Obesity is a common and increasing problem in America. In fact, some refer to it as an epidemic. Unfortunately, this epidemic is not only affecting adults but children as well. Over the last two decades, it’s estimated that the number of overweight and obese children has doubled with more than 15% of children between the ages of 6 and 19 now considered overweight or obese.
There is a difference between being overweight and being obese. Overweight refers to anyone with a body mass index (BMI) of 25 or above, while obesity refers to those with a BMI of 30 or above. Morbid obesity is a term used to refer to those with a BMI of 40 or more.
While we all know that being overweight or obese is unhealthy and can pose significant health risks to both adults and children, many are surprised to find that pediatric obesity is linked to many ear, nose and throat disorders. Some of the more common ear, nose and throat conditions seen in obese children include sleep apnea, middle ear infections, and infected or enlarged tonsils.
It’s estimated that 1% to 3% of children suffer from sleep apnea, typically between the ages of two and five. Sleep apnea causes children to stop breathing repeatedly throughout the night. This may occur anywhere from ten to sixty times in a single night and breathing may be suspended for as much as a minute or more.
Sleep apnea may be caused by a complete airway obstruction (obstructive apnea) or partial airway obstruction (obstructive hypopnea). Both can cause an individual to wake up during the night. Of the three types of sleep apnea – obstructive, central and mixed – obstructive sleep apnea (OSA) is the most common.
In children, sleep apnea is often associated with enlarged tonsils. Obesity may also increase the risk of sleep apnea as the excess weight may make it more difficult for the chest and abdomen to fully expand while breathing and thus interfere with the intake of air. Obstructive sleep apnea syndrome is a common yet rarely diagnosed childhood condition. Unfortunately, if left untreated, it can lead to serious complications including failure to grow; learning and behavioral problems; attention problems; and cardiovascular complications. Because of this, pediatricians now recommend routine screening for snoring.
Middle Ear Infections
Ear infections are the number one reason why American children see a doctor, with more than 15 to 30 million doctor visits occurring each year in the U.S. due to acute otitis media (AOM) and chronic ear infections. The incidence of AOM has also been on the rise in recent years. While there is no medical link between childhood obesity and middle ear infections, many believe there to be a behavior link. According to some studies, parents often comfort children with food or snacks when they’re found rubbing or massaging an infected ear.
Ear infections are typically first treated with antibiotics. If treatment is not successful, an ENT specialist like Michigan physician Dr. Haitham Masri may recommend a minor surgical procedure known as a bilateral myringotomy with pressure equalizing tube placement (BMT) in which small tubes are placed in both eardrums to help drain fluid behind the eardrum and equalize the pressure in the ear. This treatment has proven effective in reducing new infections and correcting associated hearing loss. This is a fairly simple procedure but is associated with a somewhat common complication known as postoperative vomiting (POV). While most common during the first postoperative day, POV may occur for up to one week after surgery. POV may delay recovery and interfere with oral medication and intake. Some factors are believed to increase the risk of POV, including obesity, gastroparesis, female gender, motion sickness, pre-op anxiety, and opioid analgesics.
In children, tonsillectomies are generally performed to remove chronically infected or enlarged tonsilswhich may be causing obstructive sleep apnea. Research has shown that morbidly obese children are at greater risk for additional medical disorders following tonsillectomy and adenoidectomy. They are also more likely to require an overnight hospital admission for removal of enlarged tonsils as well as longer overall hospital stays and increased need for intensive care. Morbidly obese children are also more likely to require continuous positive airway pressure treatment upon discharge form the hospital after tonsillectomy.
Managing Pediatric Obesity and ENT Disorders
If your child is overweight or obese, talk with your pediatrician about your child’s health and any lifestyle and diet changes that they may recommend. This is particularly important if you’re considering any treatments, including ear, nose and throat treatments, for your child. Your child should be cleared by his or her pediatrician prior to undergoing any treatment.