Ear, Nose & Throat Conditions

Auditory neuropathy/dysynchrony is a type of hearing problem. Most children have the problem from birth, but they may not show symptoms right away. Children with this condition may be able to hear sounds and speech but may not hear sounds clearly or may not understand speech. The amount of hearing loss can range from mild to severe.

What are the signs and symptoms of auditory neuropathy?

• Not reaching typical speech milestones
• Having trouble understanding speech
• Not being able to tell one sound from another
• Hearing that fades in and out

What causes auditory neuropathy?

Auditory neuropathy happens when there is damage somewhere along the nerve in the ear that is responsible for hearing. This damage can happen in the inner-ear hair cells that send information about sounds to the brain or in the nerve itself. This can cause sounds to be jumbled on their way to the brain.

Children may be more likely to have auditory neuropathy if they:

• Didn’t get enough oxygen before or after birth
• Had a low birth weight
• Had jaundice
• Were born early (premature)
• Took a medicine that damaged their hearing nerve or the inner ear

How is auditory neuropathy treated?

Treatments for auditory neuropathy may include:

• Learning visual communication skills, such as sign language
• A frequency modulation (FM) system, a personal listening device that can help reduce background noise and make a speaker’s voice louder
• Hearing aids
• Cochlear implants, a device placed surgically that directly stimulates the hearing nerve

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for auditory neuropathy.

Cholesteatoma is an abnormal skin growth inside the middle ear in the back of the eardrum. It can occur when wax and skin build up inside the ear or because of chronic ear infections.

What are the signs and symptoms of cholesteatoma?

Some symptoms of cholesteatoma include:

• A feeling of pressure or fullness in the ear
• Hearing loss
• Dizziness
• Earache
• Drainage from the ear, often with a bad odor
• Ear infections

What causes cholesteatoma?

The most common cause of cholesteatoma is a problem with the eustachian tube inside the ear. The eustachian tube connects the middle ear to the sinuses and nose, and helps control pressure behind the eardrum. When the eustachian tube does not work correctly, pressure can build up inside the ear. This pressure can pull the eardrum the wrong way, leaving an area where skin and earwax can build up, causing the cholesteatoma.

In rare cases, cholesteatoma can be a condition a baby is born with.

How is cholesteatoma treated?

The options to treat cholesteatoma may include both surgical and non-surgical options.

Surgical

• Surgery may be needed to remove the cholesteatoma if it continues to grow. Surgery may include removing bone from behind the ear, or rebuilding the hearing bones or the eardrum.

Non-surgical

• In some cases, cholesteatoma may be treated with eardrops and antibiotics.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for cholesteatoma.

Earwax, also called cerumen, is a natural substance made by the body to help lubricate and protect the ears. It contains hair, dead skin cells and discharge from glands. Usually, earwax moves through the ear canal without any problem. When it reaches the outer part of the ear, it flakes away. Most people do not need to clean their ears, they are meant to clean themselves.

Impacted earwax happens when earwax builds up in the ear canal. This can cause problems with hearing and other symptoms.

What are the signs and symptoms of impacted earwax?

Common symptoms include:

• Pain in the ear
• A feeling of fullness in the ear
• Tugging or pulling at the ear
• Loss of hearing
• Itchiness in the ear
• Ringing in the ear
• Dizziness
• Discharge from the ear

What causes impacted earwax?

Impacted earwax most often occurs when people try to clean ears with cotton swabs or other objects. This can push the earwax back inside the ear.

Some children may also have an ear canal shaped in a way that makes it harder for the earwax to move through on its own.

How is impacted earwax treated?

Do not try to remove earwax using a cotton swab or other object. This can make the problem worse.

To treat impacted earwax, a doctor may:

• Remove the earwax in the office using a special tool or suction
• Suggest a treatment at home to help soften or dissolve the earwax

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for impacted earwax.

All people have some fluid behind the eardrum, inside the middle ear. It normally drains out of the ear and into the back of the nose through the eustachian tube.

When fluid in the ear backs up behind the eardrum it can cause problems. It is known as middle ear effusion or otitis media with effusion. Fluid in the ear is a common problem in children, especially those under age 8.

What are the signs and symptoms of fluid in the ear?

• Problems with hearing
• Tugging at the ears
• Muffled hearing

What causes fluid in the ear?

Fluid in the ear can have several causes:

• A blockage in the eustachian tube, the passageway that connects the middle ear to the nose
• Ear infection
• A cold
• Cleft palate

How is fluid in the ear treated?

In most cases, the problem clears up on its own without treatment within a few weeks.

• If the child has an ear infection, a doctor may prescribe antibiotics
• If the condition does not improve after a few months, a child’s doctor may suggest implanting ear tubes in the ears to help drain the fluid

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for fluid in the ear.

Children sometimes place a foreign body, such as food, buttons or toys inside their ear. Insects can also fly into the ear and get stuck.

What are the signs and symptoms of a foreign body in the ear?

Some objects in the ear may cause no symptoms. If a child does have symptoms, they may include:

• Pain or redness in the ear
• Problems with hearing
• Drainage from the ear

What causes a foreign body in the ear?

In most cases, children place an object in the ear themselves. Common items found in the ear may include:

• Small toys
• Buttons
• Crayon pieces
• Food
• Small batteries

Insects may also get lodged into the ear.

How is a foreign body in the ear treated?

A doctor can remove the object from the ear using one of the following techniques:

• Pulling the object out using an instrument such as tweezers or forceps
• Flushing the ear with water
• Using suction to remove the object
• Using a magnet, if the object is metal

Once the object is removed, the doctor will assess the ear canal for any damage. If there is an infection, they may prescribe antibiotics.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a foreign object in their ear.

Hearing loss can happen when some part of the ear is not working as it should. This includes the inner ear, middle ear, outer ear, auditory system and hearing nerve.

When a child has hearing loss, it can cause problems with how they develop language, speech and social skills.

What are the signs and symptoms of hearing loss?

Symptoms of hearing loss in babies can include:

• Not appearing to hear loud noises
• Not saying single words by age 1
• Not looking to see the source of a sound after age 6 months
• Only seeming to hear some sounds

Symptoms of hearing loss in children can include:

• Not following directions
• A delay in speech
• Unclear speech
• Turning up volume on TV or devices very high
• Often saying “What?”

What causes hearing loss?

Hearing loss can have many causes and can happen at any point in a child’s life.

Generally, hearing loss can be grouped into three categories:

• Genetic causes: This is the most common reason for hearing loss in children. In some cases, hearing loss can run in families. A child may also be born with a syndrome that puts them at higher risk for hearing loss, such as Usher syndrome or Down syndrome .
• Acquired causes: This includes any cause of hearing loss that happens during or after birth. This can include:
  • Injury or trauma to the ear or head
  • Complications during birth
  • Having ears or a head that is formed differently than usual
  • A disease or illness that causes hearing loss such as an ear infection or meningitis
• Unknown causes: For about 1 in 4 children with hearing loss, the cause is not known.

How is hearing loss treated?

Treatments for hearing loss may include both surgical and non-surgical options:

Surgical

• Surgery may correct some types of hearing loss

Non-surgical

• Visual communication skills, such as sign language
• Hearing aids
• Cochlear implants, a device placed surgically that directly stimulates the hearing nerve

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for hearing loss.

The eustachian tubes are small passages that lead from the middle ear to the back of the throat. The eustachian tubes help normalize pressure inside the ear by opening whenever your child swallows, yawns or sneezes. When a eustachian tube gets clogged, it’s called eustachian tube dysfunction.

Children are more likely to have eustachian tube dysfunction than adults because their eustachian tubes are shorter and straighter. This allows germs to reach the middle ear and for fluid to build up there.

What are the signs and symptoms of eustachian tube dysfunction?

Symptoms of eustachian tube dysfunction may include:

• A feeling of fullness in the ears
• Muffled sounds
• Pain in the ear
• A clicking or popping feeling inside the ear
• Ringing in the ears (tinnitus)
• Problems with balance

What causes eustachian tube dysfunction?

Eustachian tube dysfunction happens when the tube becomes swollen and fluid backs up inside it. This can happen because of a cold or flu, allergies or a sinus infection.

How is eustachian tube dysfunction treated?

In many cases, eustachian tube dysfunction gets better without any treatment. Chewing gum, swallowing or yawning may help open.

If these exercises don’t work, treatments may include:

• A decongestant to reduce swelling
• An antihistamine or steroid nasal spray
• Cutting a tiny hole in the eardrum to drain the fluid out of the middle ear
• Implanting small tubes in the eardrums to drain fluid out of the middle ear
• Using a long tube (called a catheter) to place a small balloon up the nose and into the eustachian tube where it is inflated to open a pathway in the tube

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for eustachian tube dysfunction.

Conductive hearing loss occurs when sound cannot get from the outer or middle ear to the cochlea, the organ inside the inner ear that allows your child to hear. This can happen for many reasons, from a build-up of earwax to a hole in the eardrum. The hearing loss can range from mild to profound, where your child can’t hear any speech and only very loud sounds.

There are several other types of hearing loss. If your child is having trouble hearing, an ear, nose and throat specialist can help diagnose the problem.

What are the signs and symptoms of conductive hearing loss?

Some common symptoms of conductive hearing loss include:

• Hearing that seems muffled
• Feeling of fullness or stuffiness in the ear
• Draining of the ear
• Pain in the ear
• Dizziness

What causes conductive hearing loss?

Conductive hearing loss occurs when sounds don’t get through to the inner ear. This can have many different causes:

• Foreign object in the ear. This can happen when children put small objects, such as beads or beans, in their ears. It can also occur if a bug gets inside the ear.
• Earwax. In some cases, earwax can build up and completely block your child’s ear canal.
• Swimmer’s ear. This is an infection in the ear canal that can happen after swimming or other exposure to water.
• Bony lesions. These are growths of bone in the ear canal that are not cancerous.
• Aural atresia. This is a common condition that occurs when the ear canal does not develop properly.
• Fluid in the middle ear or an ear infection
• Ear drum collapse
• Hole in the ear drum
•  Cholesteatoma . This is a condition where skin cells grow in the middle ear.
• Damage to the bones in the middle ear
• Otosclerosis. This is a rare, inherited disease that causes abnormal bone growth in one of the bones in the middle ear.

How is conductive hearing loss treated?

The treatment for your child’s conductive hearing loss depends on the cause of the hearing loss and includes non-surgical and surgical options.

Non-surgical

• Observing the hearing loss over time and follow-up hearing testing
• Hearing aids or other assistive listening devices

Surgical

• Surgery may be needed to correct hearing loss caused by some of the conditions listed above, such as a hole in the eardrum, bony lesions or cholesteatoma.
• Your child’s doctor may recommend surgery to implant a hearing device

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for conductive hearing loss.

An ear infection, also called acute otitis media, is an infection that occurs in the middle ear (the space behind the eardrum). It causes pain and swelling of the eardrum. An ear infection can happen in one or both ears. Although anyone can have an ear infection, they are more common in children than adults.

Most ear infections cause no long-term problems. But children who get many ear infections may be at risk for hearing loss.

What are the signs and symptoms of an ear infection in children?

Some common symptoms of ear infection in children include:

• Ear pain
• Pulling or tugging on the ear
• Fussiness or crying
• Fever
• Trouble sleeping
• Loss of appetite

What causes an ear infection?

• Bacteria, such as Streptococcus pneumonia and Haemophilus influenza
• Viruses, such as those that cause colds and flu

Your child may be more likely to get an ear infection after having a cold or other upper respiratory infection. Children between the ages of 6 months and 2 years are especially prone to ear infections.

How are ear infections treated?

Your child’s doctor will decide how to treat the ear infection based on your child’s age and how severe the infection is.

• For mild infections, your doctor may suggest watchful waiting. This means waiting two to three days to see if the ear infection gets better on its own. In some cases, the body’s immune system can fight off the infection without any treatment.
• In some cases, your child’s doctor may also suggest an over-the-counter pain reliever, such as acetaminophen or ibuprofen. Ask your doctor or pharmacist about the right type of medicine for your child’s age and weight.
• Getting rest and drinking plenty of fluids can also help your child feel better.
• For more severe infections, your child’s doctor may prescribe an antibiotic, such as amoxicillin.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an ear infection.

Allergic rhinitis, sometimes-called hay fever, causes symptoms that affect the nose. It develops when the body’s immune system overreacts to something in the environment, such as dust mites or pollen from plants or trees.

Allergic rhinitis can either be seasonal or can last year-round.

• Seasonal allergic rhinitis usually happens in the spring, summer or early fall. It is usually caused by an allergy to mold, pollen or spores from trees, weeds or grass.
• Year-round allergic rhinitis is usually caused by an allergy to dust mites, pet hair or mold.

What are the signs and symptoms of allergic rhinitis?

• Runny nose
• Sneezing
• Stuffy nose
• Itching in the nose, eyes or throat
• Red or watery eyes
• Puffy eyelids
• Cough
• Tiredness
• Moodiness or irritability

What causes allergic rhinitis?

Allergic rhinitis is caused by an allergy to something in the environment, such as:

• Pollen, mold or spores from plants or trees
• Pet hair or dander
• Dust mites
• Mold
• Cigarette smoke
• Diesel exhaust
• Perfume

How is airway allergic rhinitis treated?

In some cases, allergic rhinitis does not need any treatment. Instead, symptoms may be controlled by avoiding the substance causing the allergy.

• Staying indoors when pollen counts are high
• Keeping windows closed in your home during allergy season
• Keeping humidity low in your house and using air conditioning
• Keeping pets out of the bedroom

If symptoms are not controlled by avoiding the allergen, a doctor may prescribe a medicine to reduce the symptoms.

• Intranasal corticosteroids
• Antihistamines
• Decongestants
• Nasal sprays
• Eyedrops
• Leukotriene pathway inhibitors

When medicines don’t work, a doctor may suggest immunotherapy, such as allergy shots or a tablet, which is placed under the tongue. This may be a longer-term solution to treating symptoms.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for allergic rhinitis.

Children sometimes place a foreign body, such as clay, beads or small toys inside their nose. When this occurs, the object needs to be removed.

What are the signs and symptoms of a foreign body in the nose?

Symptoms may include:

• Drainage from one side of the nose that may have a bad odor
• Bloody nose

What causes a foreign body in the nose?

In most cases, children place the object in the nose themselves. An object may also get stuck inside the nose when a child tries to smell it. Common objects found in the nose include:

• Beads
• Buttons
• Paper
• Food
• Pebbles
• Candle wax

How is a foreign body in the nose treated?

A doctor will remove the object from the nose using one of the following techniques:

• Pulling the object out with an instrument such as tweezers or forceps
• Using suction to remove the object
• Having the child blow their nose or having a parent or caregiver blow into their child’s mouth while the unaffected nostril is blocked to dislodge the object

Once the object is removed, the doctor will assess the nose, for any damage or infection. If there is an infection, the doctor may prescribe nose drops or antibiotics.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a foreign object in their nose.

A nasal obstruction is anything that blocks proper air flow in the nose. Many things can cause a nasal obstruction, from allergies to a problem in the way the nose is formed.

What are the signs and symptoms of nasal obstruction?

Symptoms of a nasal obstruction may include:

• Drainage from the noise
• A voice that sounds “nasal”
• Breathing through the mouth
• Frequent sinus infections

What causes a nasal obstruction?

The most common causes of a nasal obstruction in children are enlarged adenoids and colds and allergies. Other causes in children may include:

• Deviated septum
• Nasal polyps, noncancerous growths in the nose
• Foreign body in the nose
• A malformation of the nose that is present at birth

How are nasal obstructions treated?

Treatment for nasal obstruction can vary depending on the cause and may include both surgical and non-surgical options.

Surgical

• Surgery may be needed to remove the adenoids or nasal polyps or to correct a deviated septum or other malformation of the nose.

Non-surgical

• A doctor may prescribe medications to help treat allergies or colds.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a nasal obstruction.

Inside the nose, a thin wall of cartilage divides the space into two nasal passages. This wall is called the nasal septum. When the nasal septum is not centered, it causes one nasal passage to be larger than the other. This is called a deviated septum. Sometimes it can cause symptoms in the nose and sinuses.

As many as 80% of all people may have a deviated septum, but it can range from slight to severe. In some cases, it can block one side of the nasal passage.

What are the signs and symptoms of a deviated septum?

Some people have no symptoms from a deviated septum. But when symptoms do occur, they may include:

• Nosebleeds
• Sinus infections
• Trouble breathing through one or both sides of the nose
• Noisy breathing while asleep

What causes a deviated septum?

In some cases, children are born with a deviated septum. It can also be caused from an injury to the nose, such as from childbirth or playing sports.

How is a deviated septum treated?

Most people don’t need treatment for a deviated septum. If the condition is severe, it may require surgery.

• Septoplasty is a surgery to correct a deviated septum by correcting or removing parts of the septum that are very deviated. This surgery is not usually done on young children unless the problem is very severe.
• Sinus surgery also may be performed at the same time as septoplasty.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a deviated septum.

Sleep apnea is when a child stops breathing during sleep. It usually happens because of a blockage, or obstruction, in the upper airway. For this reason, it is also called obstructive sleep apnea (OSA).

When your child stops breathing during sleep, the oxygen levels in the body fall and the levels of carbon dioxide rise. This triggers the brain to wake up to breathe. Usually, this only takes a moment, and your child goes back to sleep without realizing they woke up. But this pattern of waking can continue all night, and your child may not ever reach a deeper level of sleep. This may leave them feeling tired and unrested the next day.

If not treated, OSA can lead to problems with growth, learning, behavior, and can even cause heart problems.

What are the signs and symptoms of sleep apnea?

Some common symptoms of sleep apnea include:

• Snoring that can include snorts or gasps
• Heavy breathing during sleep
• Short periods of not breathing during sleep
• Bedwetting
• Restless sleep or sleeping in unusual positions
• Daytime sleepiness or behavior problems
• Sleepwalking or night terrors
• Behavior problems, crankiness, hyperactivity or having trouble paying attention

What causes sleep apnea?

Sleep apnea in children is most commonly caused by enlarged tonsils or adenoids in the back of the throat and nose. During sleep, the muscles relax and the tonsils and adenoids can block the airway.

Other things can contribute to sleep apnea include:

• Being overweight
• Certain medical conditions, such as craniofacial syndromes, cerebral palsy or Down syndrome
• A family history of sleep apnea
• Having a small jaw

How is sleep apnea treated?

The treatment for your child’s sleep apnea depends on the cause. These include both non-surgical and surgical options.

Surgical

• Removing the tonsils (tonsillectomy)
• Removing the adenoids (adenotonsillectomy)
• Surgery to correct craniofacial conditions

Non-surgical

• Continuous positive airway pressure (CPAP) therapy. This involves wearing a mask during sleep that covers either just the nose or the nose and mouth. It is connected to a machine that pumps air to open the airways.
• Diet changes and other weight-loss methods to lose excess weight

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for sleep apnea.

Adenoiditis is swollen or enlarged adenoids. It is a condition that is common in children.

Adenoids are glands located in the throat behind the nose. The adenoids are part of the immune system along with the tonsils, which help the body fight infection. They work by trapping germs that enter through the nose and mouth.

When adenoids become enlarged in children, they can cause problems.

What are the signs and symptoms of enlarged adenoids?

• A runny or stuffy nose
• Trouble breathing through the nose
• Ear infections
• Loud breathing or snoring
• Trouble sleeping or restless sleep
• Swollen glands in the neck
• Sleep apnea , a condition that causes a child to stop breathing for a few moments while sleeping

What causes enlarged adenoids?

• Infections can cause the adenoids to swell. Sometimes, they may stay enlarged after the infection is cleared up.
• Some children are born with large adenoids.

How is adenoiditis treated?

The options to treat enlarged adenoids may vary depending on how severe the problem is.

Surgical
A doctor may suggest surgery if a child has trouble breathing, many ear or throat infections, or sleep apnea.

• An adenoidectomy is the surgical removal of the adenoids.
• Sometimes the tonsils are removed at the same time (called a tonsillectomy).

Non-surgical

• A nasal spray may help reduce swelling.
• Antibiotics may help fight off the infection causing the enlarged adenoids.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for enlarged adenoids.

A branchial cleft cyst is a fluid-filled lump in the neck or below the jaw. These cysts form before birth when tissues in the neck area do not develop normally. They usually develop on one side of the neck, but can occur on both sides. The cysts are usually painless but can cause pain if they become infected.

Branchial cleft cysts are something a baby is born with, but they may be diagnosed at any age.

What are the signs and symptoms of branchial cleft cysts?

• A small lump, pit or mass on the side of the neck below the jawbone
• Drainage from a small opening or pit on the neck
• Noisy breathing (if a cyst blocks part of the airway)

What causes branchial cleft cysts?

Branchial cleft cysts occur while a baby is still developing. They develop when the tissues in the throat and neck do not grow together properly. These tissues form pockets that contain cells from other areas of the throat and neck.

How are branchial cleft cysts treated?

The options to treat branchial cleft cysts may vary depending on whether they become infected and their size. Some cysts may need no treatment.

Surgical

• Surgery may be needed to remove the cysts if they become infected often.

Non-surgical

• A doctor may prescribe antibiotics if the cysts become infected.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a branchial cleft cyst.

A child’s voice is considered hoarse when it sounds rough, raspy or deeper than usual. In some cases, a child may only be able to whisper.

Hoarseness is common in children and may be caused by many different conditions. In most cases, the hoarseness only lasts a few days. But sometimes it can last for weeks or months.

What are the signs and symptoms of hoarseness?

Symptoms of hoarseness can include:

• Raspy, strained or breathy voice
• A change in the pitch or volume of the voice

What causes hoarseness?

A hoarse voice can have many causes. These can include:

• Infections or viruses like a cold or the flu
• Allergies
• Nodules on the vocal cords
• Growths on the voice box (larynx)
• Straining the vocal cords from crying, yelling or singing
• Paralysis of the vocal folds
• Gastroesophageal reflux disease (GERD)
• Thyroid conditions
• A laryngeal cleft

How is hoarseness treated?

In some cases, the hoarseness will improve on its own. Treatment for hoarseness depends on the cause and may include both surgical and non-surgical options:

Surgical

• Surgery may be needed if the child has nodules or growths or paralysis of the vocal folds

Non-surgical

• Behavioral changes or training with a speech therapist may help the child develop good vocal habits
• Medications may help if the child has allergies, GERD or a thyroid problem

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for hoarseness.

Chronic tonsillitis is a swelling of the tonsils that does not get better. Tonsils are the round pieces of tissue at the back of the throat. They are part of the body’s immune system and help fight off illness.

Tonsillitis is common in children and many children have acute tonsillitis that happens suddenly and then gets better on its own or with treatment. Chronic tonsillitis occurs when the symptoms are ongoing. It is more common in older children.

What are the signs and symptoms of chronic tonsillitis?

Common symptoms of chronic tonsillitis may include:

• Sore throat
• Tender lymph nodes in the neck
• Bad breath
• Breathing through the mouth
• Hard bits of debris on the tonsils, called tonsil stones

What causes chronic tonsillitis?

Tonsillitis is most often caused by viruses, such as the virus that causes the flu. It can also be caused by bacteria, such as the bacterial infection that causes strep throat. Chronic tonsillitis develops when the symptoms of tonsillitis last for longer than a few weeks.

How is chronic tonsillitis treated?

Treatment for chronic tonsillitis may include both surgical and non-surgical options.

Surgical

• Your child’s doctor may recommend surgery to remove the tonsils if your child has tonsillitis many times in one year or over several years.

Non-surgical

• If the tonsillitis is caused by a bacterial infection, your child’s doctor may prescribe antibiotics.
• If your child’s tonsillitis is caused by a viral infection, your doctor may recommend drinking extra fluids and over-the-counter pain medicines.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for chronic tonsillitis.

Airway stenosis is a narrowing in the airway that blocks air from getting from the mouth and nose to the lungs. It can happen for a few different reasons.

There are a few types of airway stenosis, depending on where the narrowing occurs. Subglottic stenosis is a narrowing below the vocal cords and above the trachea. Tracheal stenosis is a narrowing of the trachea, or the windpipe, which leads from the voice box to the airways in the lungs.

What are the signs and symptoms of airway stenosis?

• Noisy breathing
• Trouble breathing
• Shortness of breath
• Hoarseness
• Trouble swallowing or eating

What causes airway stenosis?

Airway stenosis can have many causes:

• A problem with the shape of the airway that a child is born with
• Prolonged use of a breathing tube
• Tumors (cancerous or not cancerous)
• Certain autoimmune conditions, such as Wegener’s granulomatosis
• Swallowing a caustic substance, such as laundry detergent
• An external injury to the throat
• Scar tissue
• Infection

How is airway stenosis treated?

The options to treat airway stenosis may vary depending on the cause of the problem and how severe it is.

Surgical

• Laser surgery can remove scar tissue that is causing stenosis.
• A full tracheal resection and reconstruction involves removing the damaged section of the trachea and joining the remaining ends.

Non-surgical

• Airway stenting uses a mesh-like tube to keep the airway open.
• Widening of the trachea can be done using a small balloon or dilator to expand the airway.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for airway stenosis.

Laryngomalacia occurs when a baby is born with a voice box (larynx) that is not formed correctly. This causes the soft tissue of the voice box to collapse inward when the baby breathes in. Laryngomalacia can cause noisy breathing and is usually noticeable shortly after birth.

What are the signs and symptoms of laryngomalacia?

Symptoms of laryngomalacia may include:

• Noisy breathing that may be worse when lying on the back or crying
• Breathing problems
• A blue tint to the skin (cyanosis)
• Trouble feeding
• Poor weight gain
• A pulling in at the chest or neck when breathing
• Pauses in breathing (apnea)
• Spitting up or vomiting

What causes laryngomalacia?

This is a condition a baby is born with. In rare cases, it may run in families. It may also be connected to some syndromes.

How is laryngomalacia treated?

In most cases, laryngomalacia is not serious and gets better on its own within about a year. But some children with severe symptoms may need medication or surgery to correct the condition.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for laryngomalacia.

Most people have heard of gastroesophageal reflux disease (GERD), where stomach acid moves up into the esophagus. Laryngopharygeal reflux (LPR) occurs when the stomach acid leaks into the throat or voice box (larynx).

What are the signs and symptoms of laryngopharygeal reflux?

Symptoms of LPR in children may include:

• Noisy breathing or hoarseness
• Coughing
• Asthma
• A blue tint to the skin (cyanosis)
• Spitting up or having trouble feeding
• Trouble gaining weight
• Pauses in breathing (apnea)

What causes laryngopharygeal reflux?

This condition can have many causes. These may include:

• Weak muscles in the esophagus
• Slow stomach emptying
• Hiatal hernia
• Growth and development issues
• Overeating
• Eating right before going to bed
• Eating certain foods, such as chocolate or fatty or spicy foods

How is laryngopharygeal reflux treated?

Treatment for LPR may depend on the cause and may include both surgical and non-surgical options.

Surgical

• Surgery to tighten the lower esophageal muscle, called fundoplication, may help in severe cases.

Non-surgical

• A doctor may suggest lifestyle changes, such as changes to diet, the size of meals or sleeping position.
• A doctor may prescribe medicines to help reduce the amount of stomach acid, such as proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2Ras).

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for laryngopharygeal reflux.

Feeding and swallowing disorders occur when a child has a problem feeding or swallowing. They are a symptom of another condition or disease.

Feeding and swallowing disorders cause aspiration, which means liquids or food getting into the lungs. They can also lead to the child not eating or drinking enough. If the condition becomes severe, the child may need a feeding tube to get proper nutrition. In some cases, feeding and swallowing disorders can lead to anxiety about eating or drinking.

Generally, feeding and swallowing disorders fall into two categories.

• Oral: when the mouth, tongue or lips and tongue have problems controlling food or liquids that are being swallowed
• Pharyngeal: a problem in the throat with swallowing

Children may have problems in just one of these areas, or both.

What are the signs and symptoms of feeding and swallowing disorders?

• Gagging or choking
• Coughing
• Trouble chewing
• Taking a long time to feed
• Having a change of skin color after feeding
• Not eating or drinking very much
• Congestion after feeding
• Refusal to eat or drink
• Not gaining weight 
• A history of pneumonia

What causes feeding and swallowing disorders?

Many conditions and diseases can cause feeding and swallowing disorders. These can include:

• Brain injury
• Cleft palate or lip
• Cerebral palsy
• Heart conditions
• Being born early (premature)
• Gastroesophageal disorders, such as reflux
• Neuromuscular disease
• Sensory problems
• Autism
• Head and neck problems
• Muscle weakness
• Breathing problems

How are feeding and swallowing disorders treated?

Treatment for feeding and swallowing disorders will depend on how severe the problem is. Treatments may include:

• Therapy to help strengthen and increase motion in the lips, tongue or jaw and decrease any aversion to foods
• Therapy to reduce the risk for aspiration
• Changing textures of foods or drinks
• Learning strategies to help eat and drink
• Changing the method used to eat or drink, such as cups, nipples, bottles or utensils

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a feeding or swallowing disorder.

A laryngeal cleft is a gap between the larynx and the esophagus. It occurs before birth, while a baby is still developing. This gap allows food and liquid to get into the airway instead of the stomach. A laryngeal cleft can cause problems with breathing and eating and can cause an infection in the lungs.

Laryngeal clefts can range from mild to severe, depending on the size of the gap. There are four types, based on their size and location:

• Type 1: The mildest type. The gap is located above the vocal cords.
• Type 2: This type of cleft extends just below the vocal cords.
• Type 3: This more severe cleft extends below the larynx (voice box) and into the trachea.
• Type 4: The most severe type of cleft. It may extend into the chest.

What are the signs and symptoms of a laryngeal cleft?

Symptoms of a laryngeal cleft may include:

• Coughing
• Choking when feeding
• Poor weight gain
• Hoarseness
• Shortness of breath
• Noisy breathing
• A blue tint to the skin (cyanosis)
• Wheezing
• Frequent lung infections

What causes a laryngeal cleft?

This is a condition that a baby is born with. The problem occurs at some point in a baby’s development during pregnancy.

How is a laryngeal cleft treated?

The treatment depends on the type of laryngeal cleft a child has.

Surgical

• Children with more severe laryngeal clefts often need surgery, called a laryngeal cleft repair.

Non-surgical

• Children with milder forms and few symptoms may not need any treatment. They are checked often to make sure their condition is not getting worse.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a laryngeal cleft.

Facial paralysis occurs when a child cannot move the muscles in their face. It can affect one or both sides of the face and can be temporary or permanent.

In most cases, babies are born with facial paralysis. But paralysis can also occur after birth.

What are the signs and symptoms of facial paralysis?

• Drooping on one side of the face
• Drooping around the eyelids or problems closing an eyelid
• Drooling
• Problems speaking
• Having a hard time drinking or eating
• An asymmetrical smile

What causes facial paralysis?

Facial paralysis can have many causes. These can include:

• The position of the baby inside the uterus
• A difficult birth or trauma during birth
• Head injury
• Bell’s palsy, an unexplained, temporary facial paralysis or weakness
• A tumor pressing on a facial nerve
• Moebius syndrome, a type of facial muscle weakness a baby is born with
• Surgery of the ear, brain or jaw

How is facial paralysis treated?

Treatment for facial paralysis will depend on the cause and the muscles affected. Treatments may include both surgical and non-surgical options.

Surgical

• Muscle transfer surgery to move a muscle from another part of the body to the face
• Surgery to insert a small weight into the upper eyelid to help it close
• A nerve graft to move a nerve from another part of the face or the body

Non-surgical

• Physical therapy or speech therapy can help with facial movements
• Steroids can help reduce inflammation
• Botulinum toxin (Botox) injections can help relax the muscles

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for facial paralysis.

Head and neck masses are bumps or lumps that appear on the head or neck. They can develop for many different reasons. Most head and neck masses in children are not cancerous.

What are the signs and symptoms of a head or neck mass?

• Lump or bump on the head or neck
• Fever
• Redness or pain in the area
• Skin that looks swollen

What causes head and neck masses?

Head and neck masses can have many causes. These may include:

• Cysts or masses that the child is born with, including:
  • Thyroglossal duct cysts (TGDCs)
  • Branchial cleft cysts (sinus tracts)
  • Dermoid cysts
  • Teratomas
• Infections in a gland or lymph node
• Blood vessel growths (vascular lesions)
• Noncancerous tumors, such as neuromas
• Cancerous tumors, such as cancers of the lymph nodes and neck (rare in children)

How are head and neck masses treated?

Treatment for the head or neck mass will depend on the cause. Some masses may need no treatment at all. Others may need surgical or non-surgical treatment.

Surgical

• Surgery may be needed to remove the mass.

Non-surgical

• Some noncancerous masses or cysts may be treated with medications.
• Cancerous masses may be treated with a combination of chemotherapy and radiation with or without surgery.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a head or neck mass.

Lymphatic malformations are noncancerous, fluid-filled cysts that grow from the lymph vessels. They can range in size from tiny bumps to the size of a baseball. Although they can be found in any area of the body, they are most common on the head and neck. A lymphatic malformation is something a baby is born with, but it might not be diagnosed right away.

Lymphatic malformations usually get larger as a child grows, but sometimes they can suddenly become smaller. They may press against or obstruct nearby body parts, such as blood vessels, the eyes or the windpipe. They can also put the child at higher risk for infection.

There are three main types of lymphatic malformations:

• Microcystic: smaller cysts or soft tissue that is enlarged without cysts
• Macrocystic: cysts that are soft, large masses, most commonly found on the neck
• Mixed: a combination of microcystic and macrocystic

What are the signs and symptoms of a lymphatic malformation?

Symptoms can vary from child to child, but may include:

• A lump or bump that feels spongy
• Small, raised sacs that might look bloody
• A large fluid-filled sac
• Swelling or pain
• Problems speaking, swallowing, breathing or feeding

What causes lymphatic malformations?

Lymphatic malformations occur because of a problem with how the lymphatic system develops before a baby is born. Experts don’t know the exact cause.

Children with certain syndromes, such as Down syndrome , Noonan syndrome and Turner syndrome, are more likely to have lymphatic malformations.

How are lymphatic malformations treated?

Treatment for lymphatic malformations can vary depending on where they are located, their size and the symptoms they are causing. In some cases, a child’s doctor may watch and wait before treating. Treatment may include both surgical and non-surgical options.

Surgical

• A lymphatic malformation may be removed with surgery if it is interfering with the function of another organ.

Non-surgical

• Sclerotherapy involves injecting a medicine into the lymphatic malformation to make it shrink.
• Laser therapy may be used to treat some lymphatic malformations.
• Radiofrequency ablation involves inserting a needle into the lymphatic malformation and using an electric current to destroy it.
• A doctor may prescribe medicines to help shrink the cysts.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a lymphatic malformation.

Most babies are born with 46 chromosomes. These contain the DNA that determine how a baby develops. Babies with Down syndrome are born with an extra copy of chromosome 21. This extra chromosome changes how the baby’s brain and body develop, and causes the physical features and traits linked to Down syndrome. It is a lifelong condition.

Down syndrome is the most common genetic chromosomal condition diagnosed in the U.S. Although children with Down syndrome share many traits and challenges, the symptoms can vary from mild to severe. Some children with Down syndrome may be more prone to serious health problems, such as heart conditions and ear and eye problems.

There are three main types of Down syndrome:

• Trisomy 21. About 95% of people with Down syndrome have Trisomy 21. Children with this type have three separate copies of chromosome 21 instead of the typical two copies.
• Translocation Down syndrome. This less common type of Down syndrome occurs when an extra chromosome 21 is attached to another chromosome.
• Mosaic Down syndrome. Children with this type of Down syndrome have some cells with three copies of chromosome 21 and other cells with two copies.

What are the signs and symptoms of Down syndrome?

Babies and children with Down syndrome share many of the same physical traits, including:

• A flattened face and small head
• A short neck
• Upward-slanting eyes
• A tongue that sticks out
• Small ears or unusually-shaped ears
• Poor muscle tone
• Shortened height
• Small hands and feet
• Small white spots on the iris (the colored part of the eye)
• Loose joints
• Delayed language
• Mild to moderate cognitive impairment

What causes Down syndrome?

Down syndrome is caused by an extra chromosome, but experts are not certain why this occurs or what factors may play a role. One factor experts do know about is a mother’s age during pregnancy. Pregnant women who are age 35 and older are more likely to have a baby with Down syndrome than younger women.

How is Down syndrome treated?

There are not any specific treatments for Down syndrome. Children with Down syndrome may have physical, speech and occupational therapy to help them overcome challenges in these areas. Children with more serious medical problems, such as a heart condition, may need treatment for these conditions.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for Down syndrome.

Drooling, also called sialorrhea, is common in babies and toddlers up to about age 4. It can increase when toddlers are teething or when young children have allergies or a cold. But excessive drooling can sometimes be a problem. This can be the case for children who have cerebral palsy or a brain injury caused by another type of brain disorder, stroke or a traumatic brain injury.

There are two main types of drooling:

• Anterior drooling. This is drooling from the front of the mouth. It can cause problems with the skin.
• Posterior drooling. This type of drooling happens in the back of the mouth, and flows down the airway. It can cause choking or lung problems.

What are the signs and symptoms of drooling?

• Anterior drooling causes saliva to run out the mouth. It can cause wet clothing or a wet bib.
• Anterior drooling may cause choking or coughing.

What causes drooling?

Drooling is usually caused by decreased sensation in the mouth or poor motor control. This most often occurs in children who have a neurological problem, such as cerebral palsy or a brain injury caused by another type of brain disorder, stroke or a traumatic brain injury.

How is drooling treated?

Treatment options for drooling may include:

Surgical

• Surgical treatment may target the tonsils, adenoids, or salivary ducts or glands.

Non-surgical

• Anticholinergic medications may reduce drooling.
• Botulinum toxin (Botox) injections may help reduce the amount of saliva.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for drooling.

Tongue tie is a condition a baby is born with that keeps the tongue from moving freely in the mouth. It occurs when a band of tissue (called the frenulum) connects the underside of the tongue to the floor of the mouth. Usually, this tissue goes away on its own before birth, leaving just the back of the tongue attached.

Tongue tie can range from mild to severe, depending on the thickness of the tissue and where it is attached to the tongue. In some cases, it can make it hard for a baby to breastfeed. Tongue tie can also affect a child’s speech, eating and swallowing.

What are the signs and symptoms of tongue tie?

Some common symptoms of tongue tie include:

• Having trouble breastfeeding
• Difficulty speaking clearly
• Having trouble licking the lips or moving the tongue
• A tongue that looks heart-shaped or notched when it’s stuck out

What causes tongue tie?

Experts don’t know why the frenulum in some babies does not fully separate from the bottom of the mouth before birth. But tongue tie can run in some families, and it is more common in boys than in girls.

How is tongue tie treated?

Some children with mild tongue tie don’t need any treatment, especially if it is not causing any problems or symptoms. The frenulum can also stretch over time. This can make it easier for a child to move the tongue and speak clearly.

If your child’s tongue tie is severe, your doctor may recommend surgical treatment:

• Frenotomy (or frenulectomy). In this surgery, the doctor cuts the frenulum. It’s most often done in babies under 3 months old in the hospital nursery or during an office visit. A frenotomy usually does not require anesthesia because the area has few blood vessels or nerve endings.
• Frenuloplasty. This is a surgery to cut the frenulum under anesthesia. It is usually done in older children or when the frenulum is too thick for a frenotomy.

Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for tongue tie.