Your Letters to Kids-ENT.com
Dear Dr. Mike:
My daughter who is 9 years old often has trapped matter in and around her tonsils. This leads to rancid breath which is eliminated when we are able to remove the white balls that seem to collect in her throat. It is very difficult and uncomfortable for her to extract this stuff as it constantly makes her gag. We try gargling and cotton tipped applicators. My question is: is this normal and is there an over the counter cleanser we can use for maintenance? She shows no inflammation or redness in the areas. It is something we would like understand so as to eliminate the problem. Thank you for your attention to this matter.
It is actually fairly common for the tonsils to become a place where food debris and other material collects, resulting in chronic irritation, bad breath, or problems with swallowing. While this might not be recognizable as food, it usually is the result of food particles being trapped in the tonsils and being partially "digested". Sometimes, the trapped debris or other secretions become hard, and are called tonsilloliths ("tonsil stones").
In many people, the tonsils have little holes in them, known as tonsillar crypts, which are farily effective at trapping debris from the mouth. It's OK to try to wash them out (gargling, waterpick, etc...) although she might cause some bleeding by pushing something like a Q-tip DEEP into her tonsils, so I wouldn't recommend that.
Sometimes this becomes so annoying that people choose to have the tonsils removed. Usually, this is a problem for teenagers or young adults, but occasionally younger children will also have this condition.
Dear Dr. Mike:
I woke up the other day and couldn't hear out of my left ear. My first thought was wax, so I proceeded to get up and clean out my ear. Not much came out, but i was still unable to hear completely. I tried putting peroxide in my ear to clean it out, nothing worked.
I would rather not go a doctor about this, beacuse it is rather embarrassing. Today, I used a rolled up kleenex and stuck it in my ear canal, I keep sticking it in until I guess I hit my ear drum. A pain went from my eyes to my throat. When I pulled out the kleenex...it was covered in a dark red substance which I percieve is wax. I have never seen it like this though. Is it possible I have wax against my drum and it is affecting my hearing? Is there a cleaning system for this? Should I go to a doctor? This is rather effecting me on my job. Thanks for your help.
Sincerely, K.D., Murfreesboro, TN
You should absolutely go to a doctor... please do not be embarrased to seek help for a hearing loss! The pain you felt in your throat may be due to injury of your eardrum or ear canal. The nerves which supply these areas also go to the throat and sometimes the signals get crossed. The dark red substance could be wax, blood or a mixture of the two.
You should never attempt to remove earwax by sticking something in your ear. Earwax rarely causes hearing loss, and when it does, it is usually because it has become packed down against the eardrum by sticking cotton-tipped applicators or kleenex in the ear. You really cannot remove any sizable collection of earwax in this manner, you will only make it worse. Remember, earwax is there for a reason, it helps prevent the ear canal from getting infected. Compulsive cleaning can cause skin infection (swimmer's ear) as well as wax impaction.
Occasionally, wax impaction needs to be treated, and can removed by a doctor using small instruments or irrigation. Sometimes, you can clear up lesser degrees of wax impaction with special eardrops and self-irrigation systems.
However, wax impaction is the least of all potential problems. I have seen patients perforate their eardrums by sticking things into their ears (which often heals), damage the little bones in the ear (which may require major surgery) or even cause "nerve" hearing loss (which is usually permanent, and may be total).
Finally, the possibility remains that hearing loss is due to something other than wax or fluid, and you may need specific treatment to prevent permanent hearing problems.
Dear Dr. Mike:
Can you define ototoxicity? Also, are ear drops recommended for recurrent ear infections, especially if the child has had tubes placed? I've heard somewhere, that some ear drops can erode the bones in the middle ear, is this true? Thanks, N.D.
Ototoxicity refers to the injury of the cells in the inner ear hearing mechanism by certain drugs. It is usually not used to refer to erosion of the bones in the middle ear, which is more likely the result of chronic infection, eardrum collapse or other diseases.
In general, research suggests that many of the drops put into ears are safe even in the presence of a hole (like a tube) in the eardrum. These drops are widely used in children with draining ears without causing inner ear damage. Nevertheless, the theoretical potential for such an injury with permanent hearing loss remains so drops should be used carefully, and only when there is drainage and infection. Like any drug or operation, one must balance the risks and the benefits before proceeding.
Dear Dr. Mike:
I just gave birth 3 weeks ago to a baby girl. At her last doctor's appointment, we discovered that her tongue is apparently attached more than it should be. Her pediatrician said it was called a frenulum. She said that she still has plenty of movement and that we had a couple of options. We could leave it alone and our daughter may have some speech problems later on that would require a speech therapist, or we could see an ENT Dr. and they could snip the skin that is attached. We do not have any info on this subject to make an educated decision about our daughter. If you could help us on this that would be wonderful. Also if you could give us any advice as to how you may handle this situation. The thought of cutting her seems "mean" but the thought of her struggling to say her words correctly seems worse. Thank you in advance for any info you can give us on this.
Congratulations on the birth of your daughter! What you are describing is called ankyloglossia, in which the little band under the tongue (the frenulum) is short, which limits the mobility of the tongue. Although many people in the past have recommended "snipping" this in early infancy, I prefer to wait for 12-18 months if there is no major problem with breast feeding. If the tongue has not improved (some of them do), I cut the band under general anesthesia and take the time to sew the opening under the tongue closed with dissolving sutures. This has some advantages:
1) It is less painful and traumatic for the child
2) there is less of a chance that the scar band will reform and the operation will have to be repeated if you sew the wound closed
3) some children may not need any procedure at all
4) it would be extremely unusual for this tethering to cause a significant permanent speech problem in the first year of life
The one down side to this approach is that it requires general anesthesia, which many parents are concerned about. I feel that modern general anesthesia given by a pediatric anesthesiologist is very safe, and that the benefits outweigh the risks. That is just my opinion, other people feel differently!
Dear Dr. Mike:
I seem to get very red burning ears from time to time, not always the same ear. The ear itself feels very hot and is considerably redder than the other. It never seems to happen to both at once. I don't feel sick or have a fever. I'm not sure what it is. I would appreciate any advice you can give.
Thank you, B.R.
Sometimes, the blood supply to the ear will be increased for reasons such as cold temperatures or local trauma (rubbing), which will result in the ears appearing red. However, if the redness is associated with pain, there may be inflammation of the ear cartilage or the tissue around the cartilage.
One condition which can cause this symptom is known as "relapsing polychondritis" which results in recurrent episodes of inflammation in structures containing cartilage (such as the ears or nose), and can be quite painful. This is something that could be evaluated by an ear, nose and throat specialist or perhaps a specialist in inflammatory diseases (a rheumatologist). If the redness is limited to the top part of the ear, it suggests that there is a cartilage problem, since there is no cartilage in the earlobes.
Finally, a few papers have described something called the "Red Ear Syndrome", which seems to be the result of abnormal nerve impulses resulting in dilation of the blood vessels in the ear, causing redness. A neurologist may help to pinpoint the cause of the trouble, if it occurs frequently.
Dear Dr. Mike:
I am a 21 year-old living in Wales. I visited a disco on Monday night and had the misfortune to stand in front of a huge speaker. Ever since I have suffered loss of hearing in my left ear and a constant ringing. I would appreciate any advice you can give.
Sincerely, M.J., Wales, UK
Hearing loss can definitely follow exposure to a loud noise. In most cases this is temporary- a temporary threshold shift. However, repeated exposure to loud noise (as in, for example, operators of heavy machines or artillery officers) can cause a permanent hearing loss. In addition, a powerful explosion nearby can instantly cause permanent damage to the inner ear (acoustic trauma). Ringing in the ear (tinnitus) can be associated with permanent or temporary hearing loss.
The best thing to do is to be careful with your ears, wear earplugs when exposed to uncomfortably loud sound, avoid high volumes on personal stereos, and have an examination by an ear specialist to rule out other problems. There is no good treatment for noise induced hearing loss, only prevention...!
Dear Dr. Mike:
My 3 year old daughter is getting her adenoids removed in 2 days. I appreciate the information that you have offered on your web page. It was everything that our Doctor said, and went into a little more depth in some areas. I feel more educated and more at ease with the procedure for her.
I would like to note one statement that you made, though:
"Even though children may become frightened during the administration of the anesthetic, after the operation they usually do not remember anything about the time just before they went to sleep."
I had my thonsils and adenoids removed when I was 4. That was 30 years ago. I remember it like it was yesterday. They put the IV in the back of my hand, which was rather painful and then the Doctor proceeded to be rude and condescending to me. I was very scared and that didn't help me at all. I'm sure I must be an exception, but I certainly do remember the time just before I went out.
Again, thank you for the information. As a mom, I appreciate having access to it.
You make an interesting point, which reflects a considerable change in anesthetic practice over the past few decades... In the past, intravenous inductions were common, which means that the IV was put in while the child was awake. This can be quite painful (as I am sure that you remember!) as it is often hard to get an IV into a child's small veins. The IV is then used to induce anesthesia. Today (in my practice, anyway), induction is usually done by breathing anesthetic agent and the IV is put in after the child is asleep.
Of course, there are some circumstances when the IV still needs to be in before starting anesthesia (such as stomach acid reflux, obesity, or a variety of diseases of the heart and airway). However, the majority of children do not need to have an IV before being put to sleep.
Some children are so anxious and distraught by the time they reach the operating room, that just bringing the mask near them causes terror and panic, and no amount of storytelling, joking or comfort will help. Nevertheless, with the right bedside manner on the part of the anesthesiologist, even small children can be helped to play the game of "blowing up the balloon" on the anesthesia machine and allowed to drift off to sleep without any excessive emotional trauma in many cases.
On my web site, the "not remembering" statement referred to the few minutes just before being completely asleep... this phenomenon is known as "retrograde amnesia", in which the last few minutes of consciousness before anesthesia starts is frequently not remembered. Of course, this is not a universal finding...
The entire experience of having surgery can be traumatic for anyone, especially a child... this often starts in the hospital parking lot or before... We do try to make things as nice as possible for children, but in many health care situations there can be unavoidable discomforts.
I am sorry that you had to go through such a traumatic experience. There always have been rude and condescending doctors, and there always will be (just like any other profession!). The best we can do as health care providers and parents is to try to set a good example in our teaching and our behavior. Children generally are not willing participants in their own health care, but it is important for them to know that their parents and doctors do care about them, are not trying to punish them, and are doing their best to make things painless....
Good luck with the surgery, feel free to write again any time!
© 2005 Michael Rothschild, MD