Common pediatric ears, nose and throat (ENT) problems
Our ENT specialists care for children with chronic or recurring conditions such as ear infections, sinus infections, and tonsillitis. If your child has frequent infections, their primary care provider—or you—can contact our clinic to schedule a visit. Our team will guide your child’s care with a personalized treatment plan and recommend specialized procedures when needed.
Diagnosing and treating common ENT problems
Ear conditions
Ear infections (acute otitis media, AOM)
What is acute otitis media (AOM)?
AOM is an infection of the middle ear—the space just behind the eardrum. This is common between the ages of 6 months to 3 years.
When is ear tube placement considered?
Ear tube placement may be considered if your child has:
- 4 infections in 12 months, or
- 3 infections in the last 6 months
Our accelerated care clinic
We provide fast, specialized care for children who have repeated ear infections or fluid that won’t go away. During the visit, a pediatric ENT provider will check your child’s ears and help decide if ear tubes are the right next step. When ear tubes are recommended, we work to schedule surgery as quickly as possible. For questions about appointment timing, contact us today.
Ear fluid (otitis media with effusion, OME)
What is otitis media with effusion (OME)?
OME is fluid that is trapped behind the eardrum without signs of infection. This is common between the ages of 6 months to 3 years.
When is ear tube placement considered?
Ear tube placement may be recommended if fluid has been present for 3 months or longer.
Our accelerated care clinic
We provide fast, specialized care for children who have repeated ear infections or fluid that won’t go away. During the visit, a pediatric ENT provider will check your child’s ears and help decide if ear tubes are the right next step. When ear tubes are recommended, we work to schedule surgery as quickly as possible. For questions about appointment timing, contact us today.
Perforated or ruptured eardrum
What is a perforated or ruptured eardrum?
A perforated or ruptured eardrum means there is a hole in the eardrum. This can occur from infection or injury.
Treatment options
Most holes will heal on their own, but surgery may be needed for a persistent perforation.
When is surgery considered?
Tympanoplasty surgery is a common way to repair an eardrum that has not healed. Several surgical techniques may be used, and the surgeon will discuss which option is best for your child’s condition.
Swimmer’s ear (otitis externa, OE)
What is otitis externa?
OE is an infection of the outer ear canal—the part that goes from the outside of the ear to the eardrum.
How is it treated?
Treatment includes:
- Otic (ear) drops placed in the ear canal
- Strict water precautions
If infections are recurrent
If OE is recurrent, additional options may be recommended, such as custom earplugs and preventive treatments.
Tonsil and adenoid conditions
Adenoid hypertrophy
What are adenoids?
The adenoid is a small piece of tissue that sits at the back of the nose. This can only be seen using a special noodle-like camera, called a scope, that goes through the nose or by taking an x-ray of the head and neck.
Common symptoms
- Chronic nasal congestion
- Mouth breathing
- Snoring
Diagnosis and treatment
If symptoms are present, a provider may recommend imaging or scoping. Treatment may include nasal sprays or surgical removal of the adenoid tissue, called an adenoidectomy.
Chronic adenoiditis
What is chronic adenoiditis?
Persistently inflamed or infected adenoid tissue can cause symptoms that mimic a sinus infection.
Common symptoms
- Chronic nasal congestion
- Chronic nasal drainage
- Postnasal drip
- Cough
Treatment options
Symptoms may improve temporarily with antibiotics but often return. A scope may be recommended to directly evaluate the adenoids.
Recurrent tonsillitis or strep throat
What is tonsillitis?
Tonsillitis occurs when the tonsils become red and inflamed, often due to infections like strep throat.
When is surgery recommended?
Children are considered to have recurrent tonsillitis if they have:
- 7 episodes in one year
- 5 episodes per year for two consecutive years
- 3 episodes per year for three consecutive years
Benefits of surgery
Tonsillectomy or adenotonsillectomy can help prevent future infections and reduce repeated antibiotic use.
Tonsillar hypertrophy
What is tonsillar hypertrophy?
The tonsils are two small pieces of tissue at the back of the throat. When enlarged, they can result in obstructive sleep apnea (OSA).
What is obstructive sleep apnea (OSA)?
OSA is characterized by loud snoring and pauses in breathing during sleep, often leading to restless sleep and daytime fatigue.
How is OSA diagnosed?
OSA can be diagnosed with a sleep study—an overnight test that monitors breathing, oxygen levels, and sleep patterns.
Treatment options
Children with OSA are recommended to undergo adenotonsillectomy, as obstructive adenoid and tonsil tissues are often a cause.
Sleep apnea
What is sleep apnea?
Sleep apnea is a sleep disorder where breathing repeatedly pauses or becomes shallow during sleep. In children, this can disrupt normal sleep and lower oxygen levels. Because kids are still growing and developing, untreated sleep apnea can affect behavior, learning, growth, and heart health—even if it happens quietly at night.
What causes sleep apnea?
The most common cause in children is enlarged tonsils and/or adenoids that block the airway during sleep. Other contributors can include:
- Nasal congestion or allergies
- Obesity
- Certain facial or jaw shapes that narrow the airway
- Neuromuscular or genetic conditions
- Prematurity or a history of breathing problems
- Often, more than one factor is involved
How is sleep apnea diagnosed?
Diagnosis starts with a careful history and physical exam by an ENT specialist. Parents may report snoring, pauses in breathing, gasping, restless sleep, bedwetting, or daytime issues like hyperactivity or sleepiness.
The gold standard test is an overnight sleep study (polysomnography). This painless test measures breathing, oxygen levels, heart rate, and sleep stages while your child sleeps.
How is sleep apnea treated?
Treatment depends on the cause and severity:
- Tonsillectomy and/or adenoidectomy is the most common and effective treatment for many children.
- Medical therapy, such as nasal steroid sprays or allergy management, may help in mild cases.
- CPAP (continuous positive airway pressure) may be recommended if surgery isn’t appropriate or if apnea persists.
- Weight management and treatment of underlying conditions can also be important.
Nose and sinus conditions
Nose bleeds
Why nosebleeds happen
Nosebleeds happen when the lining of the nasal passages is damaged, allowing blood vessels that are very close to the surface to break open. Most nosebleeds come from the septum, the plate dividing the two nasal passages.
Important reassurance
Nosebleeds are often scary but rarely dangerous. Even when bleeding looks heavy, actual blood loss is usually small.
Home care recommendations
When nosebleeds happen:
- Add moisture with saline sprays or ointments, we recommend a small amount of Aquaphor just inside the nostril.
- Avoid directly applying ointment to the septum. It’s best to place this right in the front of the nostril and gently squeeze to distribute
How to stop a nosebleed
The best way to stop nosebleeds is to hold firm pressure over the whole soft part of the nose all the way back to the cheeks. This usually applies pressure over the source of the bleed, which will help it to stop faster.
When medical treatment is needed
When home care doesn’t get nosebleeds under control, we can do a quick procedure to cauterize, or burn, the blood vessels that are causing problems. Nosebleeds will sometimes return in the future, but cautery is usually very helpful. This can often be done in clinic for older children. Younger children may require anesthesia.
Sinus infections
What are sinuses?
Sinuses are air spaces in the bones of the face around the nose. There are four sets of sinuses.
- In the cheekbones (maxillary sinuses)
- Forehead (frontal sinuses)
- Between the eyes (ethmoid sinuses)
- Deep in the nose behind the ethmoid sinuses (sphenoid sinuses)
Young children only have maxillary and ethmoid sinuses. The frontal and sphenoid sinuses are not fully developed until late childhood into the teen years.
What is a sinus infection?
When sinuses get irritated and inflamed, it’s called sinusitis. When sinuses get inflamed or infected, the lining thickens and bacteria-filled mucus fills the sinus cavity.
What causes sinus infections?
Inflammation in the sinuses can come from:
- Germs, such as a virus, common cold/flu or bacteria
- Tobacco smoke or other air pollutants
- Environmental allergens
This causes more mucus production. With the swelling and increased mucus production, it makes it harder for the sinuses to drain. If the sinuses don’t drain appropriately, the mucus will be trapped and block the sinuses where germs can continue to grow and result in a sinus infection.
Other things that can block the sinuses and lead to a sinus infection include enlarged adenoids, nasal polyps (small growths of tissue inside the nose) or a deviated septum.
Additional risk factors for sinusitis include cystic fibrosis (CF), primary ciliary dyskinesia (PCD), Type I and II diabetes and compromised immune system.
What are the signs and symptoms of a sinus infection?
Sinus infection symptoms can look like those of a simple cold. When cold symptoms do not go away after 7 to 10 days or start to worsen it could be a sign of a sinus infection. Typical symptoms can include:
- Fevers
- Nasal congestion
- Runny nose, especially if yellow or green discharge
- Postnasal drip
- Cough
- Headache
- Facial pain or pressure
- Bad breath
How do we diagnose sinus infections?
- Most infections are diagnosed based on symptoms that last for 10 days or more.
- For concerns of chronic sinusitis that have not responded to antibiotics, nasal rinses, and nasal steroids, we may recommend imaging such as a CT scan to get more details about the sinuses.
How are sinus infections treated?
Many sinus infections are caused by viruses and usually go away without medical treatment. In these cases, comfort measures can be taken. Apply warm compresses to the area. Pain medications such as acetaminophen or ibuprofen can be given to alleviate pain or discomfort. Do not give aspirin to children who have a viral illness, as such use is linked to Reye syndrome, which can be life-threatening.
- Over-the-counter saline (saltwater) solution in drop or spray form can be used to help reduce congestion, flush the nasal passages and thin out the mucus.
- Saline rinses/irrigation can also be used when tolerated.
- Your doctor may also prescribe medications such as nasal steroid sprays.
- In some cases when the doctor feels that the symptoms are caused by bacteria, antibiotics may be prescribed. Most sinus infections are treated with 14-21 days of antibiotics.
- Adenoidectomy is a surgery to remove the adenoid. The adenoid can trap viruses and bacteria and cause chronic symptoms that can mimic sinusitis called chronic adenoiditis
- Sinus surgery is sometimes recommended for children with chronic sinus infections.
Can sinus infections be prevented?
Not all sinus infections can be prevented. Some preventative measures include:
- Nasal sprays recommended by your doctor
- Treating underlying allergies
- Good hand washing
- Avoiding exposure to sick people
When should I call the doctor?
If your child’s cold symptoms last more than 10 days or get worse, it could be a sign of a sinus infection or another infection. Call the doctor if your child has:
- A cold that lasts for more than 10 days without getting better
- A cold that seems to be getting worse after 7 days of symptoms
- Allergy symptoms that don’t clear with the usual allergy medicine
Additional conditions we treat
Facial paralysis
What is facial paralysis or weakness?
Facial paralysis or weakness happens when the nerve that controls facial movement is damaged. This can make it hard for a child to move one or both sides of the face, which affects blinking, speaking, eating, and showing emotions.
- It is rare in children and can be present at birth (congenital) or develop later (acquired).
- One or both sides of the face may be affected.
- Most cases get better on their own, especially those caused by Bell’s palsy.
- If it does not improve, seeing a specialist quickly is important for the best chance of recovery.
How is facial paralysis or weakness treated?
Treatment depends on the cause and how severe it is. Your child may be cared for by a team of specialists, which can include:
- ENT providers for common causes.
- ENT craniofacial or reconstructive surgeons if more complex treatment is needed.
The care plan is personalized to give your child the best chance for recovery.
Primary Ciliary Dyskinesia (PCD)
Our providers work alongside the Pulmonary & Respiratory program team of experts, including: pediatric pulmonologists, geneticists, respiratory therapists, and many others.
What is PCD?
PCD is a rare genetic disorder that affects the function of cilia, which are tiny hair-like structures that line the surfaces of various organs, including the respiratory tract, reproductive system, and sinuses.
What causes PCD?
PCD is caused by mutations in genes that encode proteins essential for the structure and function of cilia. These mutations lead to abnormal ciliary movement, resulting in impaired clearance of mucus and other particles.
The most common symptoms of PCD include:
- Chronic cough with thick, mucus-like sputum
- Recurrent respiratory infections, such as bronchitis and pneumonia
- Sinusitis
- Ear infections
How is PCD diagnosis?
PCD is typically diagnosed based on clinical symptoms, family history, and diagnostic tests, such as:
- Chest X-rays
- Pulmonary function tests
- Nasal nitric oxide measurements
- Genetic testing
How is PCD treated?
There is no cure for PCD, but treatments can help manage symptoms and improve quality of life. These include:
- Chest physiotherapy and airway clearance techniques
- Antibiotics to treat infections
- Medications to thin mucus
- Surgery for severe lung damage
Tongue tie (Ankyloglossia)
What is tongue tied?
Tongue tie happens when the small piece of tissue under the tongue (called the lingual frenulum) is too tight or attached too close to the tip of the tongue. This can make it harder for the tongue to move freely.
- It’s usually noticed soon after birth because it can make breastfeeding difficult.
- It rarely causes problems later in life and does not lead to speech delays, though some sounds may be harder to pronounce.
- It can also make it hard to stick out the tongue, like when licking a popsicle or ice cream cone.
How is tongue tied treated?
If tongue tie is causing problems, it can be treated with a simple procedure called a frenotomy. This is a quick surgery to release the tight tissue under the tongue so it can move more freely.
- An ear, nose, and throat (ENT) specialist usually does this after checking that the tongue tip can’t move well.
- For older children, a speech-language pathologist should also help decide if treatment is needed, especially if there are speech concerns.
Common ENT surgeries
Adenoidectomy
What is an adenoidectomy?
Adenoidectomy is a procedure to remove adenoid tissue at the back of the nose. It is performed by an ENT surgeon in the operating room under general anesthesia.
This surgery may be recommended for your child for a variety of conditions:
- Adenoid hypertrophy
- Chronic adenoiditis
- Sleep apnea
Ear tubes
What are ear tubes?
A small plastic tube is inserted into the eardrum (also called the tympanic membrane).
How do ear tubes help?
- Helps ventilate the middle ear space
- Helps decrease swelling in the Eustachian tube (the small tube that connects the middle ear to the back of the nose and throat)
How long do ear tubes last?
Ear tubes are usually in place for 6–18 months.
Tonsillectomy
What is a tonsillectomy?
A tonsillectomy is the surgical procedure where tonsils are removed from the back of the throat (through the mouth). It is performed by an ENT surgeon in the operating room under general anesthesia.
This surgery may be recommended for your child for a variety of conditions:
- Recurrent tonsillitis or strep throat
- Sleep apnea
For ENT conditions that are more complex, we offer multidisciplinary clinics
- Aerodigestive Program
- Head and neck tumors Program
- Cleft and Craniofacial Program
- Down Syndrome Clinic
- Ear Shape Program
- Prenatal with Midwest Fetal Care Center
- Endocrine thyroid
- 22q11.2 deletion syndrome/Velocardiofacial Syndrome Clinic
- Pediatric Facial Trauma and Reconstruction Program
- Hearing Health Care Program
