Pediatric Otolaryngology (Ear, Nose, and Throat)

Frenotomies performed on newborn babies allow them to feed more effectively. Michelle Merola-Lally, PA-C is a lactation specialist who works closely with Dr. Earl Harley during these procedures to make feeding a more comfortable and effective experience for mother and baby.

PANDAS, or pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, is a childhood nervous system disorder. Children with the disorder develop one or both of these conditions:

PANDAS very rarely occur after puberty. It is a rare and new disorder that experts are still learning about.

Noisy breathing in newborn infants may be secondary to several causes. These vary from a stuffy nose to a blockage of the airway. When the sound arises from a partial blockage of the airway, this is termed stridor. Stridor is simply noisy breathing caused by a partial blockage of the lower airway. The most common cause of stridor in newborns is laryngomalacia. This is usually a self-limiting condition that does not require any intervention.

Typically, the noisy breathing begins at birth or very soon after. The noise occurs when the baby is breathing in but there no associated sound when she breathes out. Typically, the sound is worse when the infant is on his back but better on the side or upright position. Also, it is not uncommon for the infants to sound worse when he is feeding. There may be associated spitting up or excess burping as these infants may have “acid reflux” associated with the breathing.

The otolaryngologist will take a detailed history including details of the pregnancy and the birth. Questions such as, "Did your child need assistance with breathing at birth?" will be asked. A complete examination of the ears, nose, throat, neck, and chest will be conducted. Included will be a measurement of the baby’s oxygen saturation and other vital signs. Most of the time the otolaryngologist will perform a procedure called a flexible laryngoscopy. Here a small fiberoptic tube will be inserted into the nose and the airway from the nasal cavity to the voice box will be assessed. This procedure takes about 5 minutes and does not require sedation or special preparation. Most of the time pictures and videos are obtained. Rarely is any other procedure needed but you may be asked to return for a follow-up evaluation.

If your child required a breathing tube, especially if he was premature, there may be scar tissue formation causing the noise. If your child has a birth mark that looks like a strawberry, there may be an association that would require further evaluation. In these circumstances additional information obtained from X-rays or scan may be asked for. An evaluation under anesthesia may be required. This procedure is called a direct laryngoscopy and bronchoscopy (DLB). Here, the entire airway is examined including the lower trachea and its branching into the lungs.

Laryngomalacia is usually self-limiting, and it is not uncommon that it resolves spontaneously by 6 months of age but may last longer. Frequently the child is given a medication for acid reflux. Only in very rare case will a child require surgical intervention.

Tonsillectomy and adenoidectomy are surgeries to remove tissues in the mouth and throat called the tonsils and adenoids. Often, they are done at the same time in a surgery called adenotonsillectomy. Tonsils and adenoids normally work to protect the body from infection. This procedure may be done if these tissues repeatedly become enlarged or infected and if other treatments are not effective.

This is a common procedure with well-recognized safety guidelines. The sore throat afterwards can be well-controlled with drinking fluids and non-opioid pain medicine. Problems that can occur, include bleeding, infection, scarring, ear pain, nausea, and vomiting, and changes in your child's voice or sense of taste.

Cochlear implant surgery is a surgery to place (implant) a hearing device (cochlear implant) in the inner ear (cochlea). The cochlear implant sends sound signals to a nerve in the ear (auditory nerve). This can help your child hear and interpret sounds. A cochlear implant contains:

Several weeks after cochlear implant surgery, your child must visit his or her health care provider to get fitted with the external part of the cochlear implant. Your child's health care provider will program the implant so your child can hear.

Your child may need a cochlear implant to treat severe hearing loss or deafness. Your child will most likely get a cochlear implant in one ear. Sometimes a device is placed in each ear. A cochlear implant enables a child to hear in a new fashion and it can help your child develop speech and language skills.

• An incision will be made behind your child's ear, and a skin flap will be formed

• Damaged or diseased cells and tissue will be removed from the space in your child's skull behind the ear

• A space will be made for the implant to be placed and secured

• An opening will be made in the cochlea, and electrodes will be placed inside and secured

• The skin flap will be closed with stitches (sutures)

Click Here to Learn More About Cochlear Implants.

Our experts are involved in clinical research involving the following:

• Role of tonsillectomy in PANDAS

• Tongue and lip ties in nursing babies