Night and Day
Pediatric otolaryngology or ENT is one of my favorite subspecialty practices. I consider myself a “general ENT” because I manage a decent portion of all of the subspecialty areas—Ears (otology), nasal and sinus (rhinology), voice and swallowing (laryngology), allergy, and head and neck oncology. However, a fair amount of my practices encompasses pediatrics. Children have always been one of my main focal points in pursuing a career in medicine. I began my career volunteering at a hospital in Toledo, Ohio, working with children with various types of cancer. I thought that I would be a pediatrician when I began medical school, but fell in love with the technical aspects of surgery.
As an ENT doctor who enjoys working with children, and as a parent myself, I understand the gravity of having a sick child. Many parents bring their children because they have chronic nasal obstruction, snoring, or difficulty sleeping. Many of these children have been in and out of their pediatrician’s offices for recurrent infections or concern about allergies and asthma. At the center of many of these children’s problems are a common thread, enlarged tonsils and adenoids.
Tonsils and adenoids are a type of tissue where the body processes and fights infected agents such as bacteria and viruses. This tissue is called lymphoid tissue and lines the entire gastrointestinal tract and is also present in the liver, spleen, and lymph nodes. When the tonsils and adenoids are enlarged, they can cause a myriad of problems. Some of these problems include recurrent ear infections, hearing loss due to chronic middle ear fluid, chronic sinusitis, mouth breathing, dental problems and facial growth abnormalities, chronic tonsillitis, snoring, and obstructive sleep apnea.
Obstructive sleep apnea or sleep-disordered breathing occur when the adenoid and/or tonsils contribute to reduced airflow through the airway when children attempt to sleep. When children fall into deep sleep and their brains attempt to reach the restorative phase of sleep, enlarged tonsils and adenoids can contribute to apnea, which is defined as a cessation of airflow. This can lead to frequent awakening as the brain senses that air exchange is inadequate. As a result, children do not rest well and can also have bedwetting, tossing and turning, and nightmares. The child then ends up waking up feeling tired and not well rested. During the day, the child may have behavioral problems, frequent napping, or headaches. Some children even may be diagnosed with attention deficit hyperactive disorder (ADHD) when they are actually starved for proper rest.
Removal of enlarged tonsils and adenoids can be curative in many children. After being cured of sleep-disordered breathing or sleep apnea, children and parents both can experience a new life. As a patient recently told one of my nurses after surgery, “it is like night and day. I have a new child.”
-Lawrence Robinson, Jr., M.D.