I’m sure many will agree there is nothing more upsetting and frustrating then seeing your child sick all the time. Unfortunately I see this often with infants and toddlers that have recurring ear infections. Many times parents of these children are already suffering from lack of sleep and then to deal with a child who has recurrent ear infections that is fussy, uncomfortable, waking up at night crying in pain and with fever can be exhausting. Also, many times these kids have already been treated with multiple rounds of antibiotics, which in itself can cause problems i.e. diaper rash from excessive diarrhea to name the most common, and so parents are left wondering what to do.

The best thing for these kids when medical treatments fail is to have a short outpatient procedure to have tubes inserted. I know surgery is scary especially for the new parent with a 6 month old, but I can’t tell you how many times afterwards I hear things like, “he’s a new baby” “She’s finally sleeping through the night” “It’s the best thing we did”. I am also speaking not only as a medical provider but as a parent of a child that has tubes. My now 22 month old son had recurring ear infections that were unresponsive to antibiotics by mouth and injection. Unlike the kids I talked about earlier he was a very happy baby but always had fluid behind his eardrums. The fluid persisted for 3 months and probably had 2-3 infections during that time. Working in the ENT field I was able to check his hearing and that was the deciding factor for me. The fluid behind his ears was causing hearing loss, which could affect his speech.

The procedure went excellent. It was quick, painless and he hasn’t had any fluid or infection issues since the tubes were placed a few months ago. I always tell parents that the surgery will be harder on them then it is for the child, especially now having experienced it myself.

If you would like more information about ear infections and ear tubes please check out our website under the pediatric tab the link for ear pain and ear tubes. If you have any comments or would like to share your experience feel free to chime in.

Jeff D’Ambrosio PA-C, MPAS

As an adult, do I need the PPSV vaccine?

• All adults 65 years of age and older.
• Anyone 2 through 64 years of age who has a long-term health problem such as: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant.
• Anyone 2 through 64 years of age who has a disease or condition that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no spleen; organ transplant.
• Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
• Any adult 19 through 64 years of age who is a smoker or has asthma.
• Residents of nursing homes or long-term care facilities.

PPSV may be less effective for some people, especially those with lower resistance to infection.

But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease.

Children who often get ear infections, sinus infections, or other upper respiratory diseases, but who are otherwise healthy, do not need to get PPSV because it is not effective against those conditions.

Please contact us for an appointment today.

Sleep apnea is known to affect 1 to 3 percent of children, but because there may be many unreported cases, could actually affect more. Sleep apnea can affect your child’s sleep and behavior and if left untreated can lead to more serious problems. Many times sleep apnea goes undiagnosed because parents don’t believe their kids are bad sleepers and Pediatricians have too many things to evaluate during a 10 minute well-child check-up. Because sleep apnea can be difficult to diagnose, it is important to monitor your child for the symptoms and have a doctor see her if she exhibits any.

What is sleep apnea?
Obstructive sleep apnea occurs when breathing is disrupted during sleep. This occurs when the airway is blocked, resulting in choking that causes a slower heart rate and increased blood pressure, alerting your child’s brain and causing him to wake up.

What kids are at risk?

• Those that were born premature
• Kids that have enlarged tonsils and adenoids, nasal septal deviation, allergies or nasal polyps.
• Kids that have asthma or recurrent upper respiratory infections.
• Obesity
• African American ethnicity
• Kids whose parents have sleep apnea.

What are the symptoms?
The first sign that your child may have sleep apnea is loud snoring that occurs regularly. You may also notice behavioral changes. Due to a lack of sleep, he or she may be crankier, have more or less energy, and have difficulty concentrating in school. Your child may also want to sleep in unusual positions (with their neck hyper extended), sweat excessively, wet the bed, awake with a morning headache, have impaired growth and even exhibit or have been diagnosed with symptoms of ADHD (attention deficit hyperactivity disorder).

How is sleep apnea diagnosed?
If you notice that your child has any of those symptoms, has him or her checked by an otolaryngologist—head and neck surgeon, who can use a sleep test to determine sleep apnea. For the test, electrodes are attached to the head to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and can be performed in a sleep laboratory or at home. Results can vary, so it is important to have the otolaryngologist determine whether your child needs treatment. Often, in mild cases, treatment will be delayed while you are asked to monitor your child and let the doctor know if the symptoms worsen. In severe cases, the doctor will determine the appropriate treatment.
What are the dangers if sleep apnea is left untreated?

Because sleep apnea can lead to more serious problems, it is important that it be properly treated. When left untreated, sleep apnea can cause:

• snoring
• sleep deprivation
• Increased bed wetting
• slowed growth
• Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
• breathing difficulty
• Heart trouble

What causes sleep apnea?
In children, sleep apnea can occur for several physical reasons, including enlarged tonsils and adenoids, and abnormalities of the jaw bone and tongue. These factors cause the airway to be blocked, resulting in vibration of the tonsils, or snoring. Overweight children are at increased risk for sleep apnea. Of the 37 percent of children who are considered overweight, 25 percent of them likely have sleeping difficulties that may include sleep apnea. This is because extra fat around the neck and throat block the airway, making it difficult for these children to sleep soundly. Studies have shown that after three months of exercise, the number of children at risk for sleep apnea dropped by 50 percent.

How is sleep apnea treated?
Because enlarged tonsils and adenoids are a common cause of sleep apnea in children, routine treatment often involves an adenotonsillectomy, an operation to remove the tonsils and adenoids. This is a routine operation with a 90 percent success rate. Studies published in Otolaryngology—Head and Neck Surgery (October 2005) and presented at the Academy’s 2006 annual meeting in Toronto showed that when children with sleep apnea were tested one to five months after their surgery, they showed extreme improvement in their sleep and behavior, and that these improvements remained nearly a year and a half later.

Benefits of proceeding with adenotonsillcetomy for the treatment of sleep apnea.

• Improved ADHD like symptoms
• Improvement in daytime sleepiness
• Improvement in your child’s grades
• Improved growth and decreased bed wetting

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.

I don’t know how many times a parent brings their child into our clinic and says something like; “he snores louder than his father” or, “I can hear him snoring from my room and I’m at the other end of the house! There are other times where a parent comes and tells me they get scared because their child is snoring and there’s a loud pause and they feel they need to go in and shake them to make sure they are breathing. These could all be signs of a real problem called sleep apnea. Sleep apnea affects 1 to 3 percent of children and can cause a slew of health issues. Sleep apnea has also been linked to ADHD problems in children.