Dr. Thomas Crews

It is not uncommon for children to have various cysts, growths, lymph nodes, which are abnormal in the neck area. 99% of the time these lesions are benign and can be diagnosed and excised with an outpatient surgical procedure. At the Pediatric Ear, Nose, & Throat Clinic, these procedures are performed as an outpatient usually with the parents or caregiver in the room when the child is incubated by anesthesia. Typically these procedures take less than 30 minutes and the recovery room time is less than 30 minutes. The surgery typically has very little blood loss and the patient can be followed postoperatively on an outpatient basis. For added comfort, the Pediatric Ear, Nose, & Throat Clinic gives all parents Dr. Crews’ cell phone number for direct access postoperatively. If you suspect your child has a neck mass or a tumor and needs an evaluation, please call Pediatric Ear, Nose, & Throat Clinic for consultation.

Often times, children have perforations in their eardrums secondary to infection or replacement of PE tubes. It is not uncommon to have to have a surgical procedure to close the small holes in the eardrum that can arise from various reasons. At the Pediatric Ear, Nose, & Throat Clinic, this procedure is performed under general anesthesia usually with masked anesthesia alone and typically takes less than 15 minutes to perform. Parents are often in the room during the intubation of anesthesia and the procedure is typically relatively painless and the patient is usually discharged 30 minutes after they have awoke.

If you suspect your child has a hearing loss or your child has a perforation in the eardrum, please contact the Pediatric Ear, Nose, & Throat Clinic for an evaluation and consultation.

Hearing loss in children is a significant matter. Almost all children in today’s society are tested with a newborn screen test in the nursery to make sure that congenital deafness is not present. For those children who develop hearing loss after having had normal hearing noted at birth, the problem typically has several main causes. Oftentimes, earwax impactions are probably the number one reason why children have temporary reversible hearing loss. This is often done because the child or the parent in an attempt to clean the ears uses a Q-tip and impacts wax down in the ear canal. This often can be relieved by various oils and a direct visualization on the part of the pediatrician or the ENT doctor for cleaning the ear directly. Children also have problems with ear fluid or otitis media, that is chronic infections that usually arise usually as a result of a problem from enlarged adenoids or chronic nasal stuffiness that leads to fluid backing up the Eustachian tube and settling behind the eardrum. This fluid behind the eardrum keeps the eardrum from moving and therefore causes the child to have a conductive hearing loss. If this fluid is present for longer than 90 days, oftentimes an ear tube is necessary to relieve the pressure, remove the fluid, and allow the eardrum to move clearly to conduct sound waves from the outer ear into the inner ear so that the child may hear. Meticulous history and physical and hearing testing should be performed on a child with such a hearing loss. If ear tubes are necessary due to otitis media or fluid behind the eardrums, it is often performed in an outpatient surgical center under anesthesia and takes usually less than 4 minutes. The parents may accompany children into the operating room for such a procedure for anesthesia induction. Typically, a child is discharged in less than 30 minutes after such a procedure and usually are seen in the office shortly thereafter for a postoperative hearing test within two weeks. Tubes typically come out by themselves as the child is being followed by the ENT doctor anywhere from 12-18 months. There are usually very few complications with ear tubes. These procedures have been performed successfully for the last 60 years and it is probably the simplest and most commonly performed surgical procedure in the United States. At the Pediatric Ear, Nose, & Throat Clinic, we have been performing ear tube placement for over 25 years. We have a board certified

PhD audiologist for hearing testing. If you suspect your child has a hearing loss or has chronic ear infections, please contact the Pediatric Ear, Nose, & Throat Clinic at 1800- 526-0998.

Hello Everyone,

We have recently created a video starring one of our patients mothers and she is explaining problems children face when dealing with enlargement of the tonsils and adenoids. We hope you enjoy this video and learn from it! Below are also some definitions related to the video.

Dr. Crews- Parent Explains Common ENT Issues

Where is the adenoid?

The adenoid is a lump of tissue at the back of the nose above the tonsils. In order to see them, your physician can look through your mouth and view the back of your nose using a mirror, may choose to look with a flexible camera in the nose, or may use an x-ray.

What is the adenoid?

The adenoid is basically a lymph node. A lymph node contains “lymphocytes”, which are cells that help to fight infection. The adenoid is a part of a group of lymph nodes that include the tonsils, found around the back of the throat (known as Waldeyer’s ring). Together, they act to help process infections in the nose and throat.

What is adenoiditis?

Unfortunately, sometimes the adenoid tissue gets infected and the infection can last for weeks or months. This is called adenoiditis. If you have adenoiditis, you may have a runny or stuffy nose, post-nasal drip, headache or cough.

How is adenoiditis treated?

Usually adenoiditis responds to antibiotics taken by mouth. If antibiotics fail to get rid of the infection, the adenoid tissue may have to be removed.

What is adenoid hypertrophy?

In most children, the adenoid enlarges normally during early childhood, when infections of the nose and throat are most common. They usually shrink as the child gets older and disappear by puberty. However, in some children, the adenoid continues to become larger and block the passage behind the nose. This can result in snoring, breathing through the mouth, and/or a HYPONASAL sound to the speech (sounds like talking with a stuffed nose). Additionally, this can result in OTITIS MEDIA (middle ear infections) because of blockage of the eustachian tube (the tube that connects the ear to the throat).

What is involved with removing the adenoids?

Every patient who is to undergo removal of adenoid tissue is first screened to make sure they are not at an increased risk to have HYPERNASAL speech (sounds like talking through the nose) following surgery. The surgery is done through the mouth under a general anesthetic. Many times we use cautery (removal with suction and heat) to perform the surgery, resulting in very little, and many times, no blood loss. This surgery is performed on an outpatient basis and lasts about 20 minutes.

What are the tonsils?

The tonsils are located in the back of the throat. They are part of a group of lymphoid tissue that collect bacteria and viruses that cause upper respiratory tract (nose and throat) infections. They also help to produce proteins (immunoglobulins) that help the body fight infections. Although the tonsils have a role in helping treat infection, the tonsils can become part of the infection as well. When this happens, removal of the tonsils will improve your child’s health. Removal of the tonsils has not led to an increase in infections or a loss of immune (disease fighting) function. This is because there are hundreds of other lymph nodes in the head and neck that perform the same function.

Where are the tonsils?

Actually, there are four areas of tonsil tissue located in the back of the throat The tissue referred to as the “tonsils” is located on either side of the back of the mouth. The second area of tonsil tissue is located behind the nose, and is called the ADENOID. The fourth area of tonsil tissue is located behind the tongue; it does not usually cause any difficulties and is rarely ever removed.

What is tonsillitis?

Tonsillitis is an infection of the tonsils. This infection usually involves the back of the throat as well (pharyngitis). This infection is uncommon in children less than one year old. It is seen most frequently in children four to seven years of age, and continues less frequently throughout late childhood and adult life.

What are some of the causes of tonsillitis?

In about 85% of cases, viruses are the most common cause of tonsillitis. The second most common cause is a bacteria known as Streptococcus (Group A Beta hemolytic Streptococcus), otherwise known as “strep throat”. Other bacteria can cause tonsillitis, but much less frequently.

How is tonsillitis treated?

It is important to have your primary care doctor determine if the cause of the infection is viral or bacterial.

Viral tonsillitis is primarily treated with bed rest, Tylenol (acetomenophen) for fever and pain relief, and lots of fluids. Antibiotics do not help treat this type of infection.

Streptococcal tonsillitis does require the use of antibiotics, primarily to help get rid of the infection quickly and prevent complications. Complications can include an infection in the bloodstream, heart problems, rash, and others.

If enlargement of only one tonsil occurs, this may be suggestive of a malignancy (cancer) and needs to be removed for biopsy.

These are the most common indications for removing the tonsils. However, each child is evaluated based on their unique history.

What is Adenoid Removal (Adenoidectomy)?

Adenoid removal (also known as an adenoidectomy) is an ENT surgical procedure for the removal of the adenoids. The adenoids is a fleshy growth on the back wall of all human beings’ noses that commonly filters the air you breathe, as well as filtering bacteria from sinuses and noses.

Photo of Adenoids and Tonsils

Often times in children, the adenoids

become enlarged or infected leading to symptoms such as mouth breathing, snoring, excessive nasal mucus, cough, frequent allergy, cold, and sinus symptoms, nasal speech, aspiration of material leading to bronchitis, pneumonia, and flare ups of asthma. Enlarged adenoids can lead to sleep apnea, snoring, and disruption of

sleep, daytime sleepiness, and alterations in behavior secondary to a poor night’s sleep. It is not uncommon to see children with enlarged adenoids also to have bed wetting and frequent ear infections. Adenoid removal (adenoidectomy) is a safe and effective surgical solution to eliminate these symptoms.

Adenoid Removal (Adenoidectomy) Procedure

Adenoid removal (adenoidectomy) is performed in an outpatient clinic setting in most cases

and generally on children between the ages of 18 months and 6 years of age. Normally, adenoid removal (adenoidectomy) is about a 7-minute procedure with little (if any) bleeding.

Intra-operatively, the patient is usually put to sleep with masked anesthesia, with no shots and no IV, until the patient is asleep. If the procedure was performed in a clinic setting, parents may accompany children into the operating room for the child’s comfort and

emotional well-being.

Adenoid removal (adenoidectomy) in selected patients, can have a profound effect on the child’s health and well-being. If instituted in the proper medical situation, can eliminate the vast majority of reasons why children have to see a doctor on a regular basis.

A Good Candidate for Adenoid Removal (Adenoidectomy)

A good candidate for adenoid removal (adenoidectomy) is any child from the age of 18

months to 6 years of age with the following symptoms. Adenoids are a mass of lymphoid tissue situated on the posterior wall of the nasal cavity where the nose bends into the throat. In children, they generally make a soft mound in the roof or posterior wall of the

nasopharynx just above and behind the uvula.

However, in many children enlargement or chronic infection of the adenoids leads to snoring, tossing and turning, pauses in breathing, waking up frequently at night, sleep walking, sleep talking, grinding of the teeth, nighttime cough, and hard to get up in the morning along with bed wetting. In younger children, you can see dark circles around the eyes, hyperactive behavior, poor attention span, slow growth, lack of weight gain, frequent

allergy, cold, and sinus symptoms, problems swallowing. foods, sore throats, nasal speech, and frequent doctor visits. It also is not uncommon to see asthma, bronchitis, pneumonia, and ADHD symptoms.

In older children, you can see that the children have exercise intolerance that leads to the

children being overweight and these are children over the age of 6. They are irritable, they are depressed, they are sleepy in class, and they lie around and avoid strenuous activity. They too have frequent runny nose, congestion, sinus, open mouth appearance, snoring, and a lot of the symptoms you see in younger children. It is not unusual to see nosebleeds and ear infections with the children getting frequently sick, but not responding to medication. For these children, adenoid removal is a simple, effective 7-minute outpatient

surgical procedure.

Recovering From Adenoid Removal (Adenoidectomy)

Recovering from adenoid removal (adenoidectomy) surgery can last anywhere from 3 to 6 days, and is usually characterized by runny nose, congestion, bad breath, low-grade fever, and a sore throat.

Directly after the adenoid removal procedure, a 30-minute recovery period is typically required, and then the patient can usually go home on a soft diet. After a period of healing

approximately 6-10 days after surgery, virtually all children have elimination of their preoperative symptoms.

Risks and Side Effects of Adenoid Removal (Adenoidectomy)

Risks and side effects of adenoid removal (adenoidectomy) are exceedingly rare, but can include bronchitis, low-grade fever, flare-ups of asthma, and sore throat with decreased intake of fluids leading to dehydration, nausea, and vomiting, constipation when narcotics are used. Re-growth of adenoids can be as much as 20 percent, but in the hands of a skilled provider re-growth can be as low as 1 percent.

By: Dr. Crews

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