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. Our pediatric otolaryngology services include:
- Ear infections
- Frenotomy/ tongue and lip ties
- Lactation consultation
- Nose and Sinuses
- Snoring - pediatric obstructive sleep apnea
- Laryngomalacia and Stridor
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS)
- Tonsillectomy and adenoidectomy
- Tongue and lip ties in nursing babies
- Thyroid conditions, including thyroglossal duct cyst removal
- Airway and swallowing disorders
- Facial Plastics
- Otoplasty (pinning of the ears)
- Keloid scar removal
- Hearing Loss & Hearing Aides
- Head and Neck Masses and Cancer
Learn more about otolaryngology services at MedStar Georgetown University Hospital.
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Pressure Equalization (PE) Tube Surgery for Children
PE Tube surgery is a surgical procedure to drain fluid from and/or ventilate the middle ear, and place a pressure equalization (PE) tube in the eardrum. Children may need this procedure if they get ear infections often. They may also need it if fluid has built up behind the eardrum and is affecting hearing or speech development.
In this procedure, a small opening is made in the eardrum. The fluid is drained through this hole. Then the PE tube is placed to keep the opening in the eardrum patent. 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 frenotomy 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.
Frenotomies 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, or pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, is a childhood nervous system 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 occur 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:
- Mood swings
- Sleep disturbances
- 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
- 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 vary from a stuffy nose to a blockage of the airway. When the sound arises from a partial blockage of the 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 to sound worse when he is feeding. There may be associated spitting up or excess burping as these infants may have “acid reflux” associated with the breathing.
The otolaryngologist will take a detailed history including details of the pregnancy and the birth. Questions such as did your child need assistance with breathing at birth 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 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 a 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). 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 in very rare case will a 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. 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.
This is a common procedure with well-recognized safety guidelines. The sore throat afterwards can be well-controlled with drinking fluids and non-opioid pain medicine. Problems that can occur, include 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 enables a child to hear in a new fashion and 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).
Pediatric Otolaryngology Clinical Research
Our experts are involved in clinical research involving the following:
- Role of Tonsillectomy in PANDAS
- Tongue and lip ties in nursing babies