Otolaryngology

The Division of Otolaryngology is staffed by board certified surgeons in otolaryngology. The physicians are available for consultation and treatment of inpatients and outpatients. Diagnosis, medical and surgical treatment are offered for children with special problems of the ears, mouth, nose, throat and sinuses. Tonsillectomies, adenoidectomies and myringotomies are performed as indicated. Frequently observed diagnoses include ear infections; nose, sinus and throat infections; hearing loss; airway problems; foreign body aspiration; and injury to the head or neck.

Hearing evaluation is available through Nemours/Alfred I. duPont Hospital for Children’s Department of Communicative Disorders which works closely with the Division of Otolaryngology. Specialists from the duPont Hospital for Children are members of the Cleft Palate Craniofacial Team, which provides evaluation and treatment of cleft palate.

The division also operates the Cochlear Implant and Auditory Rehabilitation Program for children with sensorineural hearing loss. Multidisciplinary evaluation of balance and gait disorders is also organized through the department.

Myringotomy and Placement of Tympanostomy Tubes

Serous otitis media is an inflammation of the middle ear with accumulation of serum. It is noninfectious. Suppurative otitis media is inflammation of the middle ear which is infected by bacteria and is distinguished by the presence of pus. Both of these conditions may be surgically treated by performing a myringotomy with the placement of tympanostomy tubes.

A myringotomy is the surgical opening of the eardrum to provide a means to remove fluid or infection from the middle ear. In most cases, a small tube is placed through the opening to get air into the middle ear.This tube could be made of plastic, teflon, silastic or another type of metal. Fluid in the middle ear can cause hearing loss, which usually resolves when the fluid is removed. The tube is very small and cannot be felt by the patient. It does not cause hearing loss.The tube usually stays in place for about a year before it falls out by itself.

Tonsillectomy and Adenoidectomy

The tonsils are found at each side of the back of the throat. Repeated infections or partial blockage of the airway are indications for surgical intervention. Removal of the tonsils is called a tonsillectomy.

The adenoids are located behind the nose and are hidden from view by the palate (roof of the mouth). The adenoids may need to be removed if they block the nasal airway or the eustachian tube which connects the middle ear to the throat. Frequent ear infections or sinus infections can occur when these passages become blocked by the adenoids.

Intracapsular Tonsillectomy

In the past, the removal of tonsils, tonsillectomy, was recommended for children with recurrent strep throat infections. Recently, more and more children undergo this procedure because of symptoms of airway obstruction from enlarged tonsils. Physicians have recognized that poor sleep patterns from enlarged tonsils can have a major impact on the behavior and school performance of children.

With traditional tonsillectomy, the tonsils are completely removed. The subsequent recuperation is marked by considerable pain. This may last as long as a week. For this reason, many children find it difficult to eat and maintain normal fluid intake. The severe pain is felt to result from the fact that the underlying throat muscles are left exposed to the inside of the mouth at the end of the procedure.For years physicians have sought a technique that would result in a less painful recovery, thus allowing children to resume normal diet and activities over a faster period of time.

Intracapsular tonsillectomy is a new technique for the treatment of enlarged tonsils which seems to answer this need for the majority of children. Intracapsular tonsillectomy involves the removal of all obstructing tonsil tissue, leaving a thin patch of tonsil tissue to protect the throat muscles. Most children are therefore able to resume a normal diet within a few days of surgery. Their pain is easier to control than with traditional tonsillectomy.

Since a small amount of tonsil tissue is left, the question arises about whether that remaining bit of tissue could subsequently enlarge and require further surgery. This risk is small, occurring in less than 1% of children undergoing intracapsular tonsillectomy. Given the fact that the overwhelming majority of children undergoing intracapsular tonsillectomy have a much easier recovery, we feel that it is a major improvement over the traditional surgical management of enlarged tonsils.

Noisy Breathing

Noisy breathing such as snoring can be caused by enlarged tonsils and adenoids, or other nasal obstructions. Problems in the larynx (voice box) or trachea (windpipe) can also cause noisy breathing called "stridor". Physical examination, x-rays, and/or airway endoscopy may be used to determine the cause of the problem. Often the airway is examined with fiber optic or rigid telescopes. A variety of management choices are available depending on the cause and severity of the airway problem.