A Bit of Doctor Talk, If I May

I would like to just start out by saying I know very little about the anatomy of the throat and ears so I may not say everything the way I should and I might not make complete sense in my explanations but I have gathered a lot of information from Google and compiled it with what the doctor said this morning and the paperwork I was sent home with and came up with the following.

After months of questions, multiple specialists, too many appointments to count, and test after test after test I think we've finally had a breakthrough. This morning I took Titus to see Dr. Beck, a nose, ear and throat specialist and after a very informational three hour appointment, I left feeling very overwhelmed. She put a scope down his throat to take a look around and found that the opening in his pharynx is abnormally and alarmingly smaller than it ought to be. She said she was surprised that he was even able to breath let alone eat and swallow.

'The pharynx is the part of the throat situated immediately below the mouth and nasal cavity and above the esophagus and larynx. The pharynx is part of the digestive system and also the respiratory system; it is also important in vocalization.' So says wikipedia (I forgot how to site my sources....obviously!)

Dr. Beck also said that he has stridor (noisy breathing), which 'can be caused by any process that causes airway narrowing. In the infant, stridor usually indicates a congenital disorder (problem that you child is born with).' This obviously goes hand in hand with the narrow opening in his pharynx.

Another issue we addressed at the appointment was the fluid in his ears, behind his ear drums. Doctor said that the fluid is causing him to hear things as though he is under water and is probably the cause for delay in speech and babbling in general. She seemed far more worried about the left ear than the right, which I'm pretty sure is the ear that almost failed the hearing screening in the NICU.

The solution to both: surgery. This Monday. It will be done at the St. Luke's downtown early in the morning. He will of course be sedated and he will spend the day there as well as Monday night and possibly most of the day on Tuesday.

Doctor will be preforming a myringotomy with tubes, which is 'a surgical procedure that makes a small hole in the eardrum through which fluid can be removed from the middle ear. A tube is inserted in the hole, allowing air into the middle ear. This prevents fluid from building up again.' This is seemingly simple, should only take 8 - 10 minutes. Titus may be uncomfortable or even frustrated after the procedure due to the change in middle ear pressure and also the increase in hearing but he should adjust pretty quickly and will be able to hear normally immediately after. 

Doctor will also be preforming a direct laryngoscopy bronchoscopy. She said she will be using a rigid and fiberoptic scope to pass through the mouth and down the throat, at which point she will use a laser to make the opening in the pharynx a bit wider. Then she will pass through the vocal cords. She will be able to see the entire anatomy from there and will be able to assess the right and left lung and will sample secretions and send them off to pathology to evaluate for aspiration and reflux. 

This procedure is much more invasive. Titus will have about a 4 to 6 week recovery time. For the past year he has learned how to swallow and breath in a way that is completely abnormal so the weeks after surgery will be all about learning those things all over again. They will monitor him, specifically his breathing, for at least 24 hours after he gets out of surgery and will keep him longer if things don't seem to be going as smoothly as they would like. We'll be home by Tuesday night, fully loaded with reflex medication, antibiotics, and a nebulizer.

I also forgot to mention that Titus' adenoid is much too big causing it to be very difficult for him to breath through his nose due to excessive mucus production. Doctor will be removing that as well by performing an adenoidectomy. Most of the time the tonsils would be removed at the same time and even though his are slightly bigger than doctor would like them to be she has decided it it best to keep them in there for now because they don't seem to be causing Titus any discomfort or problems.
(The adenoid is highlighted in green.)

The next couple of weeks will hold their challenges but they will also be so rewarding. My sweet boy will be able to hear clearly, he will learn to eat and breath properly and instead of using up extra calories with those two tasks he will be able to put so much more of his energy into growing and learning! He has an occupational, physical, and speech therapist coming out every Friday for the next couple of months to help him learn how to sit, crawl, walk, and talk and I am just thrilled to see everything that Mr. Titus is capable of without his current restraints.

Well, I know that's a lot of information and is a bit much to digest, trust me, it's taken me all day to wrap my head around it and I still feel like I'm missing pieces. If you have questions, feel free to ask! I'll keep you updated while we're in the hospital and after. I'm so proud of my little trooper...after months of poking and prodding and we can finally see the light at the end of the tunnel. Until next time, happy blogging!