Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Is my son’s Speech Therapy causing more harm than good?

Question: I am concerned that while my son (aged 5) is attending a Speech and Language Therapist (SALT) for voice retraining for over a year, I feel it is causing more harm than good.

He had a nodule removed about a year ago. He continues to talk deep and hoarse and becomes high pitched when self-conscious, especially when with SALT.

Very concerned as he knows she not only thinks he talks wrong but watches how he walks, etc as attending physio for tippy toe walking.

My child is bright but has little developmental problems due to prematurity. Born at 26weeks. He is extremely social and totally tuned in. But as soon as he goes into the clinic his voice changes and the poor child tries to walk correctly as feels she is checking that out as well.

I am a Nurse and am increasingly concerned. I do not want my son to stop going if he will benefit but feel the negative effect will outweigh any possible benefit at this stage. Do you think his therapy is causing him more harm than good? Any suggestions?

Answer:
I would suggest a fresh ENT and SALT evaluation. New opinions can always help.

If you are in the New York area I would start with Dr. Robert Pincus at our practice.

Hope this clears things up!

Dr. Scott Gold

Q & A

My 5 month’s voice has gone hoarse after a long crying episode

Question: My 5 month’s voice has gone hoarse after a long crying episode. It happened about two days ago and I think his voice sounds raspy now and not as hoarse. He seems to have a hard time making the same high pitched sounds he used to be able to make during spontaneous vocalizations and during vocal play. What should I do, is this kind of hoarseness in infants common? Any help from your specialists would be greatly appreciated. Thank you!

Answer: Thanks for your question. Hoarseness for infants is not uncommon. It i quite comon for anyone, babies included, to develop hoarseness after vocal abuse. Certainly a long crying episode would fit.

When we breath- our vocal cords open to allow air to pass. When we speak or make noise, the vocal cords come together. They must come together smoothly for us to have a normal voice. However, when we speak loudly, or yell (or cry) – we are often banging the vocal cords together. This causes swelling, so that the closure becomes uneven and we percieve hoarseness. Most often, this is temporary, until the swelling goes down. Sometimes, we can develop a nodule or a polyp from this- which is really like a callus on the vocal cords. This would cause the poor voice to persist.

Using your voice minimally (modified voice rest) would help in the healing process. However, it is really impossible to get your baby to do so.

Almost always, his voice will come back to normal over the next few days or a week. If not, he should have an ear nose and throat doctor take a look at the vocal cords, (laryngoscopy) to make sure there has been no significant damage.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

NY Otolaryngology Group

Q & A

Bump in the Nose: Can Anything Be Done?

Question: My three-year-old daughter sustained a childhood nose injury to her by running into my husband’s knee. We did not take her to the ER because after some blood and tears, she seemed fine (she felt pain in the nose only to the touch and felt no pain at all the following day). She had no problems breathing. Three weeks later after the bruising seems to be almost 100 percent gone, I’m noticing a bump on the top (bone) part of her nose. A trip to an ENT today completely devastated me when he told me she probably fractured the bone and the bump may or may not go away. Either way, I was informed, nothing could be done at this point. Do you agree?

Answer: Nasal trauma often can be best addressed within the first few weeks, because the bones are mobile and easier to align. But, we can also address fractures in a delayed fashion, so I would recommend that she be evaluated to see if she would potentially benefit from surgery for the childhood nose injury. We would be very happy to see her in the office.

—Corinne E. Horn, MD

Q & A

My 15 year old has 6-8 colds a year. Could she have sinusitis?

Question: My teenage daughter (15) has been challenged with recurrent colds since she was at least 3 years old. At this time she still gets 6-8 colds a year, very heavy, sometimes turning into a sinus infection. Enlarged adenoids were removed in 2012 with no improvement. No OTC meds (pain or cold) have any impact, even prescription strength pain meds offer no relief. Excessive absences from school – feels too ill to go. Very heavy mucous production. CT scan in 2011 shows focus of mucosal thickening in the right maxillary sinus. Undulation of the nasal septum. No one has suggested chronic sinusitis. Are there cases of chronic sinusitis in teenagers? Our school is looking for a medical condition for the cause of her recurrent colds and seemingly continuos sinus infection. I’m looking to improve my daughter’s health.

Answer: Thank you for your question. One would not expect a healthy 15 year old to still get 6-8 colds a year. Chronic sinusitis in teenagers is rare. While upper respiratory tract infections are quite common in children, they tend to get less frequent as they enter the teen years. If she has continous sinus infections, I would suggest looking into other factors that could be causing these .

Among the possibilities (not all mutually exclusive) are: sinus infections or a chronic low grade infection with exacerbations, allergies, or least likely a partial weakness in her immune system.

Sinusitis can certainly cause her recurrent infections. Her CT scan sounds like it showed a sinus infection. The most common cause of recurrent sinus infections in children is chronic infections in the adenoids- and this seems like it was addressed. Sometimes, though, adenoids can regrow and get re-infected. I would ask your pediatrician to have her get an ENT evaluation.

She could also have allergies- either causing what seems like recurrent colds- or as a factor causing recurrent sinusitis.

Less likely is a selective immune deficiency. Some children may have a weakness in their ability to fight off colds because they have a diminished antibody response to certain viruses. This is not in any way related to AIDs- but can cause a child to have an increased number of these URIs.

If you are in the NY area- we would be happy to see your daughter here at the NY Sinus Center…

I hope this helps clears things up

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

My granddaughter has a hearing loss

Question:

My granddaughter is 3 months old. she did not pass the hearing test in the hospital and she have not passed 2 more since the original. They say she can hear high tones in one ear and the other ear has a retracted eardrum and she is not responding at all in that ear. She was born 3 weeks early but had no problems or issues other than this hearing problem. Is this normal? And can the retracted eardrum be corrected with a possibility of her hearing being restored completely? Thank you for any information regarding this situation.

Answer:

It is advantageous to you and your granddaughter to be pro-active when it relates to congenital hearing loss. The earlier the investigation, the better. It sounds as though you are already doing the right thing and are connected to an experienced pediatric hearing center. They should guide you through a stepwise investigation and treatment plan, which may include surgery for eardrum repair and/or cochlear implantation. These decisions are individualized based on the details of each case.

Where is she being treated? If you are in NY and wish an evaluation, I would be happy to help.

Best of luck

Neil M Sperling, MD

New York Otolaryngology Group

36A East 36th Street

New York, New York

www.NYOGMD.com

Associate Professor

Department of Otolaryngology

SUNY-Downstate College of Medicine

Brooklyn, New York

Q & A

My daughter has had ear tubes and an adenoidectomy was recommended

Question: My daughter is 6 years old and suffers from eustachian tube blockage (dysfunction). She has chronic fluid in her middle ear. She had a third ventilation tube put in her left ear in June 2012, and that ear is doing fine. Her right ear had a fungal infection which caused its second ventilation tube to fall out and created a perforation that lasted for nearly a year. The doctor thought it would not heal on its own, however, in December 2012 the perforation had closed.

The right ear now has a retracted eardrum. It is not a pocket, but rather the entire eardrum is retracted. The recommendation is to place a ventilation tube in that right ear and also remove the adenoid. I’d like to know if the retraction should be corrected with a vent tube or if this will cause an increase in the possible recurrence of the retraction. What is a safe amount of time that we can monitor a retraction if we choose to observe, rather than surgery?

Also, have any studies been done that can conclusively say that removing the adenoid will decrease the middle ear fluid? I would love to read current studies and recommendations for children with middle ear fluid.

Thank you!

Answer:

Thanks for your question. Unfortunately, your daughter has had a lot of trouble with her ears, but the good news is that she and you should get through this fine.

We place ventilation tubes through the eardrum to drain the middle ear in children (and adults) whose own normal drainage through their eustachian tubes is not working well. In these people, fluid builds up behind the eardrum and can cause infection and hearing loss. Only if the fluid fails to drain, do we recommend drainage tubes. They tend to stay in about 6 months, and then come out on their own. You usually don’t feel the tubes, or when they come out, but they should help in terms of middle ear infection and bringing back any hearing loss caused by the fluid. Putting in tubes doesn’t really get to the cause of the eustachian tube blockage (dysfunction) but usually allows time for your child to “grow out” of the problem.

Studies by Maw in England showed that if children needed a second set of tubes, an adenoidectomy if done at that second time, would lessen the need for a third set of tubes by almost 50 %.

Paradise in Pittsburgh showed that if an adenoidectomy were done at that second set of tubes, children spent 47% less time with fluid the first year after and 37% less time with fluid the next.

Usually, one would suggest doing an adenoidectomy should your daughter need tubes again. We do recommend putting tubes in for eardrums that are getting “retracted” or sucked back. The hope is that the tubes allow air to get into the middle ear space and push the eardrum back to its normal position. Once an eardrum is scarred in a retracted position, there may be a persistent hearing loss. I don’t know of any study saying how long one can observe a retraction, as I believe the development of scarring in that position is quite variable. I would discuss this with your doctor.

The good news though is that she is already 6, and most children are aging out of the problem about this age. There always is a possibility that this will resolve without further intervention, but it is hard to predict.

Robert Pincus MD

NY Sinus Center

NY Otolaryngology Group

Q & A

Causes (And Treatments) For Your Baby’s Hoarse Voice

Unfortunately, even though infants don’t possess fully developed vocal skills, they’re not immune to the hoarseness and vocal problems that can plague adults. If you notice that your infant has a raspy voice, there are a number of simple causes and solutions for that hoarse baby voice.

Common Causes of Hoarse Baby Voice

Prolonged crying. Although all infants cry, some do so more frequently, especially when suffering from colic. Excessive crying can lead to swollen vocal cords and a raspy voice. Once infants rest their voices, the hoarseness can diminish. Many infants outgrow phases of heavy crying on their own.
Acid reflux. Gastroesophageal disease, or acid reflux, is common in babies, and severe or frequent attacks can lead to a raspy voice. Although the condition occurs in many infants, it’s important to visit a doctor if you suspect acid reflux in your infant; the child’s eating and sleeping patterns also can be disrupted. Diet changes and medication often offer relief.
Vocal cord nodules. When the voice is used excessively, including from long crying spells, callous-like nodules can grow on the vocal cords and prevent them from functioning effectively. Vocal rest is usually recommended for these nodules, meaning that treatment can be difficult in infants, who cannot directly comprehend medical instructions. Check with a doctor if hoarseness persists – though in this condition, many infants must outgrow their crying before finding ease.
Allergies. Symptoms of allergies, including post-nasal drip, can lead to vocal-cord irritation and swelling. Hoarseness and other complications can result, so it’s especially important to consult a doctor to determine the cause of any allergic reactions.

Any general illness – even a cold – can be linked to hoarseness if it means your infant is suffering from congestion and a post-nasal drip. The accompanying raspy voice and discomfort should both pass once the illness does.

If your infant is experiencing vocal trouble, including signs of hoarseness, then feel free to contact our office anytime for personalized advice.

Sources:

http://www.livestrong.com/article/244436-causes-of-hoarseness-in-infants/

http://heartburn.about.com/od/infantschildrenandreflux/a/refluxininfants.htm

pediatric ENT Archives - The New York Otolaryngology Group

Is my son’s Speech Therapy causing more harm than good?

My 5 month’s voice has gone hoarse after a long crying episode

Bump in the Nose: Can Anything Be Done?

My 15 year old has 6-8 colds a year. Could she have sinusitis?

My granddaughter has a hearing loss

My daughter has had ear tubes and an adenoidectomy was recommended

Causes (And Treatments) For Your Baby’s Hoarse Voice

Common Causes of Hoarse Baby Voice