How many ear infections does a child need to have before surgery becomes an option? Turns out the answer to that question is pretty straightforward.
"Kids who have had three ear infections in six months or four in a year meet criteria for seeing an ear, nose and throat specialist," says Dan Nicklas, MD, a primary care pediatrician at Children's Colorado's Child Health Clinic. "So that’s pretty easy."
Also called otolaryngologists, or ENTs, ear, nose and throat specialists see a lot of kids with common conditions that might lead to minor procedures like ear tubes, adenoidectomies and tonsillectomies. They're also trained in surgery.
But just because there's a referral doesn't mean there's automatically going to be surgery.
Plotting the course of ENT care
"Our approach is not simply to do surgery but to provide an opinion on the best treatment for the condition, whether that be surgery or medicine," says Kenny Chan, MD, Chief of the Department of Pediatric Otolaryngology at Children's Colorado. "Or it might just be watchful waiting."
In the process of forming an opinion, Dr. Chan might look at the patient's history with the condition, risk factors such as other complicating conditions, and the severity of the illness and its impact on the patient's life. He might evaluate a child's hearing or just meet with the family and ask questions. Most of the time, surgery is not the first step.
"We work closely with our colleagues in ENT," says Dr. Nicklas. "So if a kid is snoring, say, because of enlarged adenoids, we might try an initial intervention like nasal steroids, since if we sent them to ENT that's what they'd do. We try to coordinate to lessen parents' burden of care by minimizing visits."
How ENT specialists work with primary care providers
Since Dr. Nicklas and primary care providers at his clinic share electronic medical records with all Children's Colorado's specialists, they also have the advantage of a service that allows them to refer questions directly to specialists through the record system. The specialists can then direct them on initial treatments or tests - saving the patient an additional visit.
But even for patients at practices outside Children's Colorado, says Dr. Chan, his team works as closely as possible with local pediatricians to keep their patients where the provider knows them best: in primary care.
"Our job is to give parents and primary care providers all the information that would contribute to making an informed choice," says Dr. Chan. "Without that, the surgeon is merely a technician."