Frequently Asked Questions


When a plant or animal substance which is foreign to the human, invades the body (through the membranes of the eyes, nose or throat) an immune reaction occurs which is intended to counteract such invasion. Under ordinary circumstances that is a helpful, natural protection. However, some individuals exhibit an exaggerated inflammatory response to certain substances. This response is termed an allergic response. It is a trait that tends to run in families.The allergens stimulate the body to form sensitizing antibodies which then combine with the allergens. The combination causes the body to release a number of chemicals that produce undesirable effects. Histamine is the best known of these chemicals; it causes swelling of the nasal membranes, itching, irritation and excess mucus production.

Click here for our allergy and sinus services.

Early springtime allergy is most often caused by pollens or common trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, mountain cedar, pecan, cottonwood and alder. Late springtime pollens come from the grasses, i.e. timothy, orchard, red top, sweet vernal, Bermuda , Johnson and some bluegrasses. Colorful or fragrant flowering plants rarely cause allergy, because their pollens are too heavy to be airborne. They rely on insects (bees and butterflies) to carry their pollens from one plant to another.The most significant allergy producing pollen in the United States comes from ragweed. It begins pollinating in late August and continues through October or until the first frost. Other allergenic weeds of lesser importance also pollinate in this season.

Molds are fungi that spoil bread, rot fruit, and mildew clothing. They also grow on dead leaves, grass, hay, straw, grains, and on other plants and in the soil. Since they are not killed by frost, the mold allergy season is long. Mold spores may be in the outside air year-round except when snow covers the ground.Indoors, molds grow on houseplants and in their soil. They also grow in damp places such as basements and laundry rooms. Molds can also be found in cheeses and fermented alcoholic beverages.

Allergens that are present through all seasons include animal dander (cats, dogs, horses and other pets, wool and feathers), cosmetics, molds, foods and house dust. House dust is a complex mixture of disintegrating cellulose (furniture stuffing), molds, dandlers (i.e. from household animals) and insect parts and small mites. Allergies that become worse in wintertime, when the hot air furnaces are turned on, are usually due to house dust.

The initial visit includes a complete medical history and a focused physical examination. In some instances the upper airway is assessed with examination scopes. In some cases pulmonary function tests may be performed. In most instances tests for specific allergies are performed.

Testing for specific causes is usually done by skin testing. Drops of extracts of the substances known to cause allergic reactions are placed on the arm and a plastic device is pressed into the drops to allow them to soak into the skin. Reactions occur at the site within 20 minutes if the person is allergic to the material. When results on the arm are not conclusive, a few tests may be performed on the forearm. Solutions of allergens are injected into the skin and the sites are observed for 20 minutes for the appearance of allergic reactions.

There are three approaches to dealing with allergic disorders:

  • Avoidance of the causes
  • Medications to suppress the reactions
  • Allergy vaccines that decrease the person’s reactions to the allergens

In order to intelligently apply these measures we must establish that the problem is an allergy, and then identify the causes.

Click here for our allergy and sinus services.

The likelihood that allergic rhinitis or asthma will spontaneously go away is approximately 1% per year. That means medications usually will be needed for many years. The main advantage of allergy vaccines is that they greatly diminish the severity of a person’s allergic reactions, reducing the need for medications while further reducing symptoms. The disadvantages of allergy vaccine are that several injections are needed to build up to the monthly maintenance injections, and the person might have an allergic reaction to an injection. Many people would rather have monthly injections for 3 years than take medications for an indefinite period of time.


Tonsil and adenoids are part of the lymphoid tissue system. The lymphoid system, as a whole, works to help the body’s immune system. Tonsils and adenoids, however, have not been found to contribute much to the body’s immune system. Tonsils are located in the back of the throat and adenoid tissue is located in the roof of the throat. Tonsils can become a source of recurrent infection or airway obstruction. Adenoids usually disappear by adulthood, but can be a source of nasal obstruction and a reservoir for chronic ear infections in children.

Tonsillectomy and Adenoidectomy have been performed for centuries. No studies have ever shown that removing tonsil or adenoid tissue has a negative effect on the immune system.

Surgical removal of the tonsils and adenoids (known as a T&A) is one of the most common operations performed on children in the U.S.

T&A procedures are not without risk. Under ideal conditions, the death rate is 1 child per 250,000 operations. Approximately 4% of children bleed on the fifth to eighth day after surgery. A few of these children may need a blood transfusion or additional surgery. All children experience throat discomfort for several days. Some children whose speech was previously normal develop hypernasal speech because the soft palate no longer closes completely.

Some T&As are performed for unwarranted reasons. You can always find someone to perform surgery on your child; in fact, this is the main risk of “doctor shopping.”

  1. Large tonsils
    Large tonsils do not mean “bad” tonsils or infected tonsils. The tonsils are normally large during childhood (called “physiological hypertrophy”). They can’t be “too large” unless they touch each other. The peak size is reached between 8 and 12 years of age. Thereafter, they spontaneously shrink in size each year, as do all of the body’s lymph tissues.
  2. Recurrent colds and viral sore throats
    Several studies have shown that T&As do not decrease the frequency of viral upper respiratory infections (URIs). These URIs are unavoidable. Eventually your child develops immunity to these viruses and experiences fewer colds per year.

Sometimes the tonsils should come out. But the benefits must outweigh the risks. All but the first three of the following valid reasons are rare. Once you decide a T&A is needed, the ear, nose, and throat surgeon will decide if the tonsils, adenoids, or both need removal.

  1. Persistent mouth-breathing
    Mouth-breathing during colds or hay fever is common. Continued mouth-breathing is less common and deserves an evaluation to see if it is due to large adenoids. The open-mouth appearance results in teasing, and the mouth-breathing itself leads to changes in the facial bone structure (including an overbite that could require orthodontia).
  2. Abnormal speech
    The speech can be muffled by large tonsils or made hyponasal (no nasal resonance) by large adenoids. Although other causes are possible, an evaluation is in order.
  3. Severe snoring
    Snoring can have many causes. If the adenoids are the cause, they should be removed. In severe cases, the loud snoring is associated with retractions (pulling in of the spaces between the ribs) and is interrupted by 30- to 60-second bouts of stopped breathing (sleep appnea).
  4. Heart failure
    Rarely, large tonsils and adenoids interfere so much with breathing that blood oxygen is reduced and the right side of the heart goes into failure. Children with this condition are short of breath, have limited exercise tolerance, and have a rapid pulse.
  5. Persistent swallowing difficulties
    During a throat infection, the tonsils may temporarily swell enough to cause swallowing problems. Some children refuse solid foods. If the problem is persistent and the tonsils are seen to be touching, an evaluation is in order. This problem more often occurs in children with a small mouth.
  6. Recurrent abscess (deep infection) of the tonsil
    Your child’s physician will make this decision.
  7. Recurrent abscess of a lymph node draining the tonsil
    Your child’s physician will make this decision.
  8. Suspected tumor of the tonsil
    These rare tumors cause one tonsil to be much larger than the other. The tonsil is also quite firm to the touch, and usually enlarged lymph nodes are found on the same side of the neck.

Snoring / Sleep Apnea

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This is the collapsible part of the airway where the soft palate and uvula (fleshy structure that dangles from the roof of the mouth back into the throat). The vibration of these structures during breathing produces snoring. Problem snoring grows worse with age. 25% of all adults are habitual snorers.

Medically – Yes. Heavy snorers tend to develop high blood pressure at a younger age than non-snorers. Obstructive sleep apnea is an exaggerated form of snoring. Loud snoring is interrupted by frequent episodes of totally obstructed breathing. These people may spend up to half their sleep time with blood oxygen levels below normal. During these obstructive episodes, the heart must pump harder. This can cause irregular heartbeats, and eventually high blood pressure. Sleep apnea patients may spend little of their nighttime hours in deep sleep stages. They awaken unrefreshed and are sleepy much of the day. They may fall asleep while driving or while on the job.Socially – yes. It disrupts family life. Spouses often have sleep deprivation, depression, and mood alteration. Marital discord is a common result.

Finding the cause is a first step. Snoring is a common problem when people age (the tissues in their throat loses elasticity), experience weight changes or have fat deposits throughout their throat and soft palate. Snoring and sleep apnea can be a mechanical problem even in a child who has large tonsils/adenoids or nasal obstruction from allergies. To evaluate sleep disorders, we include talking to the significant other, when appropriate, to determine if pauses in breathing (sleep apnea) exist. A sleep study is performed to determine if sleep apnea can be documented. If it is exclusively a snoring problem and not sleep apnea, we will discuss options to deal with this as more of a social problem. Should the problem be obstructive sleep apnea, there are several corrective options including the initial use of a non-surgical mechanical CPAP mask which can be tried at the patient’s discretion. There are many surgical procedures that can also be considered, and the success rates have been greatly improved over the years. It is very important to determine if the snoring indeed is sleep apnea, since there is a high correlation between sleep apnea and more serious diseases such as coronary artery disease and stroke if left untreated.

Nose / Sinus

Certainly in the Dallas area with our high incidence of allergies we do see patients suffering from chronic nose and sinus congestion with associated headaches. However, there are many different causes of headaches and one can have additional types of headaches as well. For instance, it is not uncommon for people to have ocular migraine headaches worsened by their chronic sinus headaches. People may also have tension headaches associated with the above. Headaches from hypertension and other medical conditions are also things to consider.

We listen and talk to the patient about his/her concerns. The cause of obstruction can be due to swelling of nasal tissues, infection, or a mechanical obstruction due to displaced bone or cartilage. Often, nasal obstruction can be relieved by medicine or allergy treatment. If the problem is mechanical obstruction, however, surgery often offers the fastest and surest road to recovery. Surgery can involve straightening out the nasal septum and enlarging the nasal airway. Nasal surgery is most often a day surgery and no hospitalization is required.

Often, a patient’s history gives us the best clue as to the nature of the problem. Patients who suffer from nasal discharge, sinus pressure and pain for more than 12 weeks out of the year, may be suffering from chronic sinusitis. These patients deserve a thorough sinus evaluation. This evaluation often includes nasal endoscopy, allergy evaluation, and CT scan of the sinuses. Treatment can vary from medical regimens to surgery.

Usually nasal sinus surgery can be done without packing the nose. Packing the nose has been a source of major discomfort.

Both can be safely done in an outpatient environment without a hospital stay.

Hearing Care

Ringing in the ears, or tinnitus, is caused by injury or irritation of the inner ear. The cause of tinnitus is often benign. In many instances, the cause of tinnitus is never conclusively found. Tinnitus can also be a presentation for brain tumors and other serious disorders and thus, should be investigated thoroughly.

Tinnitus (“TIN-a-tus” or “Tin-EYE-tus”) is the perception of sound in the head when no outside sound is present. It is typically referred to as “ringing in the ears,” but other forms of sound such as hissing, roaring, pulsing, whooshing, chirping, whistling and clicking have been described.Tinnitus can occur in one ear or both ears and can be perceived to be occurring inside or outside the ear. Tinnitus can be a symptom of a condition that causes hearing loss, or it can exist without any hearing loss.

Yes. Almost everyone at one time or another has experienced brief periods of mild ring or other sound in the ear. Some people have more annoying and constant types of tinnitus. One third of all adults report experiencing tinnitus at some time in their lives. Ten percent to 15% of adults have prolonged tinnitus requiring medical evaluation. Prevalence estimates of individuals with tinnitus vary widely, from 7.9 million to more than 37 million.

No. Just as fever or headache accompanies many different illnesses, tinnitus is a symptom common to many problems, both physiological and psychological.

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus.Chances are the cause of your tinnitus will remain a mystery. Only when a specific factor is linked to the appearance or disappearance of the tinnitus can a cause be stated with certainty. Blows to the head, large doses of certain drugs such as aspirin, anemia, hypertension, noise exposure, stress, impacted ear wax and certain types of tumors are examples of conditions that might cause tinnitus.What happens in my head to produce tinnitus? Although there are many theories about how sounds in the head are produced, the exact process is not known. One thing is certain. Tinnitus is not imaginary.

During the day, the distraction of activities and the sounds around you make your tinnitus less obvious. When your surroundings are quiet, your tinnitus may seem louder and more constant. Fatigue may also make your tinnitus worse.

Since tinnitus is a symptom, the first step should be to try to diagnose the underlying cause. You should have a medical examination with special attention given to checking for factors sometimes associated with the tinnitus such as blood pressure, kidney function, drug intake, diet and allergies. Your hearing should be evaluated by an audiologist to determine if hearing loss is present.

The most effective treatment for tinnitus is to eliminate the underlying cause. Unfortunately, the cause often cannot be identified so, in some cases, the tinnitus itself may need to be treated. Drug therapy, vitamin therapy, biofeedback, hypnosis and tinnitus maskers are types of treatments that have been helpful for some people.The American Tinnitus Association (ATA) Web site has information on various treatment options. Visit or write them at PO Box 5, Portland, Oregon 97207.

If you have a hearing loss, there is a good chance that a hearing aid will both relieve your tinnitus and help you hear. An audiologist can assist with the selection, fitting and purchase of the most appropriate aid and help with training to use the aid effectively.

  • Aging
  • Noise exposure
  • Hereditary factors
  • Ototoxic medications
  • Your ear receives sound waves and sends them through a delicately balanced system to the brain. Part of this remarkable system, the cochlea, is a chamber in the inner ear filled with fluid and lined with thousands of tiny hair cells. The hair cells signal the auditory nerve to send electrical impulses to the brain. The brain interprets these impulses as sound. When you are exposed to loud or prolonged noise, the hair cells are damaged and the transmission of sound is permanently altered.

Both the amount of noise and the length of time you are exposed to the noise determine its ability to damage your hearing. Noise levels are measured in decibels (dB). The higher the decibel level, the louder the noise. Sounds louder than 80 decibels are considered potentially hazardous. The noise chart to the right gives an idea of average decibel levels for everyday sounds around you.Painful


  • 150 dB = rock music peak
  • 140 dB = firearms, air raid siren, jet engine
  • 130 dB = jackhammer
  • 120 dB = jet plane take-off, amplified rock music at 4-6 ft., car stereo, band practice

Extremely Loud

  • 110 dB = rock music, model airplane
  • 100 dB = snowmobile, chain saw, pneumatic drill
  • 90 dB = lawnmower, shop tools, truck traffic, subway

Very Loud

  • 70 dB = busy traffic, vacuum cleaner
  • 60 dB = dishwasher


  • 50 dB = moderate rainfall


30 dB = whisper, quiet library

  • You must raise your voice to be heard.
  • You can’t hear someone two feet away from you.
  • You have pain or ringing in your ears (tinnitus) after exposure to noise.

Noise not only affects hearing. It affects other parts of the body and body systems. It is now known that noise:

  • Increases blood pressure
  • Has negative cardiovascular effects such as changing the way the heart beats
  • Increases breathing rate
  • Disturbs digestion
  • Can cause an upset stomach or ulcer
  • Makes it difficult to sleep, even after the noise stops
  • Intensifies the effects of factors like drugs, alcohol, aging and carbon monoxide.

Wear hearing protectors when exposed to any loud or potentially damaging noise at work, in the community (heavy traffic, rock concerts, hunting, etc.) or at home (mowing the lawn, snow blowing the driveway, etc.). Cotton in your ears won’t work. Hearing protectors include ear muffs and ear plugs (not swimmer’s plugs), some that are custom-made and individually molded. This protection can be purchased at drug stores, sporting goods stores or can be custom-made. Check with your audiologist to find out what best suits you.Limit periods of exposure to noise. Don’t sit next to the speakers at concerts, dance clubs, or auditoriums. If you are at a rock concert, walk out for awhile to give your ears a break. If you are a musician, wear ear protection–it is a necessity! Take personal responsibility for your hearing.


Pump down the volume! When using headsets or listening to amplified music in a confined place like a car, turn down the volume. Remember: if a friend can hear the music from your headset when standing three feet away, the volume is definitely too high. Don’t be afraid to ask others to turn down the volume.

Educate yourself about the damaging effects of noise and what you can do to prevent your exposure to noise.

Educate others and take action! Educate your children through discussion and by example. Wear your ear protection and encourage your children to follow your example.

Be a responsible consumer. Look for a noise rating when buying recreational equipment, children’s toys, household appliances, and power tools. Choose quieter models, especially for equipment that you use often or close to your ears like a hair dryer.Inspect your child’s toys for noise danger just as you do for small parts that can cause choking. Remember, too, that children tend to hold toys close to their ear which can pose additional threat for hearing damage.


Have your hearing tested by an audiologist especially if you are concerned about possible hearing loss.

Be an advocate! Remember there are no regulations governing how loud sound can be in public places such as dance clubs, movie theaters, and exercise centers. Work with owners, managers, and community leaders to create a healthier, less noxious listening environment.

  • A person that operates loud machinery
  • Airplane engineers & airlines ground transportation personnel
  • Printing press operators
  • Noise of power tools
  • Gunfire
  • Military/ law enforcement
  • Music
  • Lawn Equipment
  • Gunfire
  • Motorcycles
  • Fireworks
  • Behind-the-ear (BTE)- the hearing aid components are encased behind the ear.
  • In-the-ear (ITE)- the components of the hearing aid are encased in a custom made shell that fills the entire bowl portion of the ear.
  • In-the-canal (ITC)- the components of the hearing aid are encased in a custom made shell that fills the canal portion of the ear.
  • Completely-in-the-canal (CIC)- the components of the hearing aid are encased in a custom made shell that fits deeply into the canal of the ear.

Hearing aids do not come in a “one-size-fits-all”. Therefore, the audiologists at Ear, Nose and Throat Associates of Frisco work with each patient to meet individualized hearing care needs.

The offers in the paper are often at facilities which do not have medical backgrounds. Their main interest is in the sale of the hearing aid device. Sometimes, this can be at the expense of needed and beneficial medical treatment. At Ear, Nose and Throat Associates of Frisco, P.A. we are dedicated to the health and well-being of our patients and offer Hearing Aid options as a convenient service to those patients who desire to pursue an improvement in hearing.

Approximately 6 in 1000 babies are born with a significant hearing loss. Approximately 15% of US children aged six to nineteen years of age have a measurable hearing loss in one or both ears.

Unmanaged hearing loss in children can affect their speech and language development, academic capabilities and educational and can also affect their self-image and social / emotional development.

The most common type of hearing loss is sensorineural hearing loss. These causes include present at birth infections, medications, noise, and genetics. Sensorineural hearing loss can also develop later in life due to excessive exposure to loud noise. In 50 % of at birth hearing loss cases, a cause is never found.Hearing loss can also be cause by recurrent ear infections and persistent fluid in the middle ear. These are causes that can often be treated medically and surgically.

Hearing loss is invisible, and the signs are subtle in young children. If children are not reaching the speech and language milestones at the appropriate levels, or you suspect your child has hearing difficulties, they should see their physician or audiologist to have their hearing tested.

The audiologist has several tools that allow a child’s hearing to be tested from birth to age one.Tympanometry introduces air pressure into the ear canal making the eardrum move back and forth. The test measures the mobility of the eardrum and can assist in the detection of fluid in the middle ear, perforation of the eardrum, or wax blocking the ear canal.During soundfield testing in the sound booth, infants and toddlers are observed for changes in their behavior such as sucking a pacifier, quieting, or searching for the sound and are rewarded for the correct response by getting to watch an animated toy ( visual reinforcement audiometry ).

Otoacoustic emissions (OAE) are inaudible sounds emitted by the cochlea when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate. The vibration produces an inaudible sound that echoes back into the middle ear. The sound can be measured with a small probe inserted into the ear canal and determined to be within a normal range or not.

Auditory brainstem response (ABR) is an auditory evoked potential that originates from the auditory nerve. Electrodes are placed on the head (similar to electrodes placed around the heart when an electrocardiogram is run), and brain wave activity in response to sound is recorded.

  • It causes delay in the development of receptive and expressive communication skills (speech and language).
  • The language deficit causes learning problems that result in reduced academic achievement.
  • Communication difficulties often lead to social isolation and poor self-concept.
  • It may have an impact on vocational choices.

Birth to three months:

  • Startles to loud sounds
  • Quiets or smiles when spoken to
  • Seems to recognize your voice and quiets if crying
  • Increases or decreases sucking behavior in response to sound
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs
  • Smiles when sees you

Four to six months:

  • Moves eyes in direction of sounds
  • Responds to changes in tone of your voice
  • Notices toys that make sounds
  • Pays attention to music
  • Babbling sounds more speech-like with many different sounds, including “p”, “b” and “m”
  • Vocalizes excitement and displeasure
  • Makes gurgling sounds when left alone and when playing with you

Seven to twelve months:

  • Enjoys games like peekaboo and pat-a-cake
  • Turns and looks in direction of sounds
  • Listens when spoken to
  • Recognizes words for common items like “cup”, “shoe,” or “juice”
  • Begins to respond to requests (e.g. “Come here” or “Want more?”)
  • Babbling has both long and short groups of sounds such as “tata upup bibibibi”
  • Uses speech or noncrying sounds to get and keep attention
  • Imitates different speech sounds
  • Has one or two words (bye-bye, dada, mama) although they may not be clear

What are ways to help my child develop appropriately?
Check your child’s ability to hear, and pay attention to ear problems and infections, especially when they keep occurring.

Reinforce your baby’s communication attempts by looking at him or her, speaking, and imitating his or her vocalizations.

Repeat his or her laughter and facial expressions.

Teach your baby to imitate actions, such as peekaboo, clapping, blowing kisses, pat-a-cake, itsy bitsy spider, and waving bye-bye. These games teach turn-taking that is needed for conversation.

Talk while you are doing things, such as dressing, bathing, and feeding (e.g., “Mommy is washing Sam’s hair”; “Sam is eating carrots”; “Oh, these carrots are good!”).

Talk about where you are going, what you will do once you get there, and who and what you’ll see (e.g., “Sam is going to Grandma’s house. Grandma has a dog. Sam will pet the dog.”).

  • Talk about colors (e.g., “Sam’s hat is red”).
  • Practice counting. Count toes and fingers.
  • Count steps as you go up and down them.
  • Teach animal sounds (e.g., “A cow says ‘moo’”).

What should my child be able to do from one to two years old?

  • Points to a few body parts when asked.
  • Follows simple commands and understands simple questions (“Roll the ball,” “Kiss the baby,” “Where’s your shoe?”).
  • Listens to simple stories, songs, and rhymes.
  • Points to pictures in a book when named.
  • Says more words every month.
  • Uses some one- or two- word questions (“Where kitty?” “Go bye-bye?” “What’s that?”).
  • Puts two words together (“more cookie,” “no juice,” “mommy book”).
  • Uses many different consonant sounds at the beginning of words.

Talk while doing things and going places. When taking a walk in the stroller, for example, point to familiar objects (e.g., cars, trees, and birds) and say their names. “I see a dog. The dog says ‘woof.’ This is a big dog. This dog is brown.”Use simple but grammatical speech that is easy for your child to imitate.

Take a sound walk around your house or in the baby’s room. Introduce him/her to Timmy Clock, who says “t-t-t-t.” Listen to the clock as it ticks. Find Mad Kitty Cat who bites her lip and says “f-f-f-f” or Vinnie Airplane who bites his lip, turns his voice motor on and says “v-v-v-v.” These sounds will be old friends when your child is introduced to phonics in preschool and kindergarten.

Make bath time “sound playtime” as well. You are eye-level with your child. Play with Peter Tugboat, who says “p-p-p-p.” Let your child feel the air of sounds as you make them. Blow bubbles and make the sound “b-b-b-b.” Feel the motor in your throat on this sound. Engines on toys can make a wonderful “rrr-rrr-rrr” sound.

Expand on words. For example, if your child says “car,” you respond by saying, “You’re right! That is a big red car.”

Continue to find time to read to your child every day. Try to find books with large pictures and one or two words or a simple phrase or sentence on each page. When reading to your child, take time to name and describe the pictures on each page.

Have your child point to pictures that you name.

Ask your child to name pictures. He or she may not respond to your naming requests at first. Just name the pictures for him or her. One day, he or she will surprise you by coming out with the picture’ s name.

  • Understands differences in meaning (“go-stop,” “in-on,” “big-little,” “up-down”).
  • Follows two requests (“Get the book and put it on the table”).
  • Has a word for almost everything.
  • Uses two- or three- word “sentences” to talk about and ask for things.
  • Speech is understood by familiar listeners most of the time.
  • Often asks for or directs attention to objects by naming them.

Use clear, simple speech that is easy to imitate.Show your child that you are interested in what he or she says to you by repeating what he or she has said and expanding on it. For example, if your child says, “pretty flower,” you can respond by saying, “Yes, that is a pretty flower. The flower is bright red. It smells good too. Does Sam want to smell the flower?”

Let your child know that what she or he has to say is important to you by asking him or her to repeat things that you do not completely understand. For example, “I know you want a block. Tell me again which block you want.”

Expand on your child’s vocabulary. Introduce new vocabulary through reading books that have a simple sentence on each page.

Name objects and describe the picture on each page of the book. State synonyms for familiar words (e.g., mommy, woman, lady, grown-up, adult) and use this new vocabulary in sentences to help your child learn it in context.

Put objects into a bucket and have your child remove one object at a time, saying its name. You repeat what your child says and expand upon it: “That is a comb. Sam combs his hair.” Take the objects from the bucket and help your child group them into categories (e.g., clothes, food, drawing tools).

Cut out pictures from old magazines and make a scrapbook of familiar things. Help your child glue the pictures into the scrapbook. Practice naming the pictures, using gestures and speech to show how you use the items.

Look at family photos and name the people. Use simple phrases/sentences to describe what is happening in the pictures (e.g., “Sam swims in the pool”).

Write simple appropriate phrases under the pictures. For example, “I can swim,” or “Happy birthday to Daddy.” Your child will begin to understand that reading is oral language in print.

Ask your child questions that require a choice, rather than simply a “yes” or “no” answer. For example, rather than asking, “Do you want milk? Do you want water?”, ask, “Would you like a glass of milk or water?” Be sure to wait for the answer, and reinforce successful communication: “Thank you for telling Mommy what you want. Mommy will get you a glass of milk.”

Continue to sing songs, play finger games (“Where is Thumbkin?”), and tell nursery rhymes (“Hickory Dickory Dock”). These songs and games introduce your child to the rhythm and sounds of language.

Strengthen your child’s language comprehension skills by playing the yes-no game: “Are you a boy?” “Is that a zebra?” “Is your name Joey?


Swimmers ear is an infection of the outer ear and ear canal. It usually presents with a red, tender ear that is painful to move or touch. Swimmer’s ear is usually caused by a bacterial infection and can frequently be treated with antibiotic ear drops.

Ear tubes, or tympanostomy tubes, are ventilation tubes that are placed in the ear drum to drain fluid in the middle ear. This procedure is most often done under general anesthesia but can be done in the office in some cooperative adults. Tympanostomy tubes help drain fluid from the middle ear, help decrease the number of ear infections, and can improve the hearing level. They usually stay in place for 9 – 18 months and fall out on their own. Some children need multiple sets of tubes while others grown out of the problem rapidly.

Tympanostomy tubes should decrease the incidence of ear infections, but children can still get ear infections. These will often show up as drainage from the ears. Up to 10% of children can have persistent drainage from the ears following ear tubes. This drainage can most often be treated with antibiotic ear drops.

Tympanostomy tubes are tiny plastic tubes that are surgically inserted through the eardrum by an ear, nose, and throat surgeon. They are also called tympanostomy tubes because they are placed in the tympanic membrane, which is another term for the eardrum. Tympanostomy tubes drain fluid out of the middle ear space and ventilate the area with air. In the U.S. at least 1 million children, usually from 1 to 3 years old, have tympanostomy tubes placed in their ears each year.

The eardrum normally vibrates with sound because the space behind it (the middle ear) is filled with air. If the middle ear is filled with fluid, as occurs during an ear infection, hearing is muffled. Sometimes after an ear is no longer infected, fluid remains in the ear. This occurs if the eustachian tube, which runs from the back of the nose to the middle ear, becomes blocked and no longer allows air in and fluid out. Approximately 30% of children still have fluid in the middle ear 1 month after an ear infection. 20% still have fluid 2 months after the infection, and 10% have fluid 3 months after the infection. Fluid is especially likely to stay in the ear if the first infection occurs before a child is 6 months old. By the time a child is 5 years old, the eustachian tube is wider and fluid usually doesn’t stay long after ear infections are treated. The main concern about having fluid in the middle ear for a long time is that the muffled hearing may affect a child’s speech development.

Tympanostomy tubes allow secretions to drain out of the middle ear space and allow air to reenter. The risk of recurring ear infections is greatly reduced. Hearing returns to normal with the tube in place and speech development can get back on track. Tympanostomy tubes also prevent the fluid from becoming thicker (a “glue ear”) and damaging the middle ear. Tympanostomy tubes give time for the eustachian tubes to begin to function better as the child grows older.

Approximately 10% of children with tympanostomy tubes continue to have ear infections with drainage and pain. However, these bouts of infection that require antibiotics probably would have occurred without the tubes. Normally the tubes come out and fall into the ear canal after about a year. Complications may occur when the tubes come out. Sometimes they come out too quickly and need to be replaced by another set. Rarely, they fall into the middle ear space and need to be removed by the surgeon. If the tubes remain in the eardrum for over 2 years, the surgeon may need to remove them. After the tubes come out, they may leave scars on the eardrum or a small hole (perforation) that doesn’t heal. Both of these problems can cause a small hearing loss. Because of these possible complications and the need to give anesthesia to young children before the operation, physicians recommend tympanostomy tubes only for children who really need them.

The surgical placement of tympanostomy tubes is usually recommended if your child has several of the following conditions:

  • Fluid has been present in the middle ear continuously for over 3 months.
  • Both ears have fluid.
  • The fluid has caused a documented hearing loss. A hearing loss greater than 20 dB can significantly affect speech. However, many children with fluid in their ears have nearly normal hearing.
  • The fluid has caused a speech delay (for example, a child is not speaking at least three words by the age of 18 months or 20 words by the age of 2 years).
  • Recurrent ear infections require repeated treatment with antibiotics.

Most children have only temporary hearing loss because of fluid in their middle ears. When you talk to your child during this time of temporary hearing loss, get close to him, seek eye contact, get his full attention, and occasionally check that he understands what you have said. If your child is not hearing you well, speak in a louder voice than you normally use. A common mistake is to assume your child is ignoring you when actually he doesn’t hear you. Reduce background noise from radio or television while you talk with your child. If your child goes to school, make sure that he sits near the teacher. (Fluid in the middle ear makes it difficult to hear in a crowd or classroom).

Chronic ear fluid and recurrent ear infections are usually caused by a blocked eustachian tube. However, there are other factors that might worsen a child’s condition:

  • Exposure to adults who smoke.
  • Drinking from a bottle while lying down (or bottle propping), which can cause milk to enter the middle ear space.
  • Nasal allergies, which can cause more frequent ear fluid buildup. Consider this factor if your child has hay fever, eczema, asthma, or food allergies.
  • Nightly snoring caused by large adenoids.

If any of these factors are true for your child, treat or eliminate them before you consider tympanostomy tubes.

Call during office hours if:

  • You have other questions or concerns about tympanostomy tubes.

Head & Neck Cancer

A lump in the neck…

Cancers that begin in the head or neck usually spread to the lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Remember, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are painless and continue to enlarge steadily.

Change in the voice…

Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see an otolaryngologist. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily in the office. While most voice changes are not caused by cancer, you shouldn’t take any chances. If you are hoarse more than two weeks, call us.

A growth in the mouth…

Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These sores and swelling may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. We can determine if a biopsy (tissue sample test) is needed.

Bringing up blood…

This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, contact us.

Swallowing problems…

Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a telescope) will be preformed to find the cause.

Changes in the skin…

The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes.

Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician.

Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may be trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a physician.

Persistent Earache…

Consistent pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms are best evaluated by an otolaryngologist.

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