Otolaringology The Otolaryngologist is also known as an ear, nose, and throat surgeon. The otolaryngologist is the physician most often consulted for disorders of breathing, hearing, and speech. Abnormal craniofacial development will commonly affect one or more of these functions, and the otolaryngologist is therefore an essential member of the craniofacial team.

Maintenance of an adequate airway is essential in all patients and particularly in those with craniofacial anomalies. Many of these patients are born with facial features such as underdeveloped upper or lower jaws or enlarged tongues which obstruct the normal breathing passages. These children often have difficulty feeding and growing, and occasionally experience life threatening events due to complete obstruction of the airway. The otolaryngologist is the specialist trained to examine these patients. Occasionally, endoscopy (examination of the airway with fiberoptic and rigid telescopes) is necessary to most accurately determine the site and severity of the problem. Surgical correction may require a variety of procedures including tonsillectomy, adenoidectomy, widening of the nasal cavity, jaw advancement, tongue reduction, and tracheotomy.

Children with craniofacial problems are known to be at increased risk for impaired hearing. In most cases, this is the result of chronic fluid in the middle ear ("ear infections") resulting from reduced ventilation through the Eustachian tube. This tube, which connects the ear to the throat, is opened by muscles in the palate, allowing air into the middle ear space with such actions as yawning or swallowing. When abnormalities of the palate or base of skull are present, this action is impaired. The negative pressure within the middle ear causes fluid to build-up, and clearance is reduced since the tube will not open. The fluid thickens and partially blocks the sound entering the ear, reducing the ability to hear. This problem is treated by evacuating the fluid from the ear, and placing a "pressure equalization" tube in the eardrum to bypass the Eustachian tube and maintain ventilation.

In other craniofacial patients, there may be abnormal development of the outer ear, ear canal, or hearing bones (aural atresia) or of the inner ear (cochlea) which may be responsible for hearing loss. In all of these children, hearing must be carefully assessed by an audiologist and aided when necessary. The ears must also be thoroughly examined, occasionally by X-ray. In some cases, reconstruction of the ear and hearing may be possible.

Abnormalities of speech in craniofacial patients may result from impaired hearing, but also may be due to poor palate function, abnormal dental development, or problems relating to the voice box. The otolaryngologist assesses all of these functions. Frequently these patients are examined in the presence of a speech pathologist so that function may be compared with structure. Occasionally, a small fiberoptic telescope may be used for more precise evaluation of these areas. In cases where speech therapy has not succeeded in correcting the problem, the otolarynogologist may recommend orthodontic consultation or surgical intervention for the throat or palate.

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