Otolaryngology: What our ENTs do to improve the quality of life for our patients

Image

Photo courtesy of Getty Images

As otolaryngologists at Texas Children’s Hospital, we specialize in the medical and surgical treatment of pediatric conditions and diseases that affect the ears, nose, throat, head and neck. In addition to being called an otolaryngologist, we are called ENTs—short for ear, nose and throat doctor.

The Pediatric Otolaryngology team is led by our Division Chief Dr. Anna Messner. We are the largest program in the Department of Surgery at Texas Children’s, and we also have grown to become the largest ENT program in the nation. To give you a brief overview of our team and what we do, we have provided answers to several of the most commonly asked questions about otolaryngology.

What is otolaryngology?

Otolaryngology focuses on the diagnosis and treatment of common to complex medical conditions of the ear, nose, throat, head and neck in children and adolescents. Our physicians are trained in delivering medical and surgical care. 

Since otolaryngology covers five areas of the body, many of our pediatric otolaryngologists have received additional training in various subspecialties so we can provide the most comprehensive care to our patients. Otolaryngology is considered the oldest medical specialty in the U.S., dating back to the 19th century.

What conditions do otolaryngologists treat at Texas Children’s?

Our otolaryngologists diagnose and treat the full spectrum of conditions affecting infants and children and have clinics at nine locations in the Houston area. Surgeries are performed at all three Texas Children’s hospitals in the Texas Medical Center, Katy and The Woodlands. Here is a list of some of the ENT conditions that we treat based on the specific area of specialization:

• Ear: We are trained in the medical and surgical treatment of hearing loss, ear infections (where ear tubes may be needed), balance disorders, ear noise (tinnitus), eustachian tube dysfunction and ruptured eardrum. Our team also manages congenital disorders of the outer and inner ear. Drs. Shraddha Mukerji and Carol Liu are able to dilate the eustachian tube in select patients with chronic ear problems.
  
  As part of the Cochlear Implant Program, Drs. Rodrigo Silva, Alex Sweeney, Henri Traboulsi and Ron Vilela specialize in cochlear implantation, a device surgically placed in the inner ear that can restore hearing to patients with severe to profound hearing loss. 
  
  Liu specializes in a different type of hearing implant, a bone anchored hearing aid (BAHA), which transfers sound by bone vibration directly to the cochlea, bypassing the outer and the middle ear. This alternative hearing device is used in patients with outer and middle ear problems and single-sided deafness. As ENT experts in ear reconstruction surgery, Liu and Silva also repair congenital ear deformities in children including microtia (an outer ear deformity) and atresia (the absence or underdevelopment of the ear canal and middle ear structures).
   
• Nose: Care of the nasal cavity and sinuses is one of our primary skills. We diagnose, manage and treat obstructed noses, sinus disease, nasal fractures and deviated septums. Dr. Uma Ramaswamy, who is fellowship trained in pediatric and anterior skull base surgery, works with our colleagues in neurosurgery to access certain aspects of the brain via the nose.
   
• Throat: Pediatric otolaryngologists have expertise in managing disease of the larynx (voice box) and upper aerodigestive tract. We treat children with voice, swallowing, and breathing difficulties. The ENT physicians on the Texas Children’s aerodigestive team include Drs. Julina Ongkasuwan, Deepak Mehta, Joshua Bedwell and Elton Ashe-Lambert. Ashe-Lambert has a special interest in caring for children with drooling problems. Ongkasuwan works with children with voice disorders, particularly children with paralyzed vocal cords, and she performed the first recurrent laryngeal nerve re-innervation at Texas Children’s Hospital. 
  
  As ENTs, we commonly care for children with snoring and sleep apnea problems related to enlarged tonsils or adenoids or other anatomic abnormalities. Dr. Mary Musso provides care for children with Down Syndrome and children with sleep apnea after their tonsils/adenoids have been removed.
  
  We also treat a common condition called ankyloglossia (tongue tie) a disorder that restricts the tongue’s range of motion and has been shown to interfere with breastfeeding. In addition, Dr.Tara Rosenberg helps patients who suffer from speech problems such as velopharyngeal insufficiency in which too much air escapes through the nose while speaking.
   
• Head and neck: Our ENT team is trained to treat acquired and congenital tumors of the head and neck, as well, as other congenital problems such as thyroglossal duct cysts or branchial cleft cysts. Our Head and Neck Tumor Program led by Drs. Daniel Chelius and Amy Dimachkieh, offer surgical care for acquired and congenital head and neck masses, head and neck cancers and thyroid disease.

Click here to visit our Otolaryngology website for a complete list of conditions that we treat.

What training did our pediatric otolaryngologists complete?

Our pediatric otolaryngologists are medical doctors or doctors of osteopathic medicine. We completed a five-year residency in otolaryngology/head and neck surgery after finishing medical school. Additionally, our ENT physicians completed fellowships after residency in pediatric otolaryngology, laryngology, anterior skull base or neurotology. Many of our otolaryngologists have double fellowships. For example, Dr. Henri Traboulsi, has two fellowships, one in otology and neurotology, and one in pediatric otolaryngology. Dr. Dimachkieh has fellowships in pediatric otolaryngology, and head and neck surgical oncology. Our otolaryngologists have faculty appointments in the Department of Otolaryngology – Head and Neck Surgery at Baylor College of Medicine and share a passion for caring for children.

How would you describe your team’s multidisciplinary approach to patient care?

Our otolaryngology team works closely with many multidisciplinary clinics across the system where we leverage each other’s knowledge and expertise to ensure the best possible outcomes for our patients. For instance, we work with audiologists and speech therapists to ensure patients with cochlear implants have the support they need to improve their hearing capabilities, speech and overall communication. Many of our otolaryngologists have even closer collaborations with other services across the hospital.

A great example of multidisciplinary collaboration is our work to support our colleagues in the Cystic Fibrosis Clinic. At Texas Children’s, our pulmonology team treats many patients with cystic fibrosis-related lung disease, which goes hand in hand with ENT since it impacts nose and sinuses. Often times, pulmonology will ask us to examine a patient’s sinuses to make sure the passages are cleared because any inflammation in the sinus tissues can create complications and worsen lung disease in CF patients.

Our team is an integral part of the Aerodigestive Program at Texas Children’s, which is dedicated to the comprehensive and multidisciplinary management of children with complex airway and digestive tract disorders. We partner with pulmonology, gastroenterology, pediatric surgery and speech pathology. Dr. Tiffany Raynor leads our tracheotomy program with a group of dedicated advanced practice providers.  

Dr. Tara Rosenberg heads our vascular anomalies team, a multi-disciplinary team consisting of ENT but also Hematology-Oncology, Interventional Radiology, Pediatric and Plastic Surgery, Dermatology and other subspecialties. The vascular anomalies team treats patients with a multitude of benign lesions such as hemangiomas, both close to the skin and deep in the soft tissues, lymphatic malformations, lymphedema, and other lesions resulting from abnormal development growth of arteries, veins, capillaries or lymphatic vessels.

Additionally, we collaborate with other specialized clinics to treat children with different medical conditions involving the ear, nose, throat, neck and head that may require surgery. 

What research is the otolaryngology team involved in?

Texas Children’s Otolaryngology currently has seven projects with grant funding. The research projects range from airway and otologic diagnostic devices development to hearing loss research. 

We are working on several projects that aim to refine the diagnostic process of acute ear infections by harnessing current technology, including otoscopes and ultrasound technology. We also are conducting a clinical trial on the use of a device that has been associated with fewer complications after a tonsillectomy surgery. Additionally, we have studies that focus on healing after tracheostomies, with different medications, dressings etc., and a study to evaluate whether children with tracheostomies have more ear infections than other children. Our sleep team also is conducting a variety of studies including one that looks at persistent obstructive sleep apnea and the relationship between teeth grinding and sleep apnea.

Click here for more information about our otolaryngology services offered at Texas Children’s. Click here for a complete list of our ENT physicians, including their bios and clinical interests.