Ear, Nose + Throat (Pediatrics)

We use advanced 3D imaging and precise tools for sinus and nasal surgery. Our safe and effective procedures include ear tubes, tonsil removal, sinus reconstruction and thyroid surgery for people of all ages.

We provide comprehensive care for those with craniofacial disorders like cleft lip and palate. Our skilled surgeons offer personalized surgery recommendations and continue to monitor patients as they grow. We provide care for adults and children with cleft and craniofacial differences and are here to help with any medical, surgical, orthodontic and dental concerns you have.

Every day we help children who suffer from voice disorders such as vocal nodules and cysts, chronic cough, vocal cord paralysis and reflux disease, to name just a few.

We are dedicated to bringing the gift of clearer, fuller and richer sound to children who are struggling to hear with implantable hearing devices and cochlear implants.

Cochlear implants could be a solution for those who have not received enough help from traditional hearing aids. We offer treatment for individuals of all ages, regardless of whether they lost their hearing before or after they began speaking. Although every experience is unique, most people who receive an implant report a significant improvement in their ability to hear.

We care for spine and brain diseases, including tumors and cerebrovascular disorders. We use minimally invasive techniques to provide neurosurgical care for children.

We are here to help children with any issues related to vascular anomalies, such as abnormalities or disorders in their veins or arteries.

We help kids build speech-language skills. We support those who need audiology care for all levels of hearing loss in people of all ages.

A cochlear implant provides a new mechanism for hearing when a hearing aid, which amplifies sound, is not enough. With most hearing loss, the hairs of the inner ear are missing or damaged. The Cochlear Implant bypasses damaged hair cells of the inner ear and sends signals to the auditory nerve.

The cochlear implant consists of both internal and external components.

External components:

• Speech processor – either worn behind the ear or on the body
• Battery
• Microphone
• A small cable
• Headpiece

Internal components:

• An electrode placed in the cochlea of the inner ear
• A small receiver and stimulator is placed under the skin behind the ear
• Magnet

How cochlear implants work

The speech processor captures the sounds from the environment through a tiny microphone. It processes the sound into digital information. It transmits the information to the implant via the headpiece. The implant converts the digital information into electrical signals. It then sends signals down tiny wires to the electrode in the cochlea of the inner ear. The electrode delivers the electrical signals to the hearing nerve. The hearing nerve carries the information to the brain, where your brain then processes it as sound.

3 types of cochlear implants

We use three brands of cochlear implants. Each manufacturer brings its own unique features. Your implant team will help determine which is right for you:

• Advanced Bionics Corporation, makers of the Clarion implant
• The Cochlear Corporation, makers of the Nucleus implant
• Med-El, makers of the Maestro implant

Is a cochlear implant the right choice?

1. You’ve taken the first step in discovering the benefits of cochlear implants — reading about them and learning about your options. We recommend you read all you can about implants.
2. To truly determine if an implant is right for you, an evaluation needs to be performed by your team.
3. If you are a candidate, the next step we recommend is talking to current users. We can connect you with patients we work with who are similar to you.

General criteria for cochlear implants

A thorough, individualized evaluation of your history and current situation will determine whether your child is a candidate. In general, children should have profound bilateral sensorineural hearing loss of 90 dB HL or greater, plus:

• A healthy child, 2 through 17 years of age.
• Lack of benefit from appropriately fit hearing aids.
• In younger children, lack of benefit is defined as a failure to attain the best auditory milestones such as a child’s inconsistent response to his/her name in quiet or to environmental sounds (MAIS).
• In older children, lack of benefit is defined as a 0% score on open-set word recognition, PBK word list administered live voice.
• Both younger and older children should demonstrate only minimal ability on age-appropriate open-set sentence measures and a plateau in auditory development.

Our process
Our process of cochlear implantation is a journey of continuous improvement. It takes dedication and commitment from your family and your child. It also takes a strong support system around that patient. The process includes the following steps:

Evaluation

1. The surgeon evaluates the medical condition of the ear, the cause of hearing loss, and your child's overall health. They determine whether your child meets the medical criteria for a cochlear implant. A CT scan of the inner ears and other necessary medical tests and evaluations are obtained.
2. The audiologist performs various measurements of auditory function and determines whether the patient meets the audiological criteria for cochlear implantation. They will discuss realistic expectations, family support, and commitment.
3. The speech-language pathologist evaluates your child's functioning regarding the hearing loss and primary mode of communication. A plan is developed if it is determined that speech therapy post-implantation would be needed.

Family dynamics, the expectations from a cochlear implant, and the level of commitment to succeed with an implant are often interconnected issues. Our team will help to clarify these issues and bring the patient and family to a unified understanding.

Once your child is deemed a candidate for a cochlear implant, the next step is obtaining insurance approval.

Insurance approval
Most insurance carriers cover the cochlear implant, the surgery, and associated services. We will work closely with you to ensure that you get the maximum coverage possible from your health insurance.
Once insurance coverage is granted, the surgery date can be scheduled.

Surgery
Cochlear implant surgery involves the placement of the internal device. The electrodes are inserted into the inner ear. The surgery typically takes 3-3.5 hours and usually requires a 1-day stay in the hospital.

Initial activation and programming
Approximately four weeks after surgery, the patient comes to the Cochlear Implant Center so that the audiologist can activate and program the device. The patient returns the following day to check the program settings.

Routine programming
The audiologist provides ongoing support through periodic programming adjustments. For some newly implanted patients, this may be once per month. For others, it may occur every 3 months and eventually once a year.

Aural rehabilitation
The rehabilitation will be set up before surgery. We want to make sure you have a program in place that is convenient and a good fit for you and your objectives. Adherence to this program is key for continued success.

Helpful websites

• For parents and caregivers: Cochlear Implant: Preparing your child for surgery
• For kids: Cochlear Implant Pre-Surgery Playbook

Most children recover from ear-tube surgery and anesthesia within a few hours. Usually, pain medicine is not required afterward, but you may give your child over-the-counter medications like acetaminophen (Tylenol) or Ibuprofen (Motrin, Advil) if they experience discomfort or is fussy.

Occasionally, some children may experience nausea or fatigue following the ear tube procedure, which should resolve on its own within a few hours. If your child is prescribed antibiotic eardrops they should be used as directed. Your child may resume normal activities including school or daycare the day after ear tube surgery.

Ear drainage

1. Drainage from the ears may occur during the first few days after ear-tube surgery. It can be any color (clear, cloudy or bloody) or you may not see any ear drainage - this is all normal.
2. Ear drainage should resolve by the time you have finished the prescribed eardrops. Please notify the office if ear drainage persists or starts again once you have finished giving the antibiotic eardrops.

Water precautions with bathing and swimming

1. During bathing, you should prevent soapy water from flooding the ears, especially when rinsing shampoo from the hair. You may use silicone earplugs, cotton balls (with the outer surface coated with Vaseline) a washcloth or your hand cupped over your child’s ear while rinsing.
2. Children may swim in a pool without earplugs, even if going underwater. Some children dislike the feeling of water entering their ears during swimming and may wear earplugs for comfort.

Follow-up care

1. Your child should be seen in the office in 3-4 weeks after surgery to check the position of the tubes to see that they are open and functioning well and arrange any post-operative hearing testing that may be appropriate.
2. Call your doctor if your child has any ear tube side effects, problems or questions.

Tonsillectomy is the third most common operation performed on children in the United States, with more than 500,000 operations occurring each year. The top reasons children get a tonsillectomy are frequent throat infections or sleep apnea (a disorder in which breathing constantly stops and starts). Having a tonsillectomy can reduce the frequency of sore throats and improve the quality of life in children who have had approximately 7 throat infections over the previous year, 5 infections per year for the past 2 years, or 3 per year for the past 3 years.

After surgery

1. Most children will nap more frequently, have less energy and may be restless at night. These symptoms will gradually improve over a period of 5-14 days. Dizziness, headache, and constipation may also occur. Good fluid intake will help minimize these symptoms.
2. A temperature of 99-101 may occur during the first several days after surgery. This is often related to dehydration and will be less likely to occur the more fluids are encouraged. Contact the doctor's office if the fever is higher than 101.5.
3. Your child may snore or sound congested for several days. The voice may also have a nasal twang or sound higher in pitch. These changes are related to initial swelling, pain, and splinting of the palate and will gradually improve over several days to two weeks.
4. Halitosis (bad breath) is common and will resolve once the scabs in the throat have healed.

Pain

1. All children will experience a sore throat postoperatively for an average period of one week and for up to 14 days. The pain may be severe and can be worse at night. Pain may also be worsened around the fifth postoperative day when the scabs in the throat begin to separate.
2. Ear pain is extremely common following a tonsillectomy. It refers to pain from the tonsil area of the throat and is not indicative of an ear infection and should be treated the same as throat pain (see below).
3. Liquid Tylenol, or the generic acetaminophen, should be given every 6 hours while awake for the first several days after surgery. Tylenol suppository may also be used if your child refuses the oral medication or has nausea.
4. You may also use liquid Motrin, Advil (Ibuprofen) every 6 hours alternating with Tylenol (for example, you may give Tylenol 3 hours after Ibuprofen, and then Ibuprofen 3 hours after Tylenol, etc.). Follow the dosing instructions on the package.
5. Drinking fluids and eating (especially cold foods such as popsicles, which numb the throat and count as fluid) are extremely important in reducing the duration of postoperative pain.
6. An ice pack placed over the front of the neck is soothing to some children.

Diet

1. Some children will experience nausea or vomiting immediately after surgery. This should be resolved by the following morning. If it occurs, do not encourage drinking right away. Your children have received enough intravenous fluids during surgery to delay drinking for 24 hours. Use plain Tylenol or a Tylenol suppository for throat pain. Gradually introduce clear liquids and advance to a bland soft diet as tolerated. If nausea or vomiting prevents your child from beginning to take liquids by the afternoon of the first post-operative day, please get in touch with our office.
2. Good fluid intake is the most important aspect of postoperative care. Offer liquids as frequently as every one to two hours while awake until your child drinks well. Avoid citrus fruit juices as they tend to sting.
3. Introduce solid foods as soon as your child is interested, which may be as early as the first postoperative day or as late as a week afterward. Begin with cool, soft foods (Jell-O, yogurt, pudding, ice cream, etc.) and advance to solid foods as tolerated. Allow hot foods and soups to come to room temperature.
4. If your child is refusing or simply not taking fluids in any form AND not urinating 2-3 times per day, you should return to the Emergency Room for evaluation for dehydration.

Activity

1. Encourage rest and quiet play for the first 3 days postoperatively.
2. Your child may return to school when he or she feels well enough (on average 10 days, but may require 2 weeks). No travel out of town.
3. Avoid vigorous or strenuous activities, such as swimming, running, dancing, organized sports, and gym class and recess activities for 14 days postoperatively to decrease the risk of bleeding.

Bleeding

Your child may cough or spit out blood-tinged mucus or saliva during the healing period, which is normal. The risk of postoperative bleeding is greatest between 5-10 days postoperatively, as the scabs in the throat break away, but can occur at any time during the 2 weeks after surgery.

Call our office if there is any bleeding from the mouth.

Follow-up

Your child should be seen for a postoperative check-up in 3-4 weeks.