Insights into Common Ear, Nose and Throat Problems

May 2, 2008

A toddler develops chronic problems with fluid in his ear, causing pain and preventing him/her from hearing clearly.

An adult’s nasal passages are chronically blocked, leading to recurrent sinus infections and severe headaches.

A child is diagnosed with sleep apnea.

These are just a few of the situations otolaryngologists, more often called ear, nose and throat specialists or ENTs, encounter every day. To provide a better understanding of these conditions and their treatment, Serge Martinez, MD, JD, otolaryngologist with Community Ear, Nose, Throat and Allergy, Daniel Akin, MD, and V. Vasu Kakarlapudi, MD, otolaryngologists with Ohio Valley ENT and Allergy, offered the following helpful information.

Aching Ears

Ear Infections – “One of the most common childhood health problems is an ear infection,” said Dr. Martinez. “Most acute cases are treated by a pediatrician. Patients tend to be referred to an ENT when the problem has entered a more chronic state, such as having persistent fluid, when we might use ventilation tubes and drainage. In determining whether or not a child needs tubes, we give careful consideration to the child’s stage in language and speech development. It is particularly important to be aggressive to maintain good hearing when the child is developing communication skills, between the ages of two months and two years.”

Middle Ear Trouble – “Other common problems include middle ear infections, in which the mastoid may need to be opened up and cleaned out,” Dr. Akin explained. “Studies also show evidence of a correlation between 6 patient focused exposure to second-hand smoke and chronic middle ear problems.” Another condition is cholesteatoma, the development of skin that gets trapped behind the eardrum and starts to grow. According to Dr. Akin, “Cholesteatoma can cause a disturbance of the bones in the ear. The removal of the bones and replacement with prosthetics may be necessary.”

Allergy – According to Dr. Kakarlapudi, “When it comes to the ears, you have to consider the role of allergy. Allergies are often overlooked, yet many times are the underlying cause of illnesses ranging from ear infections to sinusitis. If you can get to the root cause, you can successfully treat or prevent a variety of problems.”

MRSA – “We are seeing increased evidence of MRSA in both children and adults,” said Dr. Akin. MRSA, or Methicillin- Resistant Staphylococcus Aureus, is often called a “super bug” because it is resistant to most antibiotics. “MRSA is very difficult to completely eradicate in the ears,” he said. “If they continue to drain, treatment might require long-term IV antibiotics, administered for six to eight weeks.”

Hearing Difficulties – Dr. Kakarlapudi explained, “An ENT is often called upon to diagnose and treat hearing difficulties. Treatment may range from something as simple as the administration of antibiotics to complex surgeries, such as the implantation of a hearing device that is actually integrated into the bones of the skull.”

Troublesome Tonsils

Sleep Apnea – Most people don’t know that the majority of tonsillectomies are performed to treat obstruction of the airways. As Dr. Seipel, neurologist and medical director of the Sleep Disorders Center at Floyd Memorial explained, “When a child is snoring and not getting enough sleep, we often do a sleep study. When the study confirms sleep apnea, the first treatment is a tonsillectomy. It can make a significant improvement in the child’s quality of life and school performance.”

“In children who have been diagnosed with sleep apnea, a tonsillectomy is the first treatment. It is remarkably effective, solving the problem about 70 percent of the time.”

-Joseph Seipel, MD
Board Certified Neurologist Medical Director of the Sleep Disorders Center at Floyd Memorial

“Strep throat is usually treated by the child’s pediatrician. By the time a patient is referred to an ENT, he or she is already considered a candidate for surgery. There are many things we take into consideration in deciding whether or not to perform a tonsillectomy, but are most aggressive when there is obvious obstruction.”

-Daniel Akin, MD
Board Certified Otolaryngologist Ohio Valley ENT and Allergy

Strep Throat – Recurrent strep throat is another condition that may warrant a tonsillectomy. “Strep throat is usually treated by the child’s pediatrician. By the time a patient is referred to an ENT, he or she is already considered a candidate for surgery. There are many things we take into consideration in deciding whether or not to perform a tonsillectomy. For example, how much school has the child missed? Is he a carrier? How uncomfortable is the child when he gets a strep infection? We are most aggressive when there is obvious obstruction.”

Sinus Suffering Sinusitis – Sinusitis can be extremely painful and adversely affect a patient’s quality of life. In fact, chronic sinusitis is associated with an increased incidence of depression. “A number of things can cause blockage of the tiny holes that allows mucus to flow out of the sinuses,” said Dr. Martinez. “Allergy, nasal polyps and cysts are often to blame. For those with sinusitis that don’t respond to medication, surgery may be the best option.”

As Dr. Martinez explained, “Microdebriding is a minimally invasive technique that can be used to clean out the nasal passages and restore drainage and air flow to relieve chronic sinusitis. The technique allows us to remove enough of the excess tissue to correct the obstruction while still preserving the mucous lining for better long-term outcomes.” He added, “Unlike earlier techniques that required large incisions, microdebriding is performed endoscopically on an outpatient basis.”

“Microdebriding is a minimally invasive technique that can be used to clean out the nasal passages and restore drainage and air flow to relieve chronic sinusitis. The technique allows us to remove enough of the excess tissue to correct the airway obstruction while still preserving the mucous lining for better long-term outcomes.”

-Serge Martinez, MD, JD
Board Certified Otolaryngologist Community
Ear, Nose, Throat and Allergy