OSBORNE HEAD & NECK INSTITUTE

Pediatric Sleep Apnea

Sleep problems in children fall on a large spectrum called sleep disordered breathing, which includes simple snoring and true sleep apnea, among other problems.

Snoring

Snoring is simply noisy breathing while sleeping. This may indicate something simple and easily treatable such as large adenoid tissue or nasal allergy. However, it may also represent a more significant sleep problem, such as sleep apnea. It is important to have a snoring child evaluated to rule out concerning problems.

Pediatric obstructive sleep apnea

Pediatric sleep apnea is diagnosed when the child stops breathing during sleep. This may appear like snoring, as the child will also snore. However, in children with obstructive sleep apnea (OSA), the snoring progresses to where the child stops breathing.

The usual history is that of a child who snores and then, for a few seconds, makes no noise and then gasps or snorts, wakes up a little, breathes normally, and then resumes snoring. This cycle continues throughout the night.

OSA occurs due to physical obstruction of the airways during sleep. This is most commonly due to large tonsils and adenoid tissue. During sleep, the body normally relaxes, which causes collapse of the muscles of the throat. When the patient is awake, the tonsils do not touch but with the collapse of muscles during sleep, the tonsils touch and obstruct the airway. The obstruction causes a drop in oxygen, which signals the brain to try to relieve the obstruction. It does so by waking the child, so that the muscles are no longer relaxed and the airway is open. The child then falls back asleep and the cycle resumes.

The most important part of this cycle is that during the period of poor oyxgen flow, the body goes into a state of stress, which disrupts sleep quality and can be strenuous on the body. Poor sleep quality in children results in many symptoms including:

Change in the child’s temperament: the sleep-deprived child may become cranky, moody, inattentive, and disruptive at home and school.
Poor school performance
Lack of energy
Bedwetting
Slower growth or stunted growth
Attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD)

Diagnosis of sleep disordered breathing

There is perhaps no one more important in the diagnosis of pediatric sleep problems than the parent or caregiver. The parent may observe snoring, gasping, snorting, and thrashing in bed as well as unexplained bedwetting. They will receive reports from school about misbehavior and poor school performance or may notice their child does not appear their usual selves.

While it is important to bear in mind that not all children with poor school performance suffer from a sleep problem, it should be a consideration when snoring and social/school issues are noted.

The sleep study is the standard diagnostic test for sleep disordered breathing. This test can be performed in a sleep laboratory with the parents present. While not 100% reliable, they may give clues as to the nature of a child’s sleep problems. They may also help the clinician by leading towards or away from certain treatment choices.

How is sleep disordered breathing treated?

After thorough evaluation by the pediatrician and pediatric otolaryngologist, many treatment options may be considered including:

Tonsillectomy
Adenoidectomy
Nasal sprays
Nasal surgery

Tonsillectomy and adenoidectomy is not necessary in every snoring child. It is critical to form a treatment plan with your pediatric otolaryngologist. If it is determined that surgery is the right course for your child, tonsillectomy and adenoidectomy have an extremely high success rate at curing sleep disordered breathing.

A special group of children are those with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue, and associated structures. These children often have sleep disordered breathing. This must be managed and treated as the child grows.

We understand that while some children can explain what is hurting or bothering them, many cannot

Pediatric Allergy & Sinus Disease

Pediatric
Sleep Apnea

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Otoplasty is any surgery that alters the appearance of the ears.

Pediatric
Otoplasty

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Your OHNI doctor understands what you as a parent are going through, not only as a physician but also as a parent of a child. They will take the time to answer your questions and explain the medical issues in terms you can understand. You will then review the treatment choices together to determine the best option for your child.

Your doctor will first ask you about the history of this problem.

How many ear infections has your child had and over what time period?

What are the symptoms during an infection? Fever? Pain? Decreased appetite? Waking up at night?

Have you noticed a change in your child’s hearing or your child speaking loudly? How is your child’s speech?

Is your child’s balance affected?

Is your child’s ear infection normally treated with antibiotics? What antibiotics? Do they work? Does the ear fluid clear after the ear infection?

Does your child have any other medical problems? Has your child ever had surgery? Is your child allergic to any medications? Is your child taking any medications at this time? Did anyone else in the family ever have recurrent ear infections?

Your doctor will then examine your child. They will specifically be looking at the ear for fluid and position of the eardrum.
Your doctor will likely order a hearing test for your child. An order will be written and you will call to schedule this test in the near future. The audiologist will send your doctor a report of your hearing test. Your doctor will call to notify you of the results and further recommendations.
Your doctor will discuss appropriate treatment options for your child including close monitoring, medications or surgery including ear tubes and possibly adenoidectomy.

Ear tubes are small plastic grommets which look like spools of thread. During surgery, an incision is made in the ear drum and the tube is placed to keep this hole open. The tube allows fluid to drain out and air to get in the middle ear. The tubes usually stay in the ear drum for 12-18 months. The tubes normally fall out of the ear drum on their own and the ear drum hole closes. After a child has ear tubes, the ears will need to be checked periodically to make sure the tubes are in place and functioning. The tubes can get blocked, fall out to early, stay in too long requiring removal, or leave a hole in ear drum which needs to be repaired. There may be a scar or thickening of the ear drum where the tube had been. This thickening usually does not affect the hearing. Placement of ear tubes is a surgical procedure that is preformed under general anesthesia lasting about 15 minutes. Patients go home the same day with minimal ear pain. A child can return to school and normal activities the following day.

In older children who are having recurrent ear infections or a child is having a second set of tubes placed, an adenoidectomy is also often recommended. An adenoidectomy is a surgery done through the mouth to remove the adenoid tissue in the back of the nose. The adenoids are usually removed if they are enlarged blocking the back of the nose or as the source of bacteria that is re-infecting the nose and ears. Surgery is preformed under general anesthesia, usually lasting less than 30 minutes. Most often patients can go home the same day as the adenoidectomy. Recovery is usually 3 to 5 days, requiring light activity and possibly pain medication.

An x-ray or scope exam may be recommended to evaluate the adenoids. The adenoids are lymphoid tissue in the back of your nose similar to the tonsils. The scope exam can be done during your office visit. Medication is sprayed to decongest and numb the nose. A tiny camera is the used to look inside the nose to inspect the nasal passages, the adenoids and the back of the throat. If an x-ray is ordered, it can usually be done the same day in the radiology department. Once your doctor receives the report and looks at the x-ray they will notify you of the results and further recommendations.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

Your doctor will first ask you about the history of this problem.

How many strep/throat infections has your child had and over what time period?

What are the symptoms during an infection? Fever? Pain? Sore throat? Decreased appetite? Waking up at night? Does it affect your child’s breathing? Does your child snore? Do they stop breathing? Pause or gasp in their sleep? Is your child a restless sleeper?

Do the tonsils get big? Does your child have difficulty swallowing?

Is your child’s strep/throat infection normally treated with antibiotics? What antibiotics? Do they work?

Your doctor will then examine your child. They will specifically be looking at the tonsils in the back of the throat.
Your doctor will discuss appropriate treatment options for your child including close monitoring, medications or surgery including tonsillectomy.

Tonsillectomy is a surgical procedure that is preformed under general anesthesia with the patient usually going home the same day when preformed for recurrent strep. The tonsils are balls of lymphoid tissue behind the tongue on either side of the back of the throat. Often it is recommended the adenoids be removed at the same time the tonsils are removed. Adenoids are lymphoid tissue similar to tonsils but located in the back of the nose just above the tonsils behind the palate. Tonsillectomy recovery is usually 2 weeks requiring light activity, soft diet and pain medications. If a child has surgery during the school year, they usually are out of school for 1 week.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

Your doctor will first ask you about the history of this problem.

How many sinus infections has your child had and over what time period?

What are the symptoms during an infection? Fever? Headache? Facial pain? Teeth pain? Decreased sense of smell? Nasal congestion? Nasal drainage, clear, white or discolored? Bad breath? Post nasal drip? Cough? Decreased appetite? Waking up at night?

Does it affect your child’s breathing? Does your child have difficulty breathing thru their nose? Does your child mouth breathe? Does your child snore?

Does the sinus infection start after a “cold” or allergies? Does you child always have a runny nose or does it stop between infections?

Is your child’s sinus infection normally treated with antibiotics? What antibiotics? Do they work? Is your child ever treated with other medications including nose sprays, decongestants or antihistamines such as Benadryl or Claritin?

Your doctor will then examine your child. They will specifically be looking at the nose.
An x-ray or scope exam may be recommended to evaluate the adenoids. The adenoids are lymphoid tissue in the back of your nose similar to the tonsils. The scope exam can be done during your office visit. Medication is sprayed to decongest and numb the nose. A tiny camera is the used to look inside the nose to inspect the nasal passages, the adenoids and the back of the throat. If an x-ray is ordered, it can usually be done the same day in the radiology department. Once your doctor receives the report and looks at the x-ray they will notify you of the results and further recommendations.
Your doctor will discuss appropriate treatment options for your child including close monitoring, medications, allergy testing, further imaging or surgery including adenoidectomy.

Adenoidectomy is a surgery done through the mouth to remove the adenoid tissue in the back of the nose. The adenoids are usually removed if they are enlarged blocking breathing through the nose or as the source of bacteria re-infecting the nose and ears. Surgery is preformed under general anesthesia, usually lasting less than 30 minutes. Most often patients can go home the same day as the adenoidectomy. Recovery is usually 3 to 5 days, requiring light activity and possibly pain medication.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.

If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

Your doctor will first ask you about the history of this problem.

Did your child pass their newborn hearing screen? Have they had a recent hearing test? Please bring a copy of your recent hearing test to the office visit.

Have you had concerns about their hearing at home or at school? How long has the hearing been a concern?

Has your child had recurrent ear infections? How many ear infections has your child had and over what time period? Is your child’s ear infection normally treated with antibiotics? What antibiotics? Do they work? Does the ear fluid clear after the ear infection?

How is your child’s speech? Does your child complain of any ringing or other sounds in their ears?

Does your child have any other medical problems? Has your child ever had surgery? Is your child allergic to any medications? Is your child taking any medications at this time? Does anyone else in the family have hearing loss?

Your doctor will then examine your child. They will specifically be looking at the ear for fluid and position of the eardrum.
Your doctor will likely order a hearing test for your child. An order will be written and you will call to schedule this test in the near future. The audiologist will send your doctor a report of your hearing test. your doctor will call to notify you of the results and further recommendations. Depending on the type of hearing loss, your child may need a CT scan or MRI.
Your doctor will discuss appropriate treatment options for your child including close monitoring, medications, imaging studies or surgery including ear tubes.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment. You may be instructed to repeat the hearing test in the future.

Your doctor will first ask you about the history of this problem.

How long has your child snored? Does your child snore all the time or just when they are sick? Does your child stop breathing? Pause? Gasp? Wake up? Is your child a restless sleeper? In the morning, does it seem like your child has gotten a good night’s sleep? Does your child have headaches? Does your child wet the bed? Does your child have chronic nasal congestion or nasal drainage? Bad breath? Post nasal drip? Cough? Decreased appetite? Waking up at night? Does it affect your child’s breathing? Does your child have difficulty breathing thru their nose? Does your child mouth breathe?

Has your child been treated with antibiotics? What antibiotics? Did it change their breathing? Is your child ever treated with other medications including nose sprays, decongestants or antihistamines such as Benadryl or Claritin?

Your doctor will then examine your child. They will specifically be looking at the nose and the mouth.
An x-ray or scope exam may be recommended to evaluate the adenoids. The adenoids are lymphoid tissue in the back of your nose similar to the tonsils. The scope exam can be done during your office visit. Medication is sprayed to decongest and numb the nose. A tiny camera is the used to look inside the nose to inspect the nasal passages, the adenoids and the back of the throat. If an x-ray is ordered, it can usually be done the same day in the radiology department. Once your doctor receives the report and looks at the x-ray they will notify you of the results and further recommendations.
Your doctor will discuss appropriate treatment options for your child including monitoring sleep at home, a sleep study, medications or surgery including adenoidectomy and/or tonsillectomy.

A sleep study is preformed at an outpatient sleep lab where you and your child will spend the night. Before going to sleep a sleep tech will place monitors on your child to detect their snoring, breathing, oxygen, heart rate, brain activity and leg movements. It is best to prepare a child for this test as they often do better when they know what to expect. It can be described as spending the night in a special hotel with mom or dad, sleeping with lots of stickers and wires on which are not painful. When the sleep study is completed a sleep doctor will interpret the results and send your doctor a report. Once your doctor receives the report they will call you with the results and further recommendations.

Adenoidectomy is a surgery done through the mouth to remove the adenoid tissue in the back of the nose. The adenoids are removed to unblock the back of the nose and improve breathing through the nose. Surgery is preformed under general anesthesia, usually lasting less than 30 minutes. Usually patients can go home the same day after the adenoidectomy. Recovery is usually 3 to 5 days, requiring light activity and possibly pain medication.

Tonsillectomy is sometimes preformed with an adenoidectomy. Tonsillectomy is usually recommended if a child has obstructive sleep apnea where they stop breathing with pausing and gasping spells while asleep. If is unclear is a child has obstructive sleep apnea, a sleep study can be ordered to monitor a child’s breathing while asleep. Tonsillectomy is a surgical procedure that is sometimes done in the hospital with a stay overnight if a child has obstructive sleep apnea. Tonsillectomy recovery is usually 2 weeks requiring light activity, soft diet and pain medications. If a child has surgery during the school year, they usually are out of school for 1 week.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

Your doctor will first ask you about the history of this problem.

How long has your child had a stuffy nose? Does your child always sniff? Blow their nose? Does your child sneeze often? Does your child have itchy watery eyes? Does your child have a runny nose? Does your child have difficulty breathing thru their nose? Does your child mouth breathe? Does your child snore? Does your child get recurrent “colds”? Does your child get sinus infections? Does you child always have a runny nose or does it stop between infections? How many sinus infections has your child had and over what time period? What are the symptoms during an infection? Fever? Headache? Facial pain? Teeth pain? Decreased sense of smell? Nasal congestion? Nasal drainage, clear, white or discolored? Bad breath? Post nasal drip? Cough? Decreased appetite? Waking up at night? Does it affect your child’s breathing? Is your child’s sinus infection normally treated with antibiotics? What antibiotics? Do they work? Is your child ever treated with other medications including nose sprays, decongestants or antihistamines such as Benadryl or Claritin? Has your child ever been allergy tested?

Your doctor will then examine your child. They will specifically be looking at the nose.
An x-ray or scope exam may be recommended to evaluate the adenoids. The adenoids are lymphoid tissue in the back of your nose similar to the tonsils. The scope exam can be done during your office visit. Medication is sprayed to decongest and numb the nose. A tiny camera is the used to look inside the nose to inspect the nasal passages, the adenoids and the back of the throat. If an x-ray is ordered, it can usually be done the same day in the radiology department. Once your doctor receives the report and looks at the x-ray they will notify you of the results and further recommendations.
Your doctor will discuss appropriate treatment options for your child including close monitoring, medications, allergy testing or surgery including adenoidectomy.

If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
Allergy testing can be done by skin testing or blood work. Your doctor can perform skin allergy testing in the office. This is usually scheduled as a separate visit. The allergens are applied to the skin and the local reaction is measured to determine if allergies are present. The results are known with in 20 minutes. Patients must be off antihistamine medications for 2 weeks prior to allergy testing. If blood allergy testing is recommended, a lab order will be written and sent to the lab. You can schedule to have the labs drawn at your convenience. Once your doctor receives the results, they will call you to review the results and make further recommendations.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

Your doctor will first ask you about the history of this problem.

How long has the lump been present? Has it changed in size? Does it hurt? Has your child had a fever? Can your child move their neck? Does the lump affect your child’s breathing? Eating? Has you child ever had this neck lump before? How was it treated? Has your child recently been treated with antibiotics? Does your child have any other symptoms? Stuffy nose? Sore throat? Ear ache? Has your child been sick recently? Has your child had any trauma recently? Does your child have any other lumps on their body? Weight loss? Cough? Decreased appetite? Waking up at night? Night sweats? Voice changes? Has your child been around anyone sick? Have you traveled recently? Where? Any recent inset bites? Has your child been around cats? Are your child’s immunizations up to date? Has your child had any immunizations recently?

Your doctor will then examine your child. They will specifically be looking at the neck.
Your doctor will discuss appropriate treatment options for your child including imaging, fine needle aspiration, close monitoring, medications or surgery.
If imaging, fine needle aspiration or lab work is recommended, your doctor will write and order which will be sent to imaging center and/or lab. You will then call to schedule a time for these tests in the near future. Your doctor will call you when they get the results of these tests to discuss further recommendations.
If surgery is recommended, you will meet with surgery schedulers to pick a date and discuss insurance coverage.
If observation or medical treatment is recommended, your prescriptions will be sent to your pharmacy and you will schedule a follow up appointment.

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