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Pediatric Otolaryngology

Pediatric Ear Nose and Throat Services

Babies and children have adorable faces that express their personalities. So when something goes wrong, you want to be sure your little one is in capable hands. The division of Pediatric Otolaryngology at University of Maryland’s Children’s Hospital provides comprehensive evaluation and management of infants and children with all types of problems of the ears, nose, throat, head and neck. That includes ear infections and other ear diseases, snoring, neck masses, nasal obstruction in newborns and other standard ear, nose and throat services.

 Surgeon Operating on Patient"Clear diagnosis is so important to reassure worried parents,” comments Kevin Pereira, M.B.B.S., M.S. (ORL), Professor of Otolaryngology and Pediatrics at the University of Maryland School of Medicine and Director of Pediatric Otolaryngology. “Knowing what the problem is, and that we can help, allows parents to sleep at night."

At the University of Maryland, three sub-specialists help children and their families with:

  • Sleep apnea and complicated airway problems (Kevin Pereira, M.B.B.S., M.S. , Otorhinolaryngology).
  • Hearing loss and other ear problems, and diseases of the sinuses 
  • Cleft lip, cleft palate and other facial abnormalities (John Caccamese Jr., DMD, MD, Pediatric Oral-Maxillofacial Surgery).

Our physicians and practitioners who care for children include Dr. Kevin Pereira, Dr. Amal Isaiah , Judith Oakley, Nurse Practitioner, Pediatric Audiologists, Dr. Nicole Nguyen and Dr. Annie Ferruggiaro and Otorhinolaryngology-Head & Neck physicians, Dr. Jeffrey Wolf and Dr. Rodney Taylor.

The division works closely with other members of the Department of Otorhinolaryngology-Head and Neck Surgery who have sub-specialized expertise in Otology, plastic and reconstructive surgery, voice disorders and tumors of the head and neck. We also offer surgery for congenital deformities of the head and neck. In addition, our physicians work with all other medical and surgical divisions at the Hospital for Children to provide the best possible care for our young patients.

Conditions that we commonly treat:

  • Ear infections
  • Ear deformities
  • Hearing Loss
  • Snoring
  • Noisy breathing
  • Chronic cough
  • Neck masses
  • Nasal obstruction
  • Cleft Lip & Palate
  • Sinusitis
  • Speech and language delay
  • Hoarseness

Periera Examining young patient

We also provide expert care for all children with long-term airway problems, including those with a tracheostomy.

Sleep apnea affects more children

The incidence of sleep apnea in children is increasing rapidly. It’s a disorder that causes breathing to stop temporarily during sleep. “Ten years ago, sleep apnea affected 1 percent of children nationally,” says Dr. Pereira. “Today, it affects 5 percent of children. It has increased because of the rising prevalence of childhood obesity. In Baltimore, sleep disordered breathing that is associated with snoring probably affects 10 to 15 percent of children, and in the inner city, the rate is likely closer to 20 percent. It’s alarming!

“We have a pediatric sleep lab to evaluate sleep apnea,” he continues. “When an overweight or obese child comes in with symptoms of sleep apnea, we start by making sure they don’t have an endocrine or other medical problem that can explain the situation. We usually recommend a consultation with a nutritionist or dietitian. The next step would be a sleep study, and if there’s a significant obstruction of the airway, we may offer surgery to open it up. Usually, in young children that involves removing the tonsils and adenoids.”

Solving other airway problems

Chronic cough is another complex airway problem treated at the University of Maryland Children’s Hospital. It can be the result of a variety of conditions — asthma, allergies, chronic sinus disease, chronic inflammation in the nose, or large or swollen adenoids. Acid reflux (gastroesophageal reflux) can also cause a chronic cough. “This is an issue that often requires multidisciplinary input and we’ll consult with our other subspecialty colleagues before initiating treatment. If endoscopies are required we usually perform them together. That way, the child just needs one procedure, with one dose of anesthesia,” Dr. Pereira says. Endoscopy involves threading a long, thin tube with a camera on the tip — called an endoscope — down the throat to give doctors a look inside the airway and digestive tracts.

Hoarseness in children is something that parents sometimes don’t take as seriously as they should. It’s usually caused by a problem with the vocal cords, which are part of the larynx in the throat. When the vocal cords become inflamed or infected, they swell, causing hoarseness. Some babies are born with abnormalities of the vocal cords and voice box.

“Temporary hoarseness can come from screaming or yelling, but it can be far more serious, too,” Dr. Pereira says. “Hoarseness should be investigated and evaluated on a fairly urgent basis. Some cases don’t change much over time, but some progress and can lead to airway obstruction. Those have to be identified and treated right away. The bottom line is that a child who is hoarse is not normal, period. And the degree of hoarseness doesn’t matter. Whether a child is a little hoarse or very hoarse, they need to be checked out by a specialist.”

Noisy breathing mostly affects infants in the first two to three months of life, and is often congenital. “It can be caused by a variety of conditions, some of which are fairly benign and some of which lead to obstruction of the airway,” Dr. Pereira says. “Noisy breathing should be diagnosed and treated because, although it may seem stable, if the baby gets a respiratory infection, it can compromise the airway.” He notes that noisy breathing, which comes from the upper airway (windpipe and larynx) is different from wheezing, which arises in the chest.

Turn to the experts

If your child has an ear, nose, throat, head or neck problem, we’re here to help. We understand that putting children at ease and offering a compassionate response to parents and families is important, as well as providing advanced technology and expertise.

Call 410-328-6866 to get help for your child.

Leading the Way in Pediatric ENT

The University of Maryland Children’s Hospital provides new ways to help infants and children with ear, nose and throat problems:

  • Complex airway problems are usually diagnosed with a combination of endoscopy and advanced radiologic imaging of the airway. “This allows us to pinpoint the site of the obstruction and get a clear idea as to what’s going on,” says Kevin Pereira, M.B.B.S., M.S., Director of Pediatric Otolaryngology. “We’re one of only two centers in the area that offer this, and we have pediatric radiologists with expertise in airway radiology. Imaging often helps us prepare for what we may see during endoscopy and formulate a treatment plan in advance.”
  • Geneticists are available to counsel parents of children with genetic hearing loss about the risks for any future children. In addition, we also have a laboratory established by Ronna Hertzanno, MD, PhD, a nationally known expert doing research in the genetics of hearing. “This is new and unique to our division,” Dr. Pereira comments.
  • Clinician scientists are also exploring molecules and stem cells to try and reverse certain types of deafness. They’re looking at using various technologies to manipulate the tiny hair cells in the inner ear that move sound through the ear. When those hair cells are damaged, hearing loss can result.
  • Nicole Nguyen, a certified implant device audiologist in the division, provides tertiary level hearing evaluation for infants and children. She keeps up-to-date with the latest advances in implantable hearing devices and helps to match patients with the device that will work best for them. She also programs the devices and helps with long-term hearing rehabilitation.