Handle with Care: Pediatric Otolaryngology Requires Sensitivity

SAN DIEGO—Parents often bring their children to see pediatric otolaryngologists, distraught that their child’s speech is hard to understand. These can sometimes be delicate situations, and may or may not be cases for which otolaryngologists are best suited, an expert said here in January at the Triological Society Combined Sections Meeting.

Sometimes, these children will show signs of autism, and it is critical to understand what to look for so parents can be properly guided to appropriate care, said Anna Messner, MD, chief of otolaryngology-head and neck surgery at Texas Children’s Hospital in Houston. Her tips came in a session on pediatrics that also touched on the critical ways in which pediatric otolaryngology differs profoundly from adult care, and on how to manage laryngeal cleft.

Addressing Concerns

The most important features to look for in communication differences among children with autism are not saying any words by 16 months; not responding to their name being called but responding to other sounds, such as a honking car horn; possibly having a good rote memory, especially for numbers, letters, or songs; and losing language or other milestones between 15 and 24 months of age, a worrisome development known as regression.

Dr. Messner said it’s important to be tactful when interacting with parents.

“If everything else checks out, tell the family, ‘This looks like a developmental issue,’” she said. “I personally do not bring up the word ‘autism’ unless the family does first.” She suggested recommending that the family speak to a pediatrician. When she is particularly concerned, especially in cases in which speech or other developmental traits are actually getting worse, she might call the pediatrician herself.

Dr. Messner had other tips for handling speech concerns.

In cases of suspected tongue-tie, or ankyloglossia, it is important to assure parents that it typically does not affect speech, according to an upcoming clinical consensus statement from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). The statement is expected to be published in May, according to the AAO-HNS.

When parents are concerned that their child can’t say words with “R” or “S,” they should be told that those sounds are “late” sounds, and that it’s normal for those sounds not to be spoken correctly until up to age six, on the same timeline as the sounds “z,” “j,” and “th.”

An important feature to look for in children with difficult-to-understand speech is 22q11 deletion syndrome, brought on by a small deletion from chromosome 22. In these children, the most consistent feature is a fairly flat and fairly long midface, Dr. Messner said.

The syndrome is now easy to diagnose, with fluorescence in situ hybridization (FISH) testing widely available. These children frequently have palatal abnormalities, velopharyngeal insufficiency, and speech and language impairments, but treatments and services such as speech therapy can often help, Dr. Messner said.

“This is something you really don’t want to miss.”