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Kids Corner

Insights into a variety pediatric ear, nose, and throat conditions:

What is Pediatric Obstructive Sleep Apnea and how is it treated?

Children can have problems breathing at night just as adults do.  It can range from simple snoring to true obstructive sleep apnea.  In obstructive sleep apnea your child has complete or nearly complete lack of airflow through their nose and mouth.  It is worsened by upper respiratory infections and allergies.  It occurs mostly in children ages 4 to 6 years of age.  Children with chronic snoring can be suspected of apnea.  It is associated in children with failure to thrive, abnormal sleeping positions with their head and neck extended backward, restless sleep, and large adenoids and tonsils.  When their sleep is disrupted children are more likely to be hyperactive and have difficulty focusing when awake.  Some neurobehavioral problems associated in children with obstructive sleep apnea include poor attention span and learning.  There are also a multitude of associated conditions with childhood sleep apnea; such as, reduced growth hormone levels, and subsequent decreased appetite, more viral and bacterial infections that cause the tonsils and adenoids to enlarge and enlarged neck lymph nodes.

Dr. Rheuark can evaluate your child for sleep apnea in the office.  Snoring, large tonsils, and difficulty breathing through the nose are all suggestive.  However, not all large tonsils lead to sleep apnea.  What is more important is the size of the tonsils relative to the airway.

Testing includes using a polysomnograph or sleep study to count how many times in an hour your child stops breathing while asleep.  Children are not supposed to have any events in an hour.  However, a child with a negative sleep study can still have sleep problems.

An adenotonsillectomy is the first line treatment and has seen cure rates in greater than 85%, but failures still occur most commonly in obese children.

Modern Management of Middle Ear Infections:

Children are notorious for succumbing to middle ear infections.  However, there are different types of ear infections and they are treated differently.  The usual infection is the acute otitis media version.  If you can look at the ear drum, it is red, often bulging out at you and your child has pain and fever.  Your doctor may have tried decongestants, nasal steroids, antibiotics, and even suggested removing the tonsils and adenoids or placing ventilation tubes in the ear drum.  It can get a bit confusing, especially since a majority of acute infections resolve on their own.

The other version consists of persistent fluid behind the ear drum, but pain or fever may not be present.  The duration of the fluid is important as well as if your child is at risk for speech, language, and learning problems.  If they are not at risk, then you can watch them for 3 to 6 months, but it is not always so easy.  Treatment then consists of placing ventilation tubes in the ear drum if the fluid persists or they are at risk for developmental problems.  Removal of the adenoids in the back of the nose can also help.  Make an appointment with Dr. Rheuark if your child is in this situation.

Ventilation tubes look like little grommets.  They are only a few millimeters in diameter and sit within the ear drum with one flange on the outside and one flange on the inside of the ear drum.  They are ventilation tubes not drainage tubes.  If your child has these tubes in place and there is drainage coming out of the ear canal, you must call your pediatrician or Dr. Rheuark to help clear up this drainage.

Other conditions included in our “Topics” section:

There are many other ear, nose, and throat conditions commonly seen by Dr. Rheuark that can affect your child.  They are listed in our “Topics” section.  We invite you to click on them as well.  They include:

Children’s Ear Ache
Infant Hearing Loss
Is My Child’s Hearing Normal?
Second Hand Smoke and Children
Tonsils and Adenoids

Dr. Rheuark’s experiences at the Loma Linda University Children’s Hospital:

Dr. Rheuark completed his training in otolaryngology-head and neck surgery at the Loma Linda University Medical Center in Loma Linda, California.  Loma Linda Medical Center has one of the largest pediatric hospitals in the country.  It is the site of pioneering research and surgical techniques in pediatric heart transplantation.  Dr. Rheuark completed various research projects as a resident there regarding the range of ear, nose, and throat infections in his unique and complicated pediatric population.  Several of the first pediatric heart transplant recipients underwent ear, nose, and throat procedures such as adenotonsillectomy and ventilation tube placement. Dr. Rheuark studied these children and made recommendations for their cohort.

Make an appointment with Dr. Rheuark at (310) 373-8777 if you should have other questions about your child’s health.



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