Pediatric ENT

How Long Does a Tonsillectomy Take?

A tonsillectomy takes about half an hour, and the patient can usually be discharged the same day.

At What Age Can Tonsil Surgery Be Performed?

If it causes severe obstruction, it can be done from the age of 2.

Is There a Specific Season for Tonsil Surgery?

Tonsil surgery can be performed in any season.

Adenoids

Adenoid enlargement in children can block the upper airway, leading to frequent sinus infections, chronic cough, snoring due to difficulty breathing at night, mouth breathing, sweating on the neck, and frequent turning during sleep. All children have some adenoid tissue, but if it grows excessively, it can fill the nasal cavity, leading to airway obstruction. Additionally, it can block the opening of the Eustachian tube, which ventilates the middle ear, causing fluid to accumulate in the ear. Treatment is usually surgical.

How Long Does Adenoid Surgery Take?

Adenoid surgery takes about half an hour, and the patient can typically be discharged the same day.

At What Age Can Adenoid Surgery Be Performed?

If it causes significant obstruction, it can be done from the age of 2.

Is There a Specific Season for Adenoid Surgery?

There is no specific season for adenoid surgery.

Middle Ear Infections

Usually seen in childhood, middle ear infections present with symptoms such as ear pain, ear discharge, and fever. Treatment includes antibiotics and antipyretics. This condition should be taken seriously and requires a doctor’s examination to avoid complications.

Ear Tube Placement

In about one-third of children, fluid accumulation in the middle ear can occur after viral upper respiratory tract infections. This is due to Eustachian tube dysfunction and blockage. In most children, this fluid drains within 15 days to a month, and middle ear function returns to normal. However, in cases where fluid buildup continues, the mucosa lining the middle ear and the eardrum itself may begin to change, and the fluid may become jelly-like, causing hearing loss.

When Is an Ear Tube Needed?

Tubes are used to address pressure problems that cause fluid accumulation in the middle ear and eardrum retraction. This condition is usually associated with adenoids or allergies. Tubes may also be used in cases of recurrent bacterial middle ear infections, middle ear bleeding, or other causes of eardrum retraction. Although often required for children, adults may also need ear tubes.

How Are Tubes Inserted in Children?

Both local and general anesthesia can be used, but general anesthesia is more commonly used for children. A microscope is used to enter through the ear canal, and an incision is made in the eardrum, called a myringotomy. Fluid in the middle ear is then drained, and a tube is placed in the incision, with one end in the outer ear and the other in the middle ear. No visible change is seen in the patient’s ear.

Are Tubes Permanent?

No, the eardrum will eventually expel the tube on its own. Rarely, the tube may not come out naturally, and the doctor may need to remove it. The shape of the tube also affects how long it stays in place. T-tubes and Paparella tubes typically stay in place longer.

Are Tubes a Permanent Solution?

Ear tubes usually resolve middle ear issues, but if the underlying cause of pressure problems remains, the condition may recur once the tube is out. Therefore, adenoids, allergies, or other causes should be appropriately treated. Some patients may need tubes inserted multiple times, and even then, a permanent solution might not be achieved.

What Are the Risks of Ear Tube Placement?

Ear tube placement is generally a problem-free procedure, though complications can sometimes occur. Risks include anesthesia-related issues, eardrum perforation during surgery, and tube displacement into the middle ear. After surgery, ear discharge, calcification of the eardrum, or a persistent perforation may occur at the tube insertion site. Ear discharge is a sign of infection and is usually easily treated with antibiotics.

Post-Surgery Care

After ear tube placement, the most important aspect of care is preventing water from entering the ear, as this can cause infections. Other than that, the patient can resume normal activities. Regular follow-up visits, typically every three months, are recommended for patients with ear tubes.

Cholesteatoma:

Cholesteatoma usually develops as a result of middle ear ventilation problems that occur during childhood. It is a condition in which the skin of the ear canal and eardrum collapses toward the middle ear, taking on a different character and becoming an inflammation-producing tissue. This tissue progresses by eroding the small bones in the middle ear and the bones in the mastoid region behind the ear. As it advances toward the inner ear, it can cause hearing loss and dizziness. If it extends to neighboring brain tissue, it can lead to serious, life-threatening complications like meningitis and brain abscess.

Treatment involves surgically removing this inflamed tissue completely and, in suitable cases, repairing the bones to restore hearing.

Sometimes this condition can also be congenital, or it can occur due to external ear canal infections or trauma.

Cochlear Implant (Bionic Ear):

Cochlear implants are devices that restore hearing by placing electrodes directly in the inner ear for patients with severe hearing loss who cannot benefit from hearing aids. They can be placed in patients with congenital hearing loss until the age of 4, and in those who lost their hearing later in life and learned to speak, without any age limitation. Thanks to this technology, individuals who would otherwise grow up deaf and mute can learn to speak and live in society like healthy individuals without any hearing loss.

Whether a child is a suitable candidate for a cochlear implant is determined through tests and audiological evaluations conducted by specialist audiologists.

Hearing Evaluation in Children:

Evaluating hearing and detecting any hearing loss is crucial, especially in infancy and childhood, as it significantly impacts the development of language (speech) and cognitive skills later in life.

Hearing evaluation in infants and children is conducted in different ways.

1. Behavioral Observation Audiometry

Typically used in infants (0-4 months). In an open space, pure tone stimuli, speech stimuli, and various noises are presented to the baby, and the audiologist observes the baby’s behavioral responses (e.g., blinking, head turning, hand and foot movements, crying, and sucking reflex) to determine the baby’s hearing thresholds.

2. Visual Reinforcement Audiometry

Generally applied to infants and children (5-24 months). It can be done in an open space or with headphones. The child is seated to see both sides. There are illuminated boxes with moving toys on both sides. During the test, an audiologist plays with the child to focus their attention. Subsequently, sound stimuli are presented along with visual cues, and the child’s response is monitored to determine hearing thresholds.

3. Play Audiometry

Typically used in children (24 months and older). The test is conducted in an open space or with headphones. The child wears headphones, and Legos or toys are placed in front of them. The child is conditioned to place a Lego into a box each time they hear a sound. In this way, the child’s hearing thresholds are determined.

Tympanometry

The tympanometry test available in our clinic measures middle ear pressure to detect the presence of fluid in the middle ear or abnormalities in the ossicular system. It also assists in diagnosing middle ear air-pressure issues and Eustachian tube problems. It is frequently used in diagnosing ear problems in children.

Acoustic Reflex Test

Acoustic reflex testing provides detailed and objective information about the function of regulatory cells in the inner ear, as well as the auditory and facial nerves. It is also used for the objective assessment of hearing in children and infants.