Children conditions I treat

If your GP or paediatrician suggests that your child see a specialist for a problem with his ears, nose, or throat, a paediatric otolaryngologist has the widest range of treatment options, the most extensive and comprehensive training, and the greatest expertise in dealing with children and in treating children’s ear, nose, and throat disorders.

I am highly specialised professional in the care of children with Disorders of the ears, nose, and throat. I am also specialise in the treatment of premature infants and children with complex medical disease (for example children with autism, Trisomy 21, syndromes, cystic fibrosis, asthma, cancer, sickle cell, cerebral palsy, learning disorders (PDD), ADHD).

Some of our specialty areas include (but are not limited to):

» Adenoid Disease

» Airway Disease including sleep disorder breathing/ obstructive sleep apnoeas

» Laryngomalacia or floppy larynx (check video)

» Airway Disease including subglottic stenosis and Airway Reconstruction

» Bronchoscopy & oesophagosocpy

» ENT problems related to Down Syndrome

» Ear Infections

» Endoscopic Sinus Surgery

» Extraesophageal reflux disease

» Foreign Body in ears, nose, airway, lungs

» Hearing Loss in children

» Hemangioma Lymphangioma and other complex neck masses

» Hoarseness (voice changes)

» Laryngomalacia (soft larynx)

» Mastoid Disease

» Nasal Obstruction/ or congestion

» Neck Masses

» Nose Bleeds

» Reconstructive Surgery

» Rhinoplasty in children (functional)

» Salivary Diseases

» Sinus Disease

» Sleep & snoring Disorders

» Speech disorders and delay

» Swallowing / Feeding Issues

» Thyroid Surgery

» Tonsil Issues

» Tracheostomy

» Trauma to Face Head and Neck

» Tumors of the Head and Neck

» Turbinate Disease

» Voice Disorders

Airway reconstructions include procedures involving the area from the top of the voice box to the trachea. Hundreds of procedures fall into two main categories under airway reconstruction:

Open airway procedures – made with a neck incision into the airway

Endoscopic procedures (such as microscopic laryngoscopy,

bronchoscopy and esophagoscopy) – done through the mouth, limiting the need for an incision in the neck.

A laryngotracheal reconstruction is one of the more complex airway surgeries we perform and is usually only done by experienced pediatric ENT surgeons with airway surgery experience. Laryngotracheal reconstruction (LTR), also known as laryngotracheoplasty, is a surgery that is used to correct a child’s narrowed airway. The area of narrowing is often in the area of the vocal cords (glottis) or below the vocal cords (subglottic stenosis). This surgery may be recommended to help remove a tracheostomy tube, to avoid having a tracheostomy tube placed or to improve the airway enough for comfortable, safe breathing.

The procedure is based on splitting open the narrow part of the airway and placing a specially carved piece of cartilage in the gap to widen the airway. The cartilage is harvested from the child’s own body; either from the neck or from the ribcage. Two splits with two pieces of cartilage may be used in severe stenosis. This procedure can be done in various different manners. The entire process may be done at once or staged into 2 separate surgeries using a stent to keep the cartilages in place during healing. In certain situations, we are able to perform the LTR endoscopically (minimally invasive). After surgery, children need to stay in the Pediatric Intensive Care Unit during the healing process. Follow up laryngoscopies and bronchoscopies are common to ensure that the airway heals well and stays open.

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Airway Stenosis

The story

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Microlaryngoscopy and bronchoscopy (MLB)

What is a microlaryngoscopy and bronchoscopy (MLB)?

A microlaryngoscopy and bronchoscopy is a test that allows the doctor to look into your child’s airway (larynx and bronchi) using a small telescope. This telescope is contained in a piece of equipment called an endoscope.

Why does my child need this investigation?

In general, it is because your child has breathing problems and an MLB will help the medical team to establish a cause.

What happens before the MLB?

Information about how to prepare your child for the operation is included in your admission letter. Your child should not have anything to eat or drink for the time discussed at the pre-operative assessment. It is important to follow these instructions otherwise your child’s operation may have to be delayed or even cancelled.

The doctors will explain the operation in more detail, discuss any worries you may have and ask you to sign a consent form. An anaesthetist will also visit you to explain about the anaesthetic. If your child has any medical problems such as allergies, please tell the doctors.

About half an hour before your child goes to operating theatre, he or she may have a pre-medication. This is a medicine which dries up any secretions, allowing the anaesthetist to see your child’s airway more clearly. It may be given as an injection or as a liquid medicine to drink.

What does the investigation involve?

Your child will have this procedure under a general anaesthetic. Please see your admission leaflet for more information about anaesthetics.

After the general anaesthetic has been given, your child’s larynx will be sprayed with a local anaesthetic. The surgeon will then insert the telescope into your child’s airway through the mouth. The doctor can now look at your child’s larynx and bronchi.

Will the doctor do anything else?

In some cases the doctor will also ask for your permission to carry out surgical procedures using a laser or endoscopic instruments at the time of the MLB. No procedure will be carried out without your consent (unless in a rare emergency situation).

What are the risks of an MLB?

Every anaesthetic carries a risk of complications, but this is small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any problems that arise. After an anaesthetic some children may feel sick and vomit. They may also have a headache, sore throat or feel dizzy. These side effects are usually short-lived and not severe.

There is a very small risk that the telescope could damage your child’s airway. Your child's breathing problems may worsen after the procedure but this is temporary.

Are there any alternatives to having a MLB?

Although the doctors can tell a certain amount from other tests, an MLB can give them a fuller picture of your child’s condition.

What happens after the MLB?

Your child will be able to recover from the investigation on the ward. He or she may have a sore throat after the test and the doctors may prescribe some paracetamol. The doctors will see you later the same day to tell you what they found during the investigation.

Your child will not be able to eat or drink anything for three hours after the procedure.

Your child will be able to go home the next day.

Because of the anaesthetic your child may feel tired and a little clumsy for around 24 hours after the operation, so do not let him or her do anything that may lead to a fall.

You will be sent the date for a follow-up appointment either in the outpatients department or to come back to the hospital for another stay. Your child should be able to go back to school when he or she is more comfortable.

If your child develops a fever, contact your family doctor (GP) or the ward from which your child was discharged.

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