Recurrent Ear infections --
Because the immune system and eustachian tubes have not
matured, children are prone to middle ear infections. Further
exposure to cigarette smoke, daycare, or allergens just to name a
few; make middle ear infections even more common. Antibiotics are
effective, however the fluid may remain in the middle ear and
either become reinfected or cause hearing loss. PE tubes are small
tubes placed in the ear drum that act as a eustachian tube by
"ventilating" the middle ear. A general
guideline for the indications of PE tube
placement are 3 infections in the last 6 months or retained
fluid in the middle ear for 3 months.
Snoring and Obstructive Sleep
Pattern -- Obstructive sleep apnea (OSA) is a
syndrome where breathing while sleeping is impaired. Over time
(similiar to hypertension) it can cause problems with the heart and
lungs. OSA can also impair growth and development, lead to
behavioral disturbances, and can be associated with poor
performance in school. It is often caused by large tonsils and
adenoids but not always. Struggling or gasping to breathe, choking
spells or pausing of breath can all be signs of sleep apnea.
Snoring by itself may or may not be associated with sleep
apnea. It implies atleast a partial obstruction; the
significance of which depends on a careful history and physical by
Mouth Breathing and Chronic nasal
congestion -- There can be several reasons behind
this problem. The two most common are chronic allergies and adenoid
enlargement. The adenoids are lymphoid tissue in the back of the
nose, that when enlarged, make it difficult to breathe through the
nose. They can also be chronically infected causing chronic nasal
infections and drainage or cause inflammation of the eustachian
tube openings which in turn causes middle ear problems. One
option is to have the adenoids removed surgically
Allergic Rhinits is inflammation of the nasal tissues and
sometimes the adenoids caused by environmental allergies.
This can often be treated very effectively with
Hearing Problems -- Often
caused by middle ear fluid, Dr Ruggiero will perform
a careful examination of the ear under the microscope
to make the diagnosis. If the middle ear is clear then a
hearing test will be performed: the type of which is determined by
the age of the child. If the hearing is abnormal, further testing
and treatment will depend on the type and extent of hearing loss.
Neck Mass -- A lump in the neck
may be nothing more than a temporarily inflammed lymph node .
However it may also be a congenital neck mass which is
usually benign but often problematic. Although rare
other causes including malignancy (cancer) can occur. For
this reason a neck mass persisting more than 3 weeks should be
evaluated by a specialist.
Tonsillitis and Recurrent Strep
Throat -- Recurrent bacterial infections of the
throat can be quitie problematic. They are often treated
succesfully with antibiotics. However, sometimes the tonsils
can be scarred, cryptic and easily reinfected. Recurrent infections
can also be the result of being a chronic streptococcal
bacteria (strep) carrier. An evaluation will help determine if
having the tonsils removed will be beneficial.
Wide Set or Prominent ears.
Sometimes a child's or even an adult's ears can be wide set.
This can be quite troublesome and psychologically difficult for a
child. A child's ears will have nearly reached adult size
by age seven and because of this, the operation is usually not
done before this age. The operation involves pinning the ears
back through a hidden incision behing the ear. This is
a same day surgery and for children, the surgery is
often covered by insurance.