Tell Me Doctor Articles

When Does My Child Need Ear Tubes?

Michael T. Cecil, MD, FACS, Lexington Clinic Otolaryngologist

Acute otitis media (middle ear infection) is one of the most common infections in childhood. In the U.S., approximately 70% of children experience acute ear infection prior to their second birthday. Risk factors predisposing this age group to ear infections include daycare attendance, bottle feeding (no history of breast-feeding), allergy and tobacco smoke contact. Obstruction of the eustachian tube is typically the ultimate factor that results in an ear infection.

Ear tubes are commonly placed to bypass the dysfunction or obstruction of the eustachian tube. We generally consider placing ear tubes if your child has had repeated ear infections over a short period of time. Occasionally, a child will have fluid behind the eardrum that will persist for several months after an acute ear infection has resolved. If this fluid persists for up to 3 months, tubes are recommended as well.

Placement of ear tubes is typically a well tolerated procedure. In children, it is performed under general anesthesia, which is quite safe. The tubes typically remain in place for around 12 months, and most children experience a complete resolution in recurrent ear infections while the tubes are in place.

Do I Need Sinus Surgery?

Michael T. Cecil, MD, FACS, Lexington Clinic Otolaryngologist

Chronic sinusitis is a very common illness in the United States. Approximately 1 in 5 antibiotics that are prescribed in adults are for sinusitis. Chronic sinusitis is defined as persistent inflammation in the sinuses of at least 12 weeks duration. Symptoms typically include thick discolored drainage, nasal obstruction, facial pain/pressure and decreased sense of smell. Other symptoms may include fever, bad breath, dental pain and headache. Some of these symptoms can also be seen with allergic rhinitis; however, this is usually associated with clear nasal drainage as well as sneezing and itching.

Typically, a diagnosis of chronic sinusitis is made by reviewing a patient’s history, as well as a physical examination including a nasal endoscopy. This requires placing a thin scope in each nasal cavity after spraying the nasal linings with a topical anesthetic agent. It is a relatively painless procedure that is done in the office. A CT scan of the sinuses is often required as well to evaluate for inflammation in the sinus cavities.

Treatment of chronic sinusitis typically includes using a several week course of an antibiotic along with a nasal steroid spray and nasal saline irrigations. Sometimes, oral steroids are used as well. In certain instances, this medical therapy is not effective. Cases that do not respond to maximal medical therapy are then considered for Endoscopic Sinus Surgery (ESS).

ESS is performed under general anesthesia in the operating room as an outpatient procedure. It is performed by placing rigid telescopes in the nasal cavities to project an image on a monitor which magnifies the surgical field. Instruments are then placed in the nasal cavities alongside the telescopes to open the sinus cavities and allow the infection to drain more properly. It is very important to continue medical therapy for several weeks after ESS since antibiotics are still required to clear the chronic infection. Most patients respond very well to this intervention and are typically back to work within a week.

Why Should Obstructive Sleep Apnea be Treated?

Wayne B. Colin, DMD, MD, Lexington Clinic Otolaryngologist

If after a formal sleep study, the diagnosis is made of Obstructive Sleep Apnea, there are both subjective personal reasons and objective medical reasons to seriously consider treatment. Repetitive obstruction to breathing during sleep can produce blood oxygen levels dramatically below normal with resultant effects on the heart and brain. Obstruction to breathing triggers a reduction in the depth of sleep so as to improve muscle tone and relieve the blockage to breathing. The result is a poor quality of sleep and impaired "quality of life."

Chronic deprivation of quality sleep results in severe daytime sleepiness and fatigue with deficits in thinking, impaired memory and communication. It also can result in moodiness, irritability and depression and is statistically linked to a dramatic increased risk of automobile and truck accidents.

OSA is associated with and may promote severe life threatening diseases. Several reports suggest a slight decrease in life span when OSA is not adequately treated. OSA is very commonly associated with high blood pressure and has an increased risk of heart attack, irregular heart beats and stroke. The natural evolution of untreated severe OSA is often congestive heart and respiratory failure even in young patients. It seems intuitive that undiagnosed or untreated OSA appears to be associated with a dramatically higher cost of medical care. Fortunately OSA can be treated by medical and, or, surgical methods and will improve both subjective and objective deficits.