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The ABCs of Pediatric ENT: Understanding Common Issues

Great advice shared by Dr. Kubala of Texas Health, here are the most common ear, nose and throat issues in children and how you can identify and manage them.

It’s a busy time for doctors like Dr. Michael Kubala, an ear, nose, and throat (ENT) specialist on the medical staff at Texas Health Center for Diagnostics and Surgery.

That’s because Autumn is the start of the sniffles season — that time of year when many ears, noses, and throats get runny, stuffy, scratchy, or sore. 

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Dr Kubala Plano TX

Cases of upper respiratory infections (colds) and the flu occur more often in the fall and winter, typically picking up in October and peaking in December and February.1

In recent years, respiratory syncytial virus, or RSV, and COVID-19 also spiked around the same time((Understanding Today’s Tripledemic, Boston University. https://www.bu.edu/sph/news/articles/2022/rsv-flu-and-covid-19-understanding-todays-tripledemic/)).  Cases of strep throat, a bacterial infection of the throat and tonsils, peak between December and April.(( Strep on the Rise, CNN. https://www.cnn.com/2023/11/08/health/strep-amoxicillin-shortage-wellness/index.html#:~:text=Anyone%20can%20get%20strep%20throat,with%20a%20peak%20in%20February.)) 

Complicating the problem, allergies tend to gear up around the same time in the Dallas area, when pollen counts for allergens like ragweed, mountain cedar, and juniper spike.

Dallas often makes the list of “Allergy Capitals” released by the Asthma and Allergy Foundation of America (AAFA); in 2023 Dallas ranked #2 on the list of most challenging cities in the U.S. for pollen allergies.(( Press release, AAFA Announces 2023 Allergy Capitals. https://aafa.org/wp-content/uploads/2023/03/press-release-aafa-2023-allergy-capitals-report-15-march-2023.pdf))

Your first line of defense, says Dr. Kubala, is prevention. 

“Coming into the winter season, it’s all about good hand hygiene: washing your hands frequently, not sharing drinks, utensils, or food, and making sure you’re covering your mouth when you sneeze or cough, so you don’t spread disease to others,” he said. 

Dr. Kubala also encourages parents to do their part to help prevent the spread of disease to others, by keeping their kids out of school when they’re sick. But some bouts of colds or flu are inevitable this time of year.

“Honestly, once your child is in school or daycare, there’s only so much you can do,” he said. “Colds and the flu are viral and they’re highly contagious.”

Allergies aren’t preventable, of course, but you can take steps to practice “pollen hygiene.” After spending time outdoors, encourage your child to put their clothing directly into the laundry and bathe or shower right away. A saline nasal rinse can help flush pollen out of the nasal passages. These steps will help avoid bringing pollen indoors and keep pollen exposure to a minimum.((Tree Pollen Allergy, section on https://aafa.org/allergies/types-of-allergies/pollen-allergy/tree-pollen-allergy/ Section on Treatment for Tree Pollen Allergy)) 


From your ENT: Is it Cold, Flu, or Allergies? 

When a child starts sneezing or coughing, it’s often a challenge for parents to figure out what illness their kid has—and how serious it is. Is it a cold, the flu, or allergies? 

Symptoms of a cold, which usually peak within two to three days, may include runny nose, sneezing, itchy or watery eyes, and a cough or sore throat.  Your child might also experience fatigue or a slight fever. 

Flu symptoms tend to be more severe than cold symptoms and come on quickly. They include sore throat, fever, headache, muscle aches and soreness, congestion, and cough.  

Allergies typically last more than a few days, whenever the allergen is in the air. Symptoms may include runny nose, sniffling, sneezing, or itchy, watery eyes. It is unusual for a baby under 1 year old to be diagnosed with seasonal allergies; seasonal allergies typically involve older kids.((Cold, Flu or Allergy? NIH News in Health. https://newsinhealth.nih.gov/2014/10/cold-flu-or-allergy))  

Not sure whether your child has a cold or allergies? A fever typically signals that the problem is infectious; allergies do not cause fevers in children. Ditto for fatigue.  A thick nasal discharge, regardless of color, suggests a cold or other infectious disease.

When the sniffles do strike, parents can take steps to help manage the mucus production, to keep the child more comfortable, and help ward off more chronic problems.((Interview with Dr. Kubala.)) 

“Nasal saline rinses and intranasal steroid sprays such as Flonase can help, as can over-the-counter antihistamines like Zyrtec or Claritin,” said Dr. Kubala. “You can also try suction, using a bulb syringe, to help remove excess mucus from the nose.” 


What is Otitis Media? 

Most of the pediatric patients that Dr. Kubala sees have been referred by their pediatricians for persistent or chronic conditions that might warrant surgery or other interventions. 

The number one concern: chronic otitis media, or recurring ear infections. Ear infections often develop after a child of age 3 or younger has a cold or allergies, which produces excess mucus, causing fluid to build up and become infected in the middle ear. 

“A single case of an ear infection can usually be treated by a trip to the pediatrician and a round of antibiotics,” said Dr. Kubala. “But by the time they get to my office, the patient has usually had recurrent infections, either back-to-back or within a short period of time. The antibiotics just aren’t going be the most effective treatment option, so we evaluate for ear tubes.”(( Interview with Dr. Kubala. )) 

Guidelines from the American Academy of Otolaryngologists recommend ear tubes if the child has three ear infections within six months, or four or more ear infections in a year, or if the child has persistent fluid behind their eardrum for at least three months in a row.((AAO-HNSF Clinical Practice Guideline: Tympanostomy Tubes in Children https://www.entnet.org/news/aao-hnsf-clinical-practice-guideline-tympanostomy-tubes-in-children/#:~:text=Tympanostomy%20tubes%20may%20be%20offered,or%20reduced%20quality%20of%20life)) 

“Those are the standard criteria, but we may bend those criteria if the infections are really severe or to fit the patient’s needs,” said Dr. Kubala. 

Ear tubes – also called tympanostomy tubes, ventilation tubes, myringotomy tubes or pressure equalization tubes – are tiny, hollow tubes placed into the eardrums during surgery. An ear tube allows air into the middle ear. Ear tubes keep fluid from building up behind the eardrums.  

Ear tubes provide relief from ear infections, which can be painful, but also may help prevent hearing loss2.

“If you have that fluid behind the eardrum for at least three months in a row, it may lead to hearing loss,” said Dr. Kubala. “It’s just like when you dive into a pool and you’re trying to hear under water. That fluid is obstructing the sound waves from getting to the cochlea, which is the hearing center of the ear.”

Most ear tubes fall out in 4 to 18 months, and the holes heal on their own.  

Dr. Kubala notes that, in most cases, kids outgrow problems with frequent ear infections around age 4.((Interview with Dr. Kubala.)) 

“There’s a part inside each ear called the eustachian tube, which connects the middle ear to the back of the throat,” he said. “In children, up until about 3 to 4 years of age, that eustachian tube is very small, it’s collapsible and it’s more horizontal than vertical, so it doesn’t easily drain. When kids get these running noses and lots of mucus production, that fluid builds up in that eustachian tube and it can’t drain very easily.”

After age 3 or so, the eustachian tube begins to mature and the risk for ear infections significantly decreases.((Interview with Dr. Kubala.)) 


Problem Tonsils, Problem Sleep

The second most common issue that brings patients to Dr. Kubala is repeated cases of strep throat or tonsillitis. In that case, he may recommend removal of the child’s tonsils and adenoids. 

Tonsillectomies were once very common procedures, sometimes performed on young patients simply because they had enlarged tonsils, even when no significant problems were present. Today, the procedure isn’t as common, and in some cases, is recommended for very different reasons.

“There was a time when everybody who had big tonsils or big adenoids just got them out,” said Dr. Kubala. “We do still remove them, but definitely not as frequently as we did in the past. Nowadays, it’s because the patient has repeated bouts of tonsillitis or strep throat, or they’re having sleep problems.”((Interview with Dr. Kubala.))

Enlarged tonsils can contribute to sleep apnea in children. (Sleep apnea is typically diagnosed through a sleep study, also called a sleep evaluation, in which the child sleeps in a comfortable room in the sleep lab. During the sleep evaluation, a technician monitors the child’s sleeping and waking patterns, breathing patterns, body movements and brain waves.

This information is then interpreted by a board-certified pediatric sleep physician. Sleep apnea can cause sleep disturbances like snoring, restless sleep, or frequent reawakening in the middle of the night; in severe cases this disturbed sleep can cause behavioral issues or affect the child’s performance in school. 

“The number one reason that it happens in kids is because they have big tonsils and big adenoids, and the treatment would be getting them removed,” Dr. Kubala said. 


Make your Appointment Now!

ENT Specialist, Dr. Kubala sees patients at both the Plano and Dallas offices at Texas Health.

Dr. Kubala is accepting new patients so call today to set an appointment.
Call: 972-378-0633

Kubala, ENT, doctor, texas health

The advice shared here has been provided by Dr. Kubala from Texas Health. Plano Moms takes no responsibility for the accuracy of this information and does not provide Medical advice. See our Disclaimer for more information.

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  • Abbie

    Hi, I’m Abbie, super mom, and busy-bee who moved to Plano from London, England with my husband and 2 kids, Jesse and Lucy, in the Summer of 2013. Plano Moms was my lifeline when I arrived as I didn’t know anyone or anything about my new city that I now called home. When I’m not being a Plano Mom or being a taxi service to my kids, working out, cooking and reading (when I find the time!)

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  1. Centers for Disease Control, Flu Season. https://www.cdc.gov/flu/about/season/index.html []
  2. Plain Language Summary: Tympanostomy (Ear) Tubes in Children, American Academy of Otolaryngologists practice guidelines. https://journals.sagepub.com/doi/full/10.1177/01945998211065663 []