If an effusion in the middle ear occurs in the context of an infection, conservative means (nasal drops, later also prere equalization maneuvers) should be used first in an attempt to achieve a cure. Only if the disease does not improve over weeks or even months, a surgical therapy has to be performed. This involves opening the eardrum. The fluid is aspirated. If the effusion is very viscous, the opening created in the eardrum must be kept open for some time. For this purpose, a so-called tympanic tube is inserted, so that the middle ear is directly ventilated through the auditory canal.
Problems with such treatment are very rare. In the case of lying tympanostomy tubes, it is necessary to protect the ear from bathing water, since penetrating water can trigger a renewed middle ear inflammation. The tympanic tubules are usually expelled into the auditory canal by themselves. Surgical removal is only necessary in individual cases. If there is repeated effusion formation after the removal of the tympanostomy tubes, or if chronic tubal catarrh is foreseeable for years, the insertion of permanent tympanostomy tubes can also be useful. Permanent tympanostomy tubes are not rejected by themselves, but have to be removed by surgery after the disease has been cured.
Pharyngeal tonsil hyperplasia (infantile polyps, adenoids or growths)
Localization of the nasopharynx on the basis of an MRI image
The pharyngeal tonsil is part of the lymphatic pharyngeal ring. It is located in the nasopharynx and is therefore not visible when looking into the open mouth. Especially in preschool children, the pharyngeal tonsil is often the reason for an otorhinolaryngological treatment. Due to the intensive exposure to foreign substances of the environment, the tonsillar tie is very active at this age as part of the body's defense system. Under certain circumstances, this can lead to excessive enlargement of the pharyngeal tonsils. In common parlance, adenoids are often called polyps or growths. This is misleading, as they are not true polyps or even a tumorous neoplasm.
Enlarged pharyngeal tonsil (endoscopic view from the oral pharynx into the nasal pharynx)
Children with an enlarged pharyngeal tonsil suffer from obstruction of nasal breathing. They are mostly mouth breathers, which can be easily recognized by the constantly open mouth. This leads to sometimes considerable snoring during the night. This can lead to the development of a child sleep apnea syndrome. The children are poorly receptive, restless and often tired due to disturbed sleep. Furthermore, persistent infections occur in the area of the non-ventilated nose (stasis rhinitis). The loss of function of the nose leads to an accumulation of infections in the lower respiratory tract, which is caused by the lack of humidification, cleaning and warming of the respiratory air. An impairment of the hearing ability is quite essential in many children with such a disease. Due to the enlarged pharyngeal tonsil, the prere equalization between the nasopharynx and the middle ear is hindered (middle ear infection). In some cases, the persistent hearing loss leads to a disturbance in speech development.
After ablation the nose is freely visible from behind
The therapy of the enlarged pharyngeal tonsil is the removal in the context of a so-called adenotomy. This operation is one of the most common operations in children and is performed under general anesthesia. Children from the urban area of Jena can be operated on an outpatient basis. This means that on the day of the operation you and your child will have to spend about 17 hours in the hospital.00 o'clock can leave our clinic again. Children living further away and if necessary. also accompanying persons are discharged only on the first day after the operation. If you are traveling from further away, admission on the day before the operation is usually possible.
Risks of the operation
"Does not my child need the tonsil tie?" or "My child is still so small, can't the operation be performed later??" are questions of concerned parents with which we are often confronted. First of all it has to be said that in the area of the pharyngeal ring there is much more tonsil tie for immune defense. A reduced body defense due to the removal of the pharyngeal tonsil is therefore not to be expected. Delaying the therapy is also not advisable. Just the restrictions in the normal development. Delayed speech development requires prompt therapy of the pharyngeal tonsil.
The adenotomy is a routine procedure. Serious problems during or after such surgery are extremely rare. The most common problem is regrowth of the pharyngeal tonsils. This is due to the surgical technique (only curettage is performed and not complete removal) and can go as far as a finding worthy of surgery again. As with other operations in the throat, there is a risk of swallowing for ca. 1 week after the operation a risk of inflammation and postoperative bleeding. Your child cannot attend kindergarten etc. during this time. Do not visit. During this time, your child must be seen by your ENT specialist.
Tonsillectomy (tonsillectomy) for recurrent acute tonsillitis (tonsillitis)
Coatings on both tonsils in angina tonsillaris
The palatine tonsils are part of the lymphatic pharyngeal ring. They are located in the pharynx of the mouth and can usually be seen when looking into the open mouth, if they are still present. Due to the intensive exposure to foreign substances of the environment, the tonsillar tie is frequently affected by infections in childhood as part of the body's own defenses. Especially in the case of an inflammation caused by bacteria, the so-called angina (tonsillaris), there will be considerable difficulties in swallowing combined with fever and other general symptoms. In addition, secondary diseases of the heart, joints or kidneys can occur due to the bacterial toxins. A further complication of tonsillitis is the tonsillar abscess. Here pus accumulates in the tie behind or next to the tonsil.
If three or more episodes of acute tonsillitis occur per year, or if a secondary condition has been diagnosed, it should be considered whether the palatine tonsils should be removed. If more than 5-6 episodes occur, which have to be treated with antibiotics, the removal is usually recommended. We also recommend tonsillectomy for the treatment of tonsil abscesses.
The operation is performed under general anesthesia during an inpatient stay of approx. one week. If you are coming from far away, it is usually possible to be admitted the day before the operation. After the operation, your child will be cared for in our pediatric ward for a period of. Any problems with swallowing can also be treated by administering painkillers. The most frequent complication of the therapy is secondary bleeding. It is also the reason of inpatient stay after the operation. After discharge, your child will not be able to attend school or kindergarten for at least one week. During this time it is necessary to see your ENT specialist.
Tonsillotomy (tonsil capping) for enlarged palatine tonsils
Severely enlarged palatine tonsils before surgery (left) and low-bleed cutting with the CO2 laser (right)
The palatine tonsils are part of the lymphatic pharyngeal ring. They are located in the roof of the mouth and can usually be seen when looking into the open mouth, if still present. Due to the intensive exposure to foreign substances in the environment, the tonsil tie is very active in childhood as part of the body's own defense system. Under certain circumstances this can lead to excessive enlargement of the palatine tonsils.
Children with severely enlarged palatine tonsils are usually mouth breathers, which can be easily recognized by their constantly open mouths. You suffer from obstruction of nasal breathing. This leads to a sometimes considerable snoring during the night. The development of infantile sleep apnea syndrome is common with palatine tonsil enlargement. Children are poorly receptive, restless and often tired during the day due to disturbed sleep. Furthermore, swallowing may be impeded due to narrowing of the pharynx. Overall, there is a general impairment of development.
Remaining tonsil tie at the end of the operation
The therapy aims to remove the excess tie without removing the tonsils completely, so that they retain their important function for the immune system. This is possible with tonsil capping (tonsillotomy) using a modern laser. However, if your child has already had repeated tonsillitis, tonsillectomy is no longer possible. The operation is performed under general anesthesia during a short inpatient stay. If you are traveling from further away, admission the day before surgery is usually possible.
Risks of the operation
Tonsillotomy is a modern procedure. The postoperative pain is usually less than with a complete removal of the tonsils (tonsillectomy). By using the CO2 laser, the tonsil tie can be removed with little bleeding. Nevertheless, there is a small risk of post-operative bleeding. Therefore, your child will be cared for in our pediatric ward after the operation. In this case, swallowing problems can also be treated by administering painkillers. As with other pharyngeal surgeries, after discharge there is a need for ca. 10 days after the operation a risk of inflammation and post-operative bleeding. Your child may not be able to attend kindergarten, etc. during this time. do not visit. During this time it is necessary to see your ENT specialist.
Childhood hearing impairment
Hearing affects our lives to varying degrees. Disorders affect alerting to danger, orientation, social contact and, among other things, language acquisition. The extent to which the hearing impairment affects us depends on the timing, severity, type and duration of the hearing impairment. There are different causes for hearing disorders, they can be acquired but also congenital.
But how can we detect hearing disorders in our children in time? A specific observation helps. There are many indications in the domestic area:
– If the child is frightened by loud noises? – If unfamiliar sounds arouse the child's interest? (The object should not be in the field of vision of the child).) – Reaction of the child to his own name when you call him in normal volume? – If the child points to the corresponding object when asked to do so?
Any suspicion of a hearing disorder, no matter how small, should be clarified.
Regardless of age, hearing can be checked during a medical examination. The active cooperation of the child is not absolutely necessary. Through a timely diagnosis, necessary therapies can be initiated quickly and subsequent impairments can be avoided or treated.