Pediatric/Children's ENT
ENT Specialists of Arizona and your child's health
Below are some common questions and concerns related to your child's health. For more info on these or any other questions please contact us. 
How do i know if my child has sinusitis?
What causes infant hearing loss?
Is it hard to assess my baby's hearing?
How can my baby's hearing be tested?
What are ear infections?
Ear infections (otitis media) occur when fluid accumulates behind the eardrum and becomes infected. This area is called the middle ear. Ear infections are the most common illness affecting children. About 70% of children have at least one bout of otitis media before their third birthday. It is estimated over 24.5 million episodes of otitis media occur per year in the United States.
Why do ear infections occur?
Most investigators feel that an immature eustachian tube predisposes children to otitis media. The eustachian tube is a narrow tube running from the air pocket behind the tympanic membrane to the back of the nose. In children the eustachian tube is shorter than in adults and allows bacteria and viruses to enter the middle ear. In young children, the eustachian tube is almost horizontal. This positioning interferes with drainage. In addition, the muscles of the palate which open the eustachian tube with swallowing or jaw movement are less well developed. The eustachian tube is also physically small in young children. All these factors may lead to eustachian tube blockage. As a child grows, the eustachian tube enlarges, angles down, and reaches adult development at approximately age six.
How do i know if my child has sinusitis?
The diagnosis of childhood sinusitis is difficult. A child's symptoms often are not much different from a common cold. Testing can also be equivocal. X-rays and CT scans are not always helpful due to age-dependent differences in sinus development. An x--ray or CT scan may also look abnormal when a child simply has a viral upper respiratory infection. Cultures of the nose can be misleading as he bacteria obtained from the front of the nose are usually different from those infecting the sinus. The character of nasal drainage may also be misleading. Clear drainage is most commonly associated with allergy, but can occur with viral or bacterial infection. If the mucus dries out, it will not only be thicker, but may turn white, yellow, or green, regardless of cause. There doesn't seem to be a reliable way to determine the cause of nasal drainage simply by its color.
It is presumed that a child has acute sinusitis if the child has cold-like symptoms, lasting more than ten days. If the child has chronic symptoms, lasting more than a few months, the presumption is that the child has chronic sinusitis.
What causes infant hearing loss?
Hearing loss occurs in two general types. Sensori neural or "nerve" deafness occurs due to abnormalities of the inner ear (cochlea) or of the hearing (acoustic) nerve. There are numerous causes of this form of hearing loss. Sensoineural hearing loss is the most common disability noted at birth. It occurs with a frequency of about 6 per 1000 births, or approximately 14,000 cases in the U.S. per year. This form of hearing loss is permanent and sometimes progressive.
Early detection and treatment is, therefore, extremely important. Conductive hearing loss may occur if the movement of the eardrum or hearing bones is restricted, limiting sound transmission to the inner ear. For example, an ear infection may result in fluid filling the air space behind the eardrum and limiting its motion. This type of hearing loss is generally reversible with treatment. However, a prolonged conductive hearing loss can also be detrimental.
Is it hard to assess my baby's hearing?
Determining a baby's ability to hear is more difficult than it initially seems. Parents are generally very sensitive to the way a child responds to verbal stimulation and may become suspicious of a hearing problem. General developmental "landmarks" have also been established and used by physicians to monitor hearing and language development.
Until recently these behavioral assessments were the only way to evaluate a baby's hearing. These methods often picked up hearing loss late, missed subtle degrees of hearing loss, and were frequently inaccurate. Infant hearing loss is often a subtle problem-- it has no obvious symptoms and can easily be confused with other developmental problems. Unilateral (one ear) hearing loss, for example, may be impossible to detect by behavioral methods. Late treatment of hearing loss may not allow a child to fully compensate and develop normal language and learning skills. What is needed is an accurate, objective test of infant hearing.
How can my baby's hearing be tested?
In the past, newborn hearing screening was restricted to "high risk" infants whose medical problems or family history suggested a high possibility of hearing impairment. In about 1980, accurate, automated means of newborn and infant hearing assessment were developed. These tests have been refined and now are widely available. These tests, delivered by audiologists or trained technicians are:
ABR (Auditory Brainstem Response) which measures a baby's brain waves in response to a click presented to the ear.
OAE (Otoacoustic Emissions) which record sounds generated by normal hearing ears.
Both tests are painless, rapid methods to effectively screen an infant's hearing. As they are reliable and inexpensive, a larger number of infants can be screened. Using "high risk" criteria, only 5% of newborns were screened for hearing loss in 1993. The goal of hearing specialists in 1998 is to screen every baby's hearing.
What are otoacoustic emissions?
Originally detected in 1977 by David Kemp using a click stimulus, otoacoustic emissions are sounds generated within the cochlea of nearly all normal-hearing ears by active bio-mechanical process within the outer hair cells. Since OAE's are present in normal ears, it can be assumed that the absence of an emission is a sign of irregular cochlear function which could result in hearing loss.
Otoacoustic emissions testing provides you with a fast, non-invasive method of testing for cochlear pathology. What's more, by monitoring a cochlea's natural processes, OAE testing is completely objective – making it ideal for testing "hard-to-test" patients such as infants or neurologically-impaired children.
The OAE probe, similar to a tympanometry probe, contains a speaker (or speakers) and a microphone. Eartips are used to tightly seal the ear canal. An acoustic stimulus is sent from the probe speaker or speakers to the ear canal through the middle ear into the cochlea. Outer hair cells in the cochlea become excited by the stimulus and react by generating and emitting an acoustic response. This emitted response then travels in a reverse direction from the cochlea back to the ear canal, where it is detected by the probe microphone.
Unfortunately, this emitted response is very small in amplitude and gets mixed-in with other biological and environmental sounds present in the ear canal. Since the probe microphone detects all of these sounds, it is necessary to employ signal averaging techniques to separate the emitted response (signal) from these other sounds (noise).
The middle ear is an important factor in the amount of activating stimulus that reaches the cochlea - as well as the amount of emitted response that returns to the probe. Therefore, it is helpful to perform tympanometry screening in conjunction with OAE measurements wherever possible.
What is tonsillitis?
Tonsillitis occurs when the tonsils become infected. This may be caused by bacteria or viruses. Generally under preschool age children develop viral tonsillitis while older children and adults are affected by bacterial infections. Viruses can also lead to bacterial infections secondarily. Common symptoms your child may experience with tonsillitis are:
- Sore throat
- Fever
- Pain or difficulty in swallowing
- Swollen neck glands
- Ear pain
If you looked at your child's throat with a flashlight during an episode of tonsillitis, the tonsils would be red, swollen, and sometimes have a white-yellow exudate on the surface. A throat culture is necessary to diagnose bacterial tonsillitis.
What are adenoids?
Adenoids are collections of lymph tissue very similar to tonsils, found in back of the nose. As they are located near the entrance to the breathing passages, it is thought that their function is to sample or catch inhaled bacteria or viruses. In early childhood this process is important in the formation of the body's immune system to fight infection. This function diminishes with age and is probably of minimal importance after three years of age.
Adenoids shrink or atrophy as children enter adolescence or young adulthood. Long-term investigations have shown no loss of ability to fight infection or disease in children who have had their adenoids removed.