Integrating leading-edge research with multi-specialty clinical care
The University of Minnesota's Children's Ear, Nose, and Airway Center is a comprehensive, multispecialty center for treatment of: recurrent and chronic ear infections, unexplained hearing loss, infant stridor and airway obstruction and consists of three core clinics:
These clinics provide multidisciplinary diagnosis and treatment of children's hearing disorders, ear infections, sinusitis, and airway problems. The expertise of specialists in pediatric infectious disease, allergy, immunology, pulmonology, audiology, and otolaryngology is available in one integrated setting. Other pediatric subspecialists on the faculty consult as necessary.
The clinics combine the latest in diagnostic and treatment techniques with research to provide the most advanced care available for children with usual and complex ear, nose, and throat problems.
Clinic appointments may be made by calling (612) 626-0486 or (612) 625-4481 (Cindi Davis, R.N.). Emergency consultation is obtained by calling the University of Minnesota Medical Center U-Access line (1-800-888-8642) and asking for the pediatric otolaryngology or pediatric infectious disease physician on-call.
Findings included Gram-negative enteric organisms from both maxillary sinuses and a positive esophageal biopsy. Anti-reflux medication was started with little relief. Because of persistent symptoms, a Nissan fundal plication was performed, following which the child improved dramatically, with relief of head-banging and his low grade temperatures.
The Children's Sinusitis and Allergy Clinic was developed to bring together pediatric otolaryngology, pediatric infectious disease, and pediatric allergy specialists to treat more effectively those children suffering from chronic sinusitis and allergies that have been resistant to standard therapy.
A.V. was an 11-year old boy who presented with right upper lobe collapse on both physical exam and chest x-ray. He was referred to the University of Minnesota Pediatric Airway Center. After medical workup to exclude tuberculosis and other granulomatous diseases, the team of pediatric specialists in otolaryngology, cardiothoracic surgery, infectious disease and pulmonary medicine decided that the child should undergo bronchoscopy with brush biopsy and cultures. Pathology revealed massive granulomatous reaction, with the appearance of a foreign body reaction.
To save this child from lobectomy, it was decided to remove the granulation tissue endoscopically by KTP laser vaporization. After two laser procedures over a five-day period, the lung was successfully reinflated and the child discharged, with follow-up by repeat chest x-ray. The child continues to do well.
The Pediatric Airway Center was developed to provide integrated, multispecialty service to children with difficult airway problems. The team is headed by specialists in pediatric pulmonology, critical care, and otolaryngology. It includes consultation with specialists in pediatric infectious disease, allergy/immunology, anesthesia, radiology, and cardiothoracic surgery. A nurse clinician coordinates the patient's care. Team specialists' experience includes the largest published series of pediatric laser bronchoscopies as well as the development of new airway imaging modalities such as dynamic airway MRI.
Children's Hearing and Ear Disorders
T.W. was a 3 1/2-year-old boy who had a history of multiple ear infections. Shortly after PE tubes were placed, he began to experience otorrhea. The fluid was thin and white, and became brown in color. Otorrhea was resistant to treatment with oral antibiotics and assorted ear drops. He was referred to the Children's Hearing and Ear Clinic, where bacterial cultures of the drainage revealed Pseudomonas aeruginosa, Candida species, and Mycobacterium chelonei.
An exploratory tympanotomy and mastoidectomy were performed to debride the ear, and a Hickman catheter was placed to start long-term IV antibiotic therapy. Sensitivity testing indicated that the mycobacterium was resistant to common anti-mycobacterial drugs. Imipenem-cilastatin and cefoxitin were used initially, but he tolerated these drugs poorly. Testing showed that the mycobacterium was susceptible to ciprofloxacin and erythromycin. Ciprofloxacin was used on an investigational protocol because the child was younger than the approved minimum age for use. After 15 months of antibiotic treatment and four additional otologic procedures, the infection resolved. The patient recovered with normal hearing and no systemic sequelae.
The Children's Hearing and Ear Clinic was developed to make new treatment technologies available to children with acute and chronic ear infections. The clinic is staffed by specialists in pediatric infectious diseases, pediatric otologic surgery, and pediatric audiology. All three specialists examine each child during the initial visit.
Research is also a primary focus. The center is home to the oldest National Institutes of Health Otitis Media Research Center, the largest and most comprehensive of its kind in the United States. A number of important discoveries have led to better understanding and treatment of otitis media.
Some recent developments include: improved indications for and types of medical and surgical treatment; the identification of silent otitis media and development of improved diagnostic instruments; development of the Juhn Tymp-Tap for middle ear fluid collection, and identification of biochemical markers for disease progression; and better protocols for the use of ototopical antibiotics and antiseptics, some of which have inner ear toxicity.
Microbiological and biochemical studies of otitis media with effusion have led to antimicrobial and anti-inflammatory drug treatment trials. And center researchers are testing vaccines that may ultimately prevent otitis media.
Frank Rimell, M.D., is assistant professor of Otolaryngology and director of the Division of Pediatric Otolaryngology. His interest include pediatric airway problems, in which he has numerous clinical and research publications; pediatric sinusitis; and chronic middle ear disease. Dr. Rimell's clinical and research focus is on pediatric sinusitis and pediatric airway, with numerous peer-reviewed publications and national presentations in this area.
Lisa Hunter, Ph.D., is assistant professor of Otolaryngology, and director of the Lion's Children's Hearing Research Laboratory. Her interests include assessment and rehabilitation of central auditory disorders in children. Her bibliography includes numerous peer-reviewed publications and national presentations on the effects of chronic otitis media on hearing in children.