Pediatrics

Most children are happy, wonderful, carefree individuals. Most childhood illnesses arise from the ears, nose, or throat regions. When your child has recurrent ear infections, recurrent strep throat, snores, or suffers from allergies--and has spent way too much time in the pediatrician’s office; you need an ENT doctor who understands these problems and offers comprehensive care for them.

Allergies In Children

If one parent has allergies, each child has a 50/50 chance of having them as well. When both parents do, this rises to 80%. Allergy symptoms may begin as early as 6 months of age. Treatment may involve avoidance, medications, or immunotherapy. Now children less than one year of age may benefit from exposure to many allergens as this may help them to develop tolerance. Children less than 1 year who live with 2 or more pets have a lower incidence of allergic disease. This may be why allergic disease was uncommon back in the day when kids grew up on the farm.

Daily, consistent use of a second generation antihistamine (claritin, zyrtec, allegra, clarinex, xyzal) is often very helpful. However, meds only treat inhalant allergens. Food allergies can only be treated by avoiding the food group or sublingual immunotherapy. Allergy testing in children can be accomplished safely and comfortably with a blood test. This blood test, or Immunocap, will test for common inhalant allergens and food allergens. By treating allergies early, you may keep your child from progressing along the allergic march into more serious health problems such as asthma.

Sublingual Immunotherapy

This allergy treatment is performed by placing drops underneath the tongue twice daily. Once a child has been allergy tested, serum can be ordered and dispensed to the parents to use at home. Most children do not like getting shots, so this is a very easy, pain-free alternative. And since there are virtually no severe reactions or side effects, this type of immunotherapy can be done safely and conveniently at home. Although insurance does not typically cover this type of immunotherapy, costs are approximately $2 per day.

Recurrent Ear Infections and Tympanostomy (Vent) Tubes

If your child suffers from repeated ear infections or chronic ear fluid, then pressure equalization tubes (vent tubes for short) can help to improve hearing, decrease ear infections, and prevent complications of ear infections. Most importantly, they can keep your child off potentially harmful antibiotics. If your child has 3 or more ear infections in 6 months or 4 or more in a year, ear tubes should be considered. Also if ear fluid remains for more than 3 months, they should also be considered. Antibiotics only decrease infection caused by bacteria. Most ear infections begin with a viral upper respiratory infection.
Ear tubes are commonly placed in the operating room with your child asleep. An anesthesiologist who is fellowship trained in the care of pediatric patients will put your child to sleep. The surgery usually lasts for all of 5 minutes or less. Older children may be candidates for tube placement in the office. Children have minimal to no pain after surgery or are up and about almost immediately.

Recurrent Strep Throat/ Loud Snoring/Obstructive Sleep Apnea and Tonsillectomy/ Adenoidectomy

If your child has more than 5 episodes of streptococcal tonsillitis (strep throat) in 12 months s/he may need their tonsils and adenoids out. Children who snore loudly, gasp for breath at night, eat slowly, wake up fatigued, and sleep more than most children their age may also need their tonsils and adenoids out. Coblation tonsillectomy and adenoidectomy has been the preferred technology to use for tonsil and adenoid removal for the past few years. Recovery times and pain are reduced; thus complications from dehydration are rare. Most children are back to school in 1 week after surgery. The procedure takes 20 to 30 minutes. It is performed in the hospital or surgery center. Patients go home the same day in most cases.

Sinusitis in Children

Sinus disease is largely a medical disease in children. Treatment of allergic disease is critical in most children who have recurrent sinusitis. Removal of adenoids can also be very helpful. Any child who has more than 3 sinus infection per year should be evaluated. If you child needs imaging (CT scan or xray), this can be done safely and quickly in my Fort Worth office. Seven (7) second scans can be performed successfully on children as young as 3 years of age. Radiation levels are much less than traditional CT scans of the sinuses. This scan also shows if the adenoids are enlarged.

Balloon Sinuplasty in Children (Minimally Invasive Sinus Surgery)

Children who do not respond successfully to medical treatment of allergies and sinus infections, may need their adenoids out. In the past, this was typically done prior to any sinus surgery. Some studies had reported success rates of adenoid removal on sinusitis as high as 60%. Now with balloon sinuplasty, the maxillary sinuses can be safely dilated--without the removal of tissue--and irrigated to rinse any infection out. Although no tissue is removed--so scarring is minimal to none--the dilated opening stays dilated due to tiny fractures in the thin bone around the opening that is covered with functional mucosal tissue. This procedure increases the success of adenoidectomy alone without increasing postoperative pain or recovery times.

Nasal Obstruction in Children

This is commonly the result of large adenoids or allergic disease causing inferior turbinate obstruction in the nose. Children who breathe through their mouth instead of the nose may suffer from poor sleep quality or even obstructive sleep apnea. This may also cause problems with tooth and palate development. The first steps in treatment are to assess for allergic disease and consider a 1 to 2 month trial of a nasal steroid spray. Nasal steroids will reduce the inflammation and congestion in the nose. They have also been known to decrease adenoid size. Because they are absorbed mostly in the nose, they have little to no side effects. If this does not resolve the problem, adenoid removal with reduction of the turbinates using coblation can be very effective. Your child may need to be assessed for chronic sinusitis prior to surgery.

Surgery in Children

The most important things to consider are 1) Who is doing the surgery and even more importantly 2) Who is putting your child to sleep. All patients from my Fort Worth office are scheduled at USMD Hospital at Fort Worth. It is a beautiful facility whose staff are patient focused and well trained to take care of your child. North Texas Children’s Anesthesia (NTCA) is the group of anesthesiologists who will put your child to sleep. They are absolutely patient focused and are personally present during your child’s entire surgery. I have worked with them for 6 years and continue to be impressed by their skill, knowledge, and bedside manner. I have not witnessed one complication from their care in all of these years. As a member of the board and physician investor in USMD at Fort Worth, I strive to ensure that all patients receive great care and have a good experience during their time at USMD Hospital at Fort Worth.

If your child requires a procedure under anesthesia, research shows that when parents and children know what to expect, they have less anxiety, earlier discharge and require less postoperative pain medication. North Texas Children’s Anesthesia(NTCA) has an instructional video “Preparing Your Child For Anesthesia and Surgery” which may be viewed at www.NTCAdocs.com

We recommend the physicians represented through NTCAdocs.com, your direct connection to some of the most outstanding pediatric anesthesiologists in the Dallas, Fort Worth, Frisco and Southlake area.

For more information about North Texas Children’s Anesthesia please visit www.NTCAdocs.com

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