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. 
WHAT ARE EAR INFECTIONS?
WHY DO EAR INFECTIONS OCCUR?
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 OTOACOUSTIC EMISSIONS?
WHAT IS TONSILLITIS?
WHAT ARE ADENOIDS?
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.
return to top
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.
return to top
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.
return to top
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.
return to top
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.
return to top
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.
return to top
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.
return to top
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.
return to top
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.
return to top
|
