Tongue Tie - Has Major Implications - Check it and Get it Cured before its Too Late

 Tongue-tie is the non-medical term for a condition that limits the use of the tongue. Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. As we grow, it recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. 

In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems. In tongue-tie, the free movement of the tongue is restricted due to abnormal attachment of the base of the tongue (lingual frenulum) towards the tip of the tongue.

                                    

                                   Problems Associated with Tongue Tie

Feeding – A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie.  

Speech - In some children, tongue tie may also cause speech defects, preventing speech defects may be another reason to consider surgical intervention. Although, there is no obvious way to tell in infancy which children will have speech difficulties later, the following associated characteristics are common:

• V-shaped notch at the tip of the tongue
• Inability to stick out the tongue past the upper gums
• Inability to touch the roof of the mouth
• Difficulty moving the tongue from side to side

Dental - Tongue tie may contribute to dental problems as well, causing a persistent gap between the bottom two front teeth.

                               

                                             Does My Child Need Surgery for Tongue Tie?                                          

Tongue tie often resolves on its own after two or three years of age. As a child grows and develops, the frenulum often continues to recede (normally it recedes before birth), lessening the abnormality. Unless feeding is a problem, it is recommended to wait at least a year before considering surgery. If tongue tie interferes with a baby’s feeding, early intervention is usually warranted

Tongue-tie surgery (frenulectomy) is a simple procedure and there are normally no complications. Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.

What is Pediatric Sleep Apnea? What is the Main Cause

 

Chronic running nose, mouth breathing, dry Mouth frequent infections especially of the lungs, poor appetite, halitosis, nasal congestion, and ADHD like symptoms mainly aggression, poor concentration, and irritability rather than to act or complain of feeling “sleepy.”

Since OSA results from relative narrowing of upper airway rather than the absolute size of the tonsils and adenoids, tonsillar size Adenotonsillectomy is an effective first-line treatment for pediatric OSA.

Failure to thrive because of pediatric OSA is also corrected with Adenotonsillectomy and shown to increase the height and weight of children

MISDIAGNOSING SLEEP APNEA AS ADHD

Attention deficit hyperactivity disorder, also known as ADHD, is a common condition diagnosed due to symptoms indicating hyperactivity, inattentiveness, and impulsivity. Attention-deficit/hyperactivity disorder is among the neurobehavioral sequelae associated with OSA in nearly 75 percent of children. 

OSAS in children is a similar condition to the form in adults in children.

· If left untreated, OSAS is associated with adverse effects on growth and development, and can cause metabolic, cardiovascular and neurocognitive disease and behavioural changes in children.

· Daytime hyperactivity.

· Cognitive deficits.

· Cardiovascular problems - eg, hypertension, left ventricular hypertrophy, raised pulmonary artery pressure.

· Failure to thrive.

· Association with insulin resistance.

· Some studies have shown that children with OSAS have greater impulsivity when crossing streets which increases their risk of injury.

· School-aged children are at risk of developing future obesity if they have OSAS.

 

ADHD or just Adenoidal Swelling?

Many a times I see parents who have a hyperactive child and worse they would have put the child in a special school or even taken the child to a child psychologist. What majority forget is that Adenoidal swelling mimics Attention Deficit Disorder.

One of the thing every parent should note is how their child breathes at night.

If in doubt take the child to a specialist who also specializes in paediatric ENT and paediatric sleep apnea disorders, its much easier to rule out Adenoid as the cause but the negative impact on the child once branded ADHD is too huge a price to pay.

My Child Wakes Up With Pain in the Ear - What To Do

Acute Pain causing extreme discomfort to the Child will happen because of many reasons,one of  the commonest of these is Otitis media which is a build up of fluid in the middle ear, the space between the eardrum and the inner ear. The middle ear is usually filled with air. Sometimes it gets filled with fluid or mucus, for example during a cold. 

Symptoms

• severe earache, due to the pressure of the mucus on the eardrum, 
• fever; 
• flu-like symptoms in children, such as vomiting and lethargy;  
• slight deafness.

Babies with ear infections will be hot and irritable. They cannot point to the source of discomfort so it can be hard to tell what is wrong with a baby, but an ear infection is one possibility to consider if your baby is unsettled in this way.

In rare cases the eardrum will become perforated (a hole will form in it), and pus will then be seen running out of the ear.  This sometimes helps to relieve pain, by releasing the pressure on the eardrum, but can lead to reinfection.

Not all earaches are caused by ear infections - especially if there are no other symptoms. Earache may also be caused by build up of uninfected mucus after a cold, or toothache.

Causes

The infection spreads from the nose or throat through the Eustachian tube, a passage between the throat and the middle ear.

Any fluids in the ear usually run out through the nose, via the Eustachian tube. If this tube gets blocked it can lead to otitis media. Enlarged adenoids or tonsils, which are at the back of the throat, may block the Eustachian tube.

A perforated eardrum may get infected if water enters a child's ear during bathing or swimming.

Treatment

Around 80% of cases of acute otitis media clear up within three days without any treatment. Perforated ear drums also usually heal by themselves.

While antibiotics may help with the short-term symptoms, there is no evidence that they make otitis media clear up faster or reduce the chance of complications happening.

Pain killing drugs like paracetamol or ibuprofen may be used to control the symptoms of otitis media (pain and fever).

Nose drops containing decongestants or antihistamines may be used to reduce the swelling of the mucous membranes in the nose and back of the throat. In theory, this will help to keep the Eustachian tubes clear and allow mucus to drain from the middle ear, but again, this has not been proved to be an effective treatment for otitis media.

Removal of the adenoids and tonsils may help if they are blocking the entrance to the Eustachian tube.

Prevention

There is little evidence that any specific measures prevent otitis media.

If acute ear infections are treated quickly, and there is a follow up examination to check that the infection is completely cured, this reduces the chances of chronic (recurring) infection developing.

Dr.Kumaresh Krishnamoorthy, M.S (ENT)

Head and Neck Surgery Fellowship (Buffalo, USA)

Neurotology & Skull Base Surgery Fellowship (Cincinnati, USA)

Senior Consultant in ENT - Head and Neck Surgeon and Skull Base Surgeon

patients@drkumaresh.com

Know About Paediatric Sleep Apnea and Its Management

Advantages of Endoscopic Coblator Assisted Adenoid Removal

Adenoids are glandular tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity. You cannot see your adenoids. An x-ray is done to determine the size of the adenoids.

Adenoids help to defend the body from infection. They trap bacteria and viruses which you breathe in through your nose; they contain cells and antibodies of the immune system to help prevent throat and lung infections.

Although adenoids may help to prevent infection, they are not considered to be very important. The body has other means of preventing infection and fighting off bacteria and viruses. In fact, the adenoids tend to shrink after early childhood, and by the teenage years they often almost disappear completely. Generally, you can have your adenoids removed without increasing your risk of infection.

Traditionally blind curetting of adenoidal tissue was times tested method but leaves behind large amounts of adenoidtissue causing air flow obstruction. Endoscopic coblation adenoidectomy ensures complete removal of adenoid tissue and reduces postoperative adenoid grade. Another benefit is the ability to use a single instrument to ablate and coagulate tissue, with significant improvement of patient recovery. It can also reach the cranial portion of the adenoid and its intranasal extension.

The advantages observed with coblation adenoidectomy, compared with the curettage technique are:

1. the lack of bleeding (abundant bleeding with curettage);
2. provides a direct endoscopic view of the adenoid (blind surgery or mirror view with traditional cold curettage);
3. the ability to reach all the areas of the rhinopharynx up to the Eustachian tube opening (the cranial part of the rhinopharynx cannot be reached with curettage);
4. lower risk of residual adenoid tissue after coblator surgery;
5. fewer complications (no cutting blade with coblation adenoidectomy);
6. it is suitable for patients of all ages, although the decrease of pain intensity and duration is important in paediatric patients;
7. reduction in the use of post-operative drug and loss of working days for parents due to faster post-surgical healing.

Tongue Tie

Tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.
Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. As we grow, it recedes and thins. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems.
In tongue-tie, the free movement of the tongue is restricted due to abnormal attachment of the base of the tongue (lingual frenulum) towards the tip of the tongue.

Problems Associated with Tongue Tie
Feeding – A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie. Although it is often overlooked, tongue tie can be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breast feeding altogether.

Speech - In some children, tongue tie may also cause speech defects, especially articulation of the sounds - l, r, t, d, n, th, sh, and z. Preventing speech defects or improving a child’s articulation may be another reason to consider surgical intervention. Although, there is no obvious way to tell in infancy which children will have speech difficulties later, the following associated characteristics are common:
• V-shaped notch at the tip of the tongue
• Inability to stick out the tongue past the upper gums
• Inability to touch the roof of the mouth
• Difficulty moving the tongue from side to side
Dental - Tongue tie may contribute to dental problems as well, causing a persistent gap between the bottom two front teeth.

Does My Child Need Surgery?
Tongue tie often resolves on its own after two or three years of age. As a child grows and develops, the frenulum often continues to recede (normally it recedes before birth), lessening the abnormality. Unless feeding is a problem, it is recommended to wait at least a year before considering surgery. If tongue tie interferes with a baby’s feeding, early intervention is usually warranted

Tongue-tie surgery (frenulectomy) is a simple procedure and there are normally no complications. For very young infants (less than 3months old), it may be done in the office of the ENT specialist. General anesthesia may be recommended when frenulectomy is performed on older children.
While frenulectomy is relatively simple, it can yield big results. Risks of frenulectomy are very low.
Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.


If you have any further doubts contact your ENT specialist/Paediatrician who can help you.

Tonsils and Adenoids

What are adenoids and tonsils?
Tonsils
Tonsils are made of soft glandular tissue and are part of the immune system. You have two tonsils, one on either side at the back of the mouth. Tonsils vary in size from person to person. A main function of tonsils is to trap bacteria and viruses (germs) which you may breathe in. Antibodies and immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.
You can normally see your tonsils by opening your mouth wide and looking in a mirror. They are the two fleshy lumps that you can see at the sides and back of the mouth.

Adenoids
Adenoids are also made of glandular tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity. Adenoids get bigger after you are born but usually stop growing between the ages of 3 and 7 years. You cannot see your adenoids. If needed, a doctor can look at the adenoids either by using a light and a small mirror held at the back of the mouth, or by using a small flexible telescope. Occasionally, an x-ray is done to determine the size of the adenoids.
Like tonsils, adenoids help to defend the body from infection. They trap bacteria and viruses which you breathe in through your nose. Like tonsils, they contain cells and antibodies of the immune system to help prevent throat and lung infections.
Although tonsils and adenoids may help to prevent infection, they are not considered to be very important. The body has other means of preventing infection and fighting off bacteria and viruses. In fact, the adenoids tend to shrink after early childhood, and by the teenage years they often almost disappear completely. Generally, you can have your tonsils and adenoids removed without increasing your risk of infection.