Ear

Acute and chronic ear infections

• When inflammation or infection occurs in the ear, the condition is called acute otitis media.
• Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This causes earache and swelling.
• When fluid forms in the middle ear, the condition is known as otitis media with effusion. This occurs in a recovering ear infection or when one is about to occur. Fluid can remain in the ear for weeks to many months.
• When a discharge from the ear persists or repeatedly returns, this is sometimes called chronic middle ear infection. Fluid can remain in the ear up to three weeks following the infection.
• If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss.

Cholesteatoma

• A collection of skin and debris that forms a cyst behind the eardrum. This growth causes erosion of the hearing bones and can lead to several problems including hearing loss and chronic drainage from the ear. Surgery is required to treat this condition.

Cochlear implant

• A device that is surgically implanted into the inner ear hearing organ (cochlea) to electrically stimulate the hearing nerve. It is indicated for patients who have severe to profound hearing loss in both ears to the extent that a hearing aid does not provide benefit.
• A cochlear implant has three parts: a microphone, a microcomputer, and a cochlear electrode. The microphone, worn behind the ear, sends the sound to a microcomputer. The microcomputer is connected to the microphone by a wire and is worn in a pouch attached to the belt. It turns the sound into an electrical code which is sent by radio wave to the cochlear electrode. The wire electrode is surgically implanted through the skull behind the ear into the cochlea. The cochlear implant does not give the child normal hearing. However, the child may be able to interpret the signals produced by the implant after he or she gets used to the signals and what they mean.
• Your team of doctors and hearing specialists will help you decide if an implant is right for your child. The result of an implant may vary from child to child. Most children who get an implant have improved hearing and oral language abilities. Therapy given after surgery may also play an important role in how well your child's hearing improves.

Conductive hearing loss

• Hearing loss due to the inability of sound vibrations reaching the inner ear hearing organ (cochlea). This includes problems with the ear canal, such as wax impaction or infection; problems with the eardrum, such as scarring or a perforation (hole); or problems with the middle ear, such as fluid, a cholesteatoma, scarring or separation of the three tiny hearing bones. 

Ear drum perforations

• A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane.
• The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.
• A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

Mastoiditis

• Infection spreads beyond the middle ear space to affect the mastoid bone of the skull (bone felt behind the ear). This bone may then fill with infected material leading to a more severe infection.

Ossicular dysfunction

• Hearing loss due to the inability of sound vibrations reaching the inner ear hearing organ (cochlea). This includes problems with the ear canal, such as wax impaction or infection; problems with the eardrum, such as scarring or a perforation (hole); or problems with the middle ear, such as fluid, a cholesteatoma, scarring or separation of the three tiny hearing bones. 

Otitis media and complications

• Acute otitis media (AOM): The middle ear (space behind the ear drum) is infected and swollen. The eardrum itself is inflamed and pus is trapped behind the eardrum.
• Otitis media with effusion (OME): Fluid temporarily stays trapped behind the eardrum in the middle ear space without signs of infection. This may happen after an acute ear infection has been treated, viral upper respiratory infections, allergies, or exposure to irritants such as cigarette smoke.
• Chronic otitis media with effusion (COME): Fluid remains in the middle ear for a long time (months) or returns over and over again, even though there is no infection.
• Complications of Otitis Media
• • These conditions may occur if an ear infection is not recognized and treated in the proper time frame and may include:
  • Tympanic membrane rupture (rupture of the eardrum) with or without chronic drainage
  • Facial Nerve Palsy (temporary weakness of the muscles of the face)
  • Mastoiditis (inflammation and swelling of the mastoid bone behind the ear) see above
  • Meningitis (inflammation and swelling of the meninges or lining of the brain)
  • Labrinthitis (inflammation and swelling of the inner ear which may cause hearing loss and dizziness)
  • Subperiosteal abscess (collection of pus beneath the skin behind the outer ear and involving the superficial layer of the mastoid bone)
  • Brain Abscess (collection of pus in the brain)
  • Sigmoid Sinus Thrombophlebitis (infection and clotting of the large veins that drain the brain)

Sensorineural hearing loss

Nose/Sinus

Congenital and acquired defects

• Born (congenital) with a problem or has one that has developed (acquired)
• • Head and neck sinuses and masses

Epistaxis

• The nose is an area of the body that contains many tiny blood vessels (or arterioles) that can break easily.
• In the United States, one of every seven people will develop a nosebleed some time in their lifetime.
• Nosebleeds can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years.
• Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front or back of the nose.

Nasal obstruction

• Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common human complaints.
• For some, it may only be a nuisance; for others, nasal congestion can be a source of considerable discomfort.
• Medical writers have established four main causes of nasal obstruction: infection, structural abnormalities, allergic, and nonallercic (vasomotor) rhinitis. Patients often have a combination of these factors which vary from person to person.

Sinusitis

• Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants.
• Unlike a cold, or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.
• Normally, mucus collecting in the sinuses drains into the nasal passages.
• When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection.
• Your doctor will diagnose acute sinusitis if you have up to four weeks of purulent nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness or both.
• The sinus infection is likely bacterial if it persists for 10 days or longer or if the symptoms worsen after an initial improvement. 

Throat/Airway

Airway problems (breathing problems)

• Difficulty breathing through mouth or nose, chronic nasal congestion, history of having a tracheotomy tube, history of needing ventilator support during infancy and early childhood, recurrent croup, noisy breathing

Airway obstruction

• History of choking, chronic coughing, history of prematurity requiring intubation(breathing tube in throat), barky cough or recurrent croup, turning blue or need to call 911 due to problems with breathing

Chronic aspiration and drooling

• Cough always present; worse congestion or cough after eating or drinking

Congenital and acquired defects

Gastroesophageal reflux disease (GERD)

• Gastroesophageal reflux disease, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus.
• Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from refluxing or coming back up into the esophagus.
• In those who have GERD, the LES does not close properly, allowing acid and other contents of the digestive tract to move up - to reflux - the esophagus.
• When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn.
• In some cases, reflux can be silent, with no heartburn or other symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens often over a long period of time.

Head and neck lesions

Laryngeal disorders

• Symptoms include problems with hoarseness, high-pitched noisy breathing and wet voice 

Laryngopharyngeal reflux (LPR)

• During gastroesophageal reflux, the contents of the stomach and upper digestive tract may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone.
• Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning or something stuck.
• Some patients have hoarseness, difficulty swallowing, throat clearing and difficulty with the sensation of drainage from the back of the nose (postnasal drip). Some may have difficulty breathing if the voice box is affected.
• Many patients with LPR do not experience heartburn.
• In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep-disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnea), apparent life-threatening event (ALTE), and even a severe deficiency in growth.
• Proper treatment of LPR, especially in children, is criticalRecurrent infectious problems

Salivary gland diseases

• The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular and sublingual glands.
• They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth.
• Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat.
• Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.
• As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.

Sleep disordered breathing

• Symptoms include snoring, trouble breathing during sleep, pauses in breathing during sleep, struggling to breathe, restless and poor sleep, poor school performance along with snoring any medical conditions that contributes to sleep issues.

Tongue tie

• Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue - ankyloglossia.
• Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum.
• After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it recedes and thins.
• This frenulum is visible and easily felt if you look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems.
• The tongue is one of the most important muscles for speech and swallowing. For this reason having tongue-tie can lead to eating or speech problems, which may be serious in some individuals.

Tonsil and adenoid diseases

• Tonsil and adenoid disease is a broad term that can include many familiar diagnoses such as tonsillitis or strep throat, adenoiditis and sleep disordered breathing.

Tonsillitis/strep pharyngitis

• Tonsillitis refers to inflammation of the pharyngeal tonsils (glands at the back of the throat, visible through the mouth). The inflammation may involve other areas of the back of the throat, including the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute, recurrent, and chronic tonsillitis and peritonsillar abscess.
• Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Due to improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare.