Adenoid Removal & Ear Tube Insertion for Kids [Tom Tamura]

My name is Tom Tamura. I am an otolaryngologist head and neck surgeon or ENT. We've lived in South Dakota for about six years here. We moved with my wife and three kids and we've loved it here ever since.

How are the ear, nose and throat interconnected?

So sinuses are air-filled cavities that make up the majority of large portions of your face let's say your forehead, your cheeks, the areas between your eyes and also further set of sinuses that are further back in your nose there. Now how they are connected to your ear is the most common space where children get ear infections is the middle ear space such as a space behind your eardrum. Now that space is ventilated or aerated by a tube that goes to the back part of your nose called your eustachian tube. So there is a correlation between children having nasal infections or nasal congestion and middle ear infections.

Why are young children susceptible to ear infections?

There tends to be both an anatomic component to it and an inflammatory component to it, meaning we think that children that are prone to ear infections that the tube that ventilates that middle ear space, that eustachian tube, tends to be shorter and more horizontal so it doesn't ventilate that space as well but also inflammation from the nose can potentially block that space or even go up into that space more easily. So, in general, we say that children do outgrow their troubles when it comes to ear infections because as they grow older that tube becomes more vertical and longer. But it sometimes it does take, you know, months or years to that for that to occur.

Why are children susceptible to upper respiratory infections?

The most common risk factor for snotty noses and children is generally daycare settings. So children that are in daycare settings, studies would say that you know that they get 12 to 18 snotty noses a year. So a lot has to do with exposure for them.

Why do ear infections often follow a respiratory infection?

There is that connection between the nose and middle ear space, so any kind of inflammation whether it's from a sinus infection, allergies, even some studies demonstrate that reflux does play a role that any kind of inflammation in the back part of the nose where that middle ear space drains or is ventilated by can cause ear infection.

Why are ear tube and adenoid procedures often performed at the same time?

Ear tubes and adenoids are frequently performed together because as we mentioned earlier there is a relationship between inflammation in the nose and ear infection. So when we take the adenoids out, if we can decrease the nasal inflammation hopefully, we can decrease the amount of ear infections. And there's good studies to say that addressing the adenoids at the same time as the ears will have improved results in respect to not only the nasal congestion but also the ear infections.

How are ear infections treated?

The most common things that why we treat ear infections or why we put tubes in are one, very simply patient discomfort or treating discomfort. Many patients that have ear infections, you know, the young children are pulling on the ears, there's fevers, many don't sleep as well. Long term, especially if both ears are affected, it can affect the hearing and young age which is a critical time for speech and language development so children that do have more ear troubles are more prone to having speech delay troubles. And there are some rarer complications that could lead to even permanent hearing loss but those are not as commonly seen but can occur.

How are ear tubes placed in children?

Ear tube placements in adults, it's actually something that you can do in the office but children obviously can't sit still for that so it's done under general anesthesia. In general, they're brought to the operating room and no IV or intubation is generally required it's just a little bit of mask anesthesia. The children go to sleep and with a microscope, we make a small incision in the eardrum and place an ear tube on each side.

How is the recovery from an ear tube placement?

So the recovery from ear tubes is usually very quick. Children maybe stay in the hospital another half-hour or hour after their procedure and in general, they may be a little bit more tired that first day but they're usually back to normal the next day unless there's a little bit of ear drainage. In general, eight out of ten children do outgrow their troubles in the time period that the tubes are in which average is about six months to a year.

How are chronic respiratory and sinus infections treated?

Your sinuses are not fully developed until you're around 12 or 13 when they're closer to their adult form there. So in children that do have recurrent sinus troubles, and we're thinking about again every other month or so, the main focus of treatment for those to start generally is the adenoids. So removing the adenoids and children about 50% to 75% do much better from a nasal infection perspective.

How are adenoids removed?

To give you an idea anatomically where adenoids are, they are in the very back part of the nose where it starts beginning the upper part of the throat. So you can't see those in, you know, just by looking without using a scope and the treatment generally is remove those under general anesthesia. So your child would meet the operating room team here, meet the anesthesia team, meet the nursing team and they would go back to the operating room and they get a little mask, anesthesia, and they would go off to sleep. Once they are fully asleep an IV is placed and intubated. All the surgery is actually done through the mouth and the adenoids are removed in the back part of the nose, upper throat. Generally, if we're doing this for recurrent infections about 50% to 75% of children do much better for them.

How is the recovery from an adenoid removal?

Generally, removing adenoids doesn't require a significant recovery from the pain perspective as a tonsillectomy for example and in children might have about two to three days of mild sore throat and they do have about a week of increased nasal congestion as well as some bad breath that goes along with them.  But otherwise, they're usually doing very well.

Would you recommend Brookings Health System for ear tube insertion and adenoid removal?

I think it provides excellent care in a local setting here and I've had the privilege of doing a number of these pediatric cases here and I think it works out really well for the patients and especially with younger children you don't have to get up very early in the morning and drive an hour and then wait in the hospital for a long time to get checked in and for the procedure to occur. The team provides excellent care here when it comes from the nursing staff in the operating room to the anesthesia team to the recovery team. And overall, the patients that I have operated on here have been very happy with the care.