Pediatric Otolaryngology (Ear, Nose and Throat)

MedStar Georgetown University Hospital offers expert ear, nose and throat (otolaryngology) specialists. We are committed to providing a variety of diagnostic and treatment options – all within a trusting and compassionate environment. Clinical programs and treatment services include:

Learn more about otolaryngology services at MedStar Georgetown University Hospital

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Phone: 202-295-0556

Pediatric Otolaryngologists


Pressure Equalization (PE) Tube Surgery for Children

PE Tube surgery is a surgical procedure to drain fluid from the eardrum and place a pressure equalization (PE) tube in the ear. Children may need this procedure if they get ear infections often. They may also need it if fluid has built up behind the eardrum.

In this procedure, a small hole is made in the eardrum. The fluid is drained through this hole. Then the PE tube is placed to keep the hole in the eardrum open. The procedure allows air to flow into the middle ear space. This gives the child's ear condition time to heal and helps to prevent new ear infections. Usually, the procedure is done in both ears.


Lingual Frenectomy

Lingual frenectomy is a surgery to cut or remove the band of tissue (frenulum) that connects the tongue to the bottom of the mouth. This procedure is needed when the frenulum is too tight or too thick and causes difficulty speaking or eating. Lingual frenectomy results in greater range of motion for the tongue.

Frenectomies performed on newborn babies allow them to feed more effectively. Michelle Merola-Lally, PA-C is a lactation specialist who works closely with Dr. Earl Harley during these procedures to make feeding a more comfortable and effective experience for mother and baby.


PANDAS

PANDAS, or pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, is a childhood mental health disorder. Children with the disorder develop one or both of these conditions:

  • Obsessive-compulsive disorder (OCD)
  • Rapid and repetitive muscle contractions that cause purposeless body movements or noises (tics)

PANDAS very rarely occurs after puberty. It is a rare and new disorder that experts are still learning about.

What are the causes of PANDAS?

This condition may be caused by a reaction to a strep infection. When your child has a strep infection, his or her body makes proteins called antibodies in response to strep bacteria. In children with PANDAS, these antibodies attack brain cells instead of the bacteria.

What increases the risk?

This condition is more likely to develop in children who:

  • Are 3–12 years old.
  • Have or have had a strep infection, such as strep throat or scarlet fever.
  • Have OCD or tics.

What are the signs or symptoms of PANDAS?

Symptoms may start suddenly following a strep infection. They may come and go or fade over time. Symptoms of this condition may include:

  • Hyperactivity
  • Mood swings
  • Sleep disturbances
  • Bedwetting
  • Changes in handwriting
  • Inability to pay attention or remember things
  • Panic attacks
  • Obsessive fears
  • Twitches and tics
  • Increased sensitivity to touch, noise, and light
  • Separation anxiety

Children who already have OCD or tics may have new or worsening symptoms.

How is PANDAS diagnosed?

This condition may be diagnosed based on:

  • Your child's symptoms
  • Your child's medical history
  • A physical exam
  • Tests, such as:
    • Blood tests to check for a current or recent strep infection
    • A throat culture to test for strep throat

Your child's health care provider will look for an association between a strep infection and OCD or tics that has occurred in an overnight or dramatic on-or-off way. Your child's health care provider may diagnose PANDAS if your child is 3–12 years old and has:

  • Sudden OCD or tic symptoms
  • Sudden worsening of OCD or tics
  • OCD symptoms that come and go suddenly
  • An associated strep infection
  • Hyperactivity or uncontrolled movements

How is PANDAS treated?

This condition may be treated with:

  • Antibiotic medicine to treat an active strep infection
  • Talk therapy (psychotherapy) for OCD behaviors
  • Antidepressant medicines called SSRIs
  • Tonsillectomy
  • Immunoglobulins given through an IV and plasma exchange for very severe symptoms. Immunoglobulins are donor antibodies. Plasma exchange is a type of blood transfusion treatment

Laryngomalacia and Stridor

Noisy breathing in newborn infants may be secondary to several causes. These include nasal congestion to a blockage of the airway. When the sound arises from a partial blockage of the lower airway, this is termed stridor. Stridor is simply noisy breathing caused by a partial blockage of the lower airway. The most common cause of stridor in newborns is laryngomalacia. This is usually a self-limiting condition that does not require any intervention.

Typically, the noisy breathing begins at birth or very soon after. The noise occurs when the baby is breathing in but there no associated sound when she breathes out. Typically the sound is worse when the infant is on his back but better on the side or upright position. Also, it is not uncommon for the infants sound worse when he is feeding. There may be associated spiting up or excess burping as these infants may have “acid reflux” associated the breathing.

The otolaryngologist will take a detailed history including details of the pregnancy and the birth. Questions such as did your child assistance with breathing at birth such as a breathing tube will be asked. A complete examination of the ears, nose, throat, neck and chest will be conducted. Included will be a measurement of the baby’s oxygen saturation and other vital signs. Most of the time the otolaryngologist will perform a procedure called a flexible laryngoscopy. Here a small fiberoptic tube will be inserted into the nose and the entire airway from the nasal cavity to the voice box will be assessed. This procedure takes about 5 minutes and does not require sedation or special preparation. Most of the time pictures and videos are obtained. Rarely is any other procedure needed but you may be asked to return for a follow-up evaluation.

If your child required breathing tube, especially if he was premature, there may be scar tissue formation causing the noise. If your child has a birth mark that looks like a strawberry there may be an association that would require further evaluation. In these circumstances additional information obtained from x-rays or scan may be asked for. An evaluation under anesthesia may be required. This procedure is called a direct laryngoscopy and bronchoscopy (DLB) and microlaryngoscopy (MLB) and bronchoscopy. Here, the entire airway is examined including the lower trachea and its branching into the lungs.

Laryngomalacia is usually self-limiting and it is not uncommon that it resolves spontaneously by 6 months of age but may last longer. Frequently the child is given a medication for acid reflux. Only very, very rare case will the child require surgical intervention.


Tonsillectomy and Adenoidectomy for Children

Tonsillectomy and adenoidectomy are surgeries to remove tissues in the mouth and throat called the tonsils and adenoids. These surgeries may be done separately. Often, they are done at the same time in a surgery called adenotonsillectomy. Tonsils and adenoids normally work to protect the body from infection. This procedure may be done if these tissues repeatedly become enlarged or infected and if other treatments are not effective.

A tonsillectomy and adenoidectomy are surgeries that are usually done together to remove your child's tonsils and adenoids.

This procedure may be done if these tissues repeatedly become enlarged or infected and if other treatments are not effective.

Generally, this is a safe procedure. However, problems may occur, including bleeding, infection, scarring, ear pain, nausea and vomiting, and changes in your child's voice or sense of taste.


Pediatric Cochlear Implant

Cochlear implant surgery is a surgery to place (implant) a hearing device (cochlear implant) in the inner ear (cochlea). The cochlear implant sends sound signals to a nerve in the ear (auditory nerve). This can help your child hear and interpret sounds. A cochlear implant contains:

  • A microphone to pick up sounds
  • A part that organizes the sounds from the microphone (processor)
  • A part that converts signals from the processor into electric impulses (transmitter)
  • Conductors (electrodes) that send the signals to the auditory nerve.

Several weeks after cochlear implant surgery, your child must visit his or her health care provider to get fitted with the external part of the cochlear implant. Your child's health care provider will program the implant so your child can hear.

Your child may need a cochlear implant to treat severe hearing loss or deafness. Your child will most likely get a cochlear implant in one ear. Sometimes a device is placed in each ear. A cochlear implant does not make your child hear normally, but it can help your child develop speech and language skills.

What happens during the procedure?

  • An incision will be made behind your child's ear, and a skin flap will be formed.
  • Damaged or diseased cells and tissue will be removed from the space in your child's skull behind the ear.
  • A space will be made for the implant to be placed and secured.
  • An opening will be made in the cochlea, and electrodes will be placed inside and secured.
  • The skin flap will be closed with stitches (sutures).

Click here to learn more about cochlear implants.


Pediatric Otolaryngology Clinical Research

Our experts are involved in clinical research involving the following:

  • Hyoid suspension in sleep apnea
  • Environmental effects on paranasal sinus disease
  • Function and organ preservation in head and neck oncology
  • Prognosis matches in head and neck cancers
  • Thyroid cancer