Otoplasty: Is Your Child a Candidate for Prominent Ear Surgery?

Prominent ears are a cosmetic deformity that can have a serious emotional and behavioral effect on a child. Kids can sometimes be cruel, and children with protruding ears are easy targets from intentional teasing by peers and sometimes even from adults! 

The ear reaches 90% of its adult size by 5 years of age and is usually fully grown by 7 years of age. Prominent ears typically do not affect a child's self-image until the child is 5 years of age. Therefore, the best time to perform the corrective surgery for prominent ears is before the child starts school.

Surgical technique used to correct protruding ears is called otoplasty. Numerous otoplasty techniques are used to correct different types of ear deformities. Generally, the cartilage excess is removed, cartilage is remodeled, and sutures stabilizing the ear closer to the temple are placed. In adults and teenagers, otoplasty can be performed under local anesthesia, but in smaller children general anesthesia is used. The procedure lasts approximately 1-2 hours. The skin incision is made behind the ear, so the scar is out of view. This scar will fade over time and will become barely noticeable.

Following surgery, the child may be discharged on the same day. The head is wrapped in an elastic bandage. It is normal for kids to experience some soreness or swelling, but any post-operative discomfort can be easily managed through simple medications. Following otoplasty, kids can return to school or kindergarten in approximately one week.

Otoplasty is the only purely cosmetic procedure that is performed on children. It is very rewarding because it makes a difference in the life of a child, while satisfaction rate for this surgery is among the highest of all cosmetic procedures! 

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Coblation (Radiofrequency) Turbinate Reduction

Coblation involves touching the lower nasal turbinates (which are the largest nasal turbinates) with a coblator probe (small pointed instrument that releases bipolar radiofrequency waves). It then heats a part of the soft tissue inside the turbinate creating a pocket that eventually shrinks resulting in effectively a smaller turbinate and a smaller surface of turbinate mucosa. Eventually, after that procedure, if you will experience allergies, cold, or any other disease that causes nasal mucosa swelling – your turbinates will not swell up as much reducing the likelihood of having a congested nose…

Coblation turbinotomy is performed as an office procedure. This means that you can go home immediately after the treatment. Before we start, we will put into your nose a cotton pledges soaked with a local anesthetic. After 10-15 minutes, you nose will feel numb, and we will precisely deliver radiofrequency energy at several spots at your lower turbinates. After the procedure there is no bleeding or pain, you will only feel moderate swelling of inside your nose for couple of next days. In overall, turbinate coblation is quick and easy procedure that yields high patient satisfaction rate!

What Are Nasal Turbinates?

Your nasal cavities are not just a two hollow tubes! Actually, the nasal cavities are baffled by nasal turbinates, a long, narrow and curled bone shelves (that are shaped like an elongated sea-shell) that protrude into the breathing passages of the nose and are covered with the same nasal mucosa as other parts of your nasal cavity. The turbinates divide the nasal airway into groove-like air passages, and are responsible for forcing inhaled air to flow in a steady, regular pattern around the largest possible surface of mucosa. Their function is to warm, moisten and filter the air, and add some resistance to your nasal breathing.

Large, swollen turbinates may lead to blockage of nasal breathing! Allergies, exposure to environmental irritants, or a persistent inflammation within the sinuses can lead to turbinate swelling. Most people think when their nose is congested it is due to it being full of secretion. Actually, the cause of congestion may be swollen turbinates that are restricting their nasal passages and give them the stopped up feeling.

Medical treatment of the underlying allergy or irritant may reduce turbinate swelling. In cases that do not resolve with the use of medical therapy (nasal sprays etc.), coblation (radiofrequency) or laser turbinate procedure may be required.

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Sinus problems in children

Sinus problems in children are less common than in adults for a simple reason - child’s sinuses are not fully developed until late in the teen years! In adults, there are 4 main pairs of sinuses: maxillary (behind the cheek), ethmoid (between the eyes), frontal (in the forehead area), and sphenoid (the hidden paranasal cavity, located approximately in the middle of the head). In children, only the maxillary and ethmoid sinuses are present at birth!

Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such as viral illness and allergy.

The following symptoms may indicate that your child suffers from sinus infection:

• symptoms of a “common cold” lasting more than 14 days, sometimes accompanied with a low-grade fever

• thick, persistent yellow-green nasal discharge

• complaints of a post-nasal discharge, sometimes leading to sore throat, cough, bad breath, nausea or vomiting

• prolonged nighttime cough

• facial discomfort

• headache in children age six or older

• swelling around the eyes, often worse in the morning

Your child's ENT specialist can diagnose sinusitis based on your child's symptoms and physical examination. In some cases additional tests may be performed to confirm the diagnosis. These may include sinus x-rays, computed tomography, or microbial cultures from sinuses.

ULTRASOUND IMAGING OF THE THYROID GLAND

Ultrasound imaging - also called ultrasonography - involves examining your thyroid with high-frequency sound waves that are transferred back to the computer and rendered to produce pictures of the inside of your neck. Ultrasound examinations are harmless and do not use ionizing radiation (as it is used in x-rays). Because ultrasound imaging is performed in real-time, imaging can also show blood flowing through blood vessels and dynamic movements of different structures in the neck (like muscular contractions, swallowing act etc.).

The thyroid gland is located in the middle of the neck (above the trachea) and is shaped like a butterfly. It is an endocrine gland, which produces and releases hormones into the bloodstream. The thyroid hormones help to regulate a variety of body metabolic functions.

About 5 to 10 percent of adults may have lumps in their thyroid that can be palpated on physical exam. Ultrasound is much more sensitive than a physical exam and is able to show much smaller nodules that cannot be felt by palpation. In adult women, thyroid gland nodules can be found on ultrasound in 30 to 40 percent of cases!!

Fortunately, the vast majority of these nodules are just benign changes that pose no health risk. The minority could be true cancers of the thyroid and may require further diagnosis or treatment. Regular ultrasound examinations may discover these cancers in the earliest stages when they are just couple of millimeters in diameter and can be completely cured with minimally invasive surgical approaches!