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA. Recent studies indicate that mild SDB or snoring may cause many of the same problems as OSA in children.

Could my child have Obstructive Sleep Apnea?

The most obvious symptom of sleep disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted by complete blockage of breathing with gasping and snorting noises and associated with awakenings from sleep. Due to a lack of good quality sleep, a child with sleep disordered breathing may be irritable, sleepy during the day or have difficulty concentrating in school. Busy or hyperactive behavior may also be observed. Bed-wetting is also frequently seen in children with sleep apnea.

A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids. Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep disordered breathing.

Potential consequences of untreated pediatric sleep disordered breathing

  • Social: Loud snoring can become a significant social problem if a child shares a room with siblings or at sleepovers and summer camp.
  • Behavior and learning: Children with SDB may become moody, inattentive and disruptive both at home and at school. Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children.
  • Enuresis: SDB can cause increased nighttime urine production, which may lead to bedwetting.
  • Growth: Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development.
  • Obesity: SBD may cause the body to have increased resistance to insulin or daytime fatigue with decreases in physical activity. These factors can contribute to obesity.
  • Cardiovascular: OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

How is sleep apnea diagnosed?

Sleep disordered breathing in children should be considered if frequent loud snoring, gasping, snorting and thrashing in bed or unexplained bedwetting is observed. Behavioral symptoms can include changes in mood, misbehavior and poor school performance. Not every child with academic or behavioral issues will have SDB, but if a child snores loudly on a regular basis and is experiencing mood, behavior or school performance problems, sleep disordered breathing should be considered. If you notice that your child has any of those symptoms, have them checked by an otolaryngologist (ear, nose and throat doctor). Sometimes physicians will make a diagnosis of sleep disordered breathing based on history and physical examination. In other cases, such as in children suspected of having severe OSA due to craniofacial syndromes, morbid obesity or neuromuscular disorders or for children less than 3 years of age, additional testing such as a sleep test may be recommended.

The sleep study or polysomnography (PSG) is an objective test for sleep disordered breathing. Wires are attached to the head and body to monitor brain waves, muscle tension, eye movement, breathing and the level of oxygen in the blood. The test is not painful and is generally performed in a sleep laboratory or hospital. Sleep tests can occasionally produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observations and clinical evaluation.

Treatment for sleep disordered breathing

Enlarged tonsils and adenoids are a common cause for SDB. Surgical removal of the tonsils and adenoids (T&A) is generally considered the first line treatment for pediatric sleep disordered breathing if the symptoms are significant and the tonsils and adenoids are enlarged. Of the over 500,000 pediatric T&A procedures performed in the U.S. each year, the majority are currently being done to treat sleep disordered breathing. Many children with sleep apnea show both short and long-term improvement in their sleep and behavior after T&A.
Not every child with snoring should undergo T&A as the procedure does have risks. Potential problems can include anesthesia or airway complications, bleeding, infection and problems with speech and swallowing. If the SDB symptoms are mild or intermittent, academic performance and behavior is not an issue, the tonsils are small, or the child is near puberty (tonsils and adenoids often shrink at puberty), it may be recommended that a child with SDB be watched conservatively and treated surgically only if symptoms worsen.

Recent studies have shown that some children have persistent sleep disordered breathing after T&A. A post-operative PSG may be necessary after surgical intervention, especially in children with persistent symptoms or increased risk factors for persistent apnea after T&A such as obesity, craniofacial anomalies or neuromuscular problems. Additional treatments such as weight loss, the use of Continuous Positive Airway Pressure (CPAP) or additional surgical procedures may sometimes be required.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Today in the United States, studies estimate that 34% of U.S. adults are overweight and an additional 31% (approximately 60 million) are obese. Combined, approximately 127 million Americans are overweight or obese. Some 42 years ago, 13% of Americans were obese, and in 1980 15% were considered obese.

Alarmingly, the number of children who are overweight or obese has doubled in the last two decades as well. Currently, more than 15% of 6- to 11-year-olds and more than 15% of 12- to 19-year-olds are considered overweight or obese.

What is the difference between designated “obese” versus “overweight”?

Unfortunately, the words overweight and obese are often interchanged. There is a difference:

  • Overweight: Anyone with a body mass index (BMI) (a ratio between your height and weight) of 25 or above (e.g., someone who is 5-foot-4 and 145 pounds) is considered overweight.
  • Obesity: Anyone with a BMI of 30 or above (e.g., someone who is 5-foot-4 and 175 pounds) is considered obese.
  • Morbid obesity: Anyone with a BMI of 40 or above (e.g., someone who is 5-foot-4 and 233 pounds) is considered morbidly obese. “Morbid” is a medical term indicating that the risk of obesity related illness is increased dramatically at this degree of obesity.

Obesity can present significant health risks to the young child. Diseases are being seen in obese children that were once thought to be adult diseases. Many experts in the study of children’s health suggest that a dysfunctional metabolism, or failure of the body to change food calories to energy, precedes the onset of disease. Consequently, these children are at risk for Type II diabetes, fatty liver, elevated cholesterol, SCFE (a major hip disorder), menstrual irregularities, sleep apnea and irregular metabolism. Additionally, there are psychological consequences; obese children are subject to depression, loss of self-esteem and isolation from their peers.

Pediatric obesity and otolaryngic problems

Otolaryngologists, or ear, nose and throat specialists, diagnose and treat some of the most common children’s disorders. They also treat ear, nose and throat conditions that are common in obese children, such as:

Sleep apnea

Children with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer, usually ten to 60 times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea – or slow, shallow breathing), both of which can wake one up. There are three types of sleep apnea – obstructive, central and mixed. Of these, obstructive sleep apnea (OSA) is the most common. Otolaryngologists have pioneered the treatment for sleep apnea; research shows that one to three percent of children have this disorder, often between the age of two-to-five years old.

Enlarged tonsils, which block the airway, are usually the key factor leading to this condition. Extra weight in obese children and adults can also interfere with the ability of the chest and abdomen to fully expand during breathing, hindering the intake of air and increasing the risk of sleep apnea.

The American Academy of Pediatrics has identified obstructive sleep apnea syndrome (OSAS) as a common condition in childhood that results in severe complications if left untreated. Among the potential consequences of untreated pediatric sleep apnea are growth failure; learning, attention, and behavior problems; and cardio-vascular complications. Because sleep apnea is rarely diagnosed, pediatricians now recommend that all children be regularly screened for snoring.

Middle ear infections

Acute otitis media (AOM) and chronic ear infections account for 15 to 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees a doctor. Furthermore, the incidence of AOM has been rising over the past decades. Although there is no proven medical link between middle ear infections and pediatric obesity there may be a behavioral association between the two conditions. Some studies have found that when a child is rubbing or massaging the infected ear the parent often responds by offering the child food or snacks for comfort.

When a child does have an ear infection the first line of treatment is often a regimen of antibiotics. When antibiotics are not effective, the ear, nose and throat specialist might recommend a bilateral myringotomy with pressure equalizing tube placement (BMT), a minor surgical procedure. This surgery involves the placement of small tubes in the eardrum of both ears. The benefit is to drain the fluid buildup behind the eardrum and to keep the pressure in the ear the same as it is in the exterior of the ear. This will reduce the chances of any new infections and may correct any hearing loss caused by the fluid buildup.

Postoperative vomiting (POV) is a common problem after bilateral myringotomy surgery. The overall incidence is 35 percent, and usually occurs on the first postoperative day, but can occur up to seven days later. Several factors are known to affect the incidence of POV, including age, type of surgery, postoperative care, medications, co-existing diseases, past history of POV, and anesthetic management. Obesity, gastroparesis, female gender, motion sickness, pre-op anxiety, opioid analgesics and the duration of anesthetic all increase the incidence of POV. POV interferes with oral medication and intake, delays return to normal activity and increases length of hospital stay. It remains one of the most common causes of unplanned postoperative hospital admissions.

Tonsillectomies

A child’s tonsils are removed because they are either chronically infected or, as in most cases, enlarged, leading to obstructive sleep apnea. There are several surgical procedures utilized by ear, nose and throat specialists to remove the tonsils, ranging from use of a scalpel to a wand that emits energy that shrinks the tonsils.

Research conducted by otolaryngologists found that morbid obesity was a contributing factor for requiring an overnight hospital admission for a child undergoing removal of enlarged tonsils. Most children who were diagnosed as obese with sleep apnea required a next-day physician follow-up.

A study from the University of Texas found that morbidly obese patients have a significant increase of additional medical disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep-disordered breathing when compared to moderately obese or overweight patients undergoing this procedure for the same diagnosis. On average they have longer hospital stays, a greater need for intensive care and a higher incidence of the need for apnea treatment of continuous positive airway pressure upon discharge from the hospital. The study found that although the morbidly obese group had a greater degree of sleep apnea, they did benefit from the procedure in regards to snoring, apneic spells and daytime somnolence.

What you can do

If your child has a weight problem, contract your pediatrician or family physician to discuss the weight’s effect on your child’s health, especially prior to treatment decisions. Second, ask your physician about lifestyle and diet changes that will reduce your child’s weight to a healthy standard.

© 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

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

Today in the United States, studies estimate that 34% of U.S. adults are overweight and an additional 31% (approximately 60 million) are obese. Combined, approximately 127 million Americans are overweight or obese. Some 42 years ago, 13% of Americans were obese, and in 1980 15% were considered obese.

Alarmingly, the number of children who are overweight or obese has doubled in the last two decades as well. Currently, more than 15% of 6- to 11-year-olds and more than 15% of 12- to 19-year-olds are considered overweight or obese.

What is the difference between designated “obese” versus “overweight”?

Unfortunately, the words overweight and obese are often interchanged. There is a difference:

  • Overweight: Anyone with a body mass index (BMI) (a ratio between your height and weight) of 25 or above (e.g., someone who is 5-foot-4 and 145 pounds) is considered overweight.
  • Obesity: Anyone with a BMI of 30 or above (e.g., someone who is 5-foot-4 and 175 pounds) is considered obese.
  • Morbid obesity: Anyone with a BMI of 40 or above (e.g., someone who is 5-foot-4 and 233 pounds) is considered morbidly obese. “Morbid” is a medical term indicating that the risk of obesity related illness is increased dramatically at this degree of obesity.

Obesity can present significant health risks to the young child. Diseases are being seen in obese children that were once thought to be adult diseases. Many experts in the study of children’s health suggest that a dysfunctional metabolism, or failure of the body to change food calories to energy, precedes the onset of disease. Consequently, these children are at risk for Type II diabetes, fatty liver, elevated cholesterol, SCFE (a major hip disorder), menstrual irregularities, sleep apnea and irregular metabolism. Additionally, there are psychological consequences; obese children are subject to depression, loss of self-esteem and isolation from their peers.

Pediatric obesity and otolaryngic problems

Otolaryngologists, or ear, nose and throat specialists, diagnose and treat some of the most common children’s disorders. They also treat ear, nose and throat conditions that are common in obese children, such as:

Sleep apnea

Children with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer, usually ten to 60 times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea – or slow, shallow breathing), both of which can wake one up. There are three types of sleep apnea – obstructive, central and mixed. Of these, obstructive sleep apnea (OSA) is the most common. Otolaryngologists have pioneered the treatment for sleep apnea; research shows that one to three percent of children have this disorder, often between the age of two-to-five years old.

Enlarged tonsils, which block the airway, are usually the key factor leading to this condition. Extra weight in obese children and adults can also interfere with the ability of the chest and abdomen to fully expand during breathing, hindering the intake of air and increasing the risk of sleep apnea.

The American Academy of Pediatrics has identified obstructive sleep apnea syndrome (OSAS) as a common condition in childhood that results in severe complications if left untreated. Among the potential consequences of untreated pediatric sleep apnea are growth failure; learning, attention, and behavior problems; and cardio-vascular complications. Because sleep apnea is rarely diagnosed, pediatricians now recommend that all children be regularly screened for snoring.

Middle ear infections

Acute otitis media (AOM) and chronic ear infections account for 15 to 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees a doctor. Furthermore, the incidence of AOM has been rising over the past decades. Although there is no proven medical link between middle ear infections and pediatric obesity there may be a behavioral association between the two conditions. Some studies have found that when a child is rubbing or massaging the infected ear the parent often responds by offering the child food or snacks for comfort.

When a child does have an ear infection the first line of treatment is often a regimen of antibiotics. When antibiotics are not effective, the ear, nose and throat specialist might recommend a bilateral myringotomy with pressure equalizing tube placement (BMT), a minor surgical procedure. This surgery involves the placement of small tubes in the eardrum of both ears. The benefit is to drain the fluid buildup behind the eardrum and to keep the pressure in the ear the same as it is in the exterior of the ear. This will reduce the chances of any new infections and may correct any hearing loss caused by the fluid buildup.

Postoperative vomiting (POV) is a common problem after bilateral myringotomy surgery. The overall incidence is 35 percent, and usually occurs on the first postoperative day, but can occur up to seven days later. Several factors are known to affect the incidence of POV, including age, type of surgery, postoperative care, medications, co-existing diseases, past history of POV, and anesthetic management. Obesity, gastroparesis, female gender, motion sickness, pre-op anxiety, opioid analgesics and the duration of anesthetic all increase the incidence of POV. POV interferes with oral medication and intake, delays return to normal activity and increases length of hospital stay. It remains one of the most common causes of unplanned postoperative hospital admissions.

Tonsillectomies

A child’s tonsils are removed because they are either chronically infected or, as in most cases, enlarged, leading to obstructive sleep apnea. There are several surgical procedures utilized by ear, nose and throat specialists to remove the tonsils, ranging from use of a scalpel to a wand that emits energy that shrinks the tonsils.

Research conducted by otolaryngologists found that morbid obesity was a contributing factor for requiring an overnight hospital admission for a child undergoing removal of enlarged tonsils. Most children who were diagnosed as obese with sleep apnea required a next-day physician follow-up.

A study from the University of Texas found that morbidly obese patients have a significant increase of additional medical disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep-disordered breathing when compared to moderately obese or overweight patients undergoing this procedure for the same diagnosis. On average they have longer hospital stays, a greater need for intensive care and a higher incidence of the need for apnea treatment of continuous positive airway pressure upon discharge from the hospital. The study found that although the morbidly obese group had a greater degree of sleep apnea, they did benefit from the procedure in regards to snoring, apneic spells and daytime somnolence.

What you can do

If your child has a weight problem, contract your pediatrician or family physician to discuss the weight’s effect on your child’s health, especially prior to treatment decisions. Second, ask your physician about lifestyle and diet changes that will reduce your child’s weight to a healthy standard.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The Importance of Vaccinations in Cochlear Implant Users

Bacterial meningitis is a serious infection of the brain and the fluid that surrounds the brain. Bacterial meningitis is a life-threatening infection. Individuals who have a cochlear implant are at increased risk for bacterial meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated against the bacteria that can gain entry into the brain and commonly cause bacterial meningitis. Two types of bacteria have produced the vast majority of cases of meningitis after cochlear implantation. Steptococcus pneumoniae (“Pneumococcus”) and Haemophilus influenzae type b (“Hib”).

Cochlear implant users and their families should be aware that vaccines against pneumococcus (“pneumo” vaccine) and Hib are widely available. These vaccines strengthen the body’s defenses to protect against the common causes of bacterial meningitis. This is another reason for being sure to get vaccinated.

Follow-up Care

Cochlear implant users and their families should also be aware that vaccinations do not eliminate the risk of meningitis. Children and adults with cochlear implants who develop a middle ear infection (otitis media) or a fever of uncertain cause should seek medical treatment and monitoring until the infection resolves. Infections in a child or an adult with a cochlear implant should be taken seriously. Untreated middle ear and other infections may spread to produce meningitis.
In addition, if an ear with a cochlear implant develops a discharge from the ear canal, or produces unusual ear symptoms or a watery nasal discharge, it is important to have that ear examined by the surgeon who performed the surgery or another suitable experienced cochlear implant surgeon.

Patient Education Materials

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

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

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