Otolaryngology (Head & Neck Surgery)

When a child has a significant hearing loss, it can have a big impact on their ability to talk, listen, and learn. If a child is not able to hear well enough with hearing aids, a cochlear implant may be an option to help improve their hearing. A cochlear implant is an implantable, surgical device with an external sound processor that can help change lives for children with severe-to-profound hearing loss. 

A leading program in North America

The Cochlear Implant Program at SickKids is one of the largest paediatric centres for cochlear implantation in North America. Our highly specialized team of surgeons, audiologists, speech-language pathologists, social workers and researchers work as a team to see if a child is a candidate for a cochlear implant. Once a child receives a cochlear implant, our experienced team continues to follow and support children throughout their school years until they turn 18. 

Since 1990 we have implanted over 2000 children and our world-class surgeons have treated children from all around the world. 

The team

The Cochlear Implant Team at SickKids is made up of professionals from many different specialties, including Otolaryngology, Audiology, Speech-Language Pathology, Social Work, Nursing, Genetics, and Research. The team works very closely together to provide the best care possible for children with cochlear implants. 

Referrals

Parents can self-refer to the Cochlear Implant Program. To apply, please download and complete the Cochlear Implant Program Patient Questionnaire (PDF) and mail or fax the form to the Cochlear Implant Coordinator (contact information included in PDF).

The process

When a child has been identified with a severe-to-profound hearing loss, it can be a very difficult time for the family. Our highly experienced and compassionate team will meet with families shortly after their diagnosis to answer questions about the hearing loss, the implications on speech and language development, and to provide more information about cochlear implants. 

Over the next few months, the child will go through an assessment process with many of the professionals on our team to see if a cochlear implant would be beneficial for the child. The child will have multiple hearing tests with the audiologists on the team to confirm the hearing loss, and our speech-language pathologist and aural rehabilitationists will help determine the child’s communication abilities. The child will also receive an MRI as part of the assessment process. Our team social worker will help support the family through this journey. 

Once all of the necessary assessments have been completed, the team gets together to share findings and make a candidacy recommendation. If cochlear implantation has been recommended, the child is placed on the waiting list for surgery. 

The cochlear implant surgery is performed by our surgeons and is usually a day surgery (an overnight stay is not usually needed). After 3-4 weeks, the cochlear implant(s) will be activated and then comes the most exciting and happiest part – when the child will be able to hear through the implant! 

The child continues to be followed and supported by our Program until their 18th birthday.  

Outside of Ontario?

For families living outside Ontario, please contact us for information on whether your child would be eligible for a cochlear implant at our centre.  

International families can also check the International Patient Program page. 

This centre specializes in voice disorders in children, and is headed by Paolo Campisi (Paediatric Otolaryngologist), Laurie Russell and Jennifer Allegro (Speech Language Pathologists). This centre offers voice assessment which includes perceptual and acoustic evaluation of voice as well as endoscopy and/or videostroboscopy. The centre was originally known as the Paediatric Voice and Laryngeal Function Laboratory. 

The DREAMS Clinic is a specialized clinic for the assessment and treatment of children and adolescents with complex sleep-disordered breathing. The experienced team includes respirologists/sleep physicians, otolaryngologists (head and neck surgeons), neurosurgeons, plastic surgeons, paediatric orthodontists, neuroradiologists, MRI technicians, anesthesiologists, a nurse practitioner and a respiratory therapist. We provide a multidisciplinary approach to managing complex obstructive sleep apnea, which may include surgical and non-surgical options. 

The ENT Clinic provides multidisciplinary care for all types of otolaryngology cases, including complex airway cases; surgical rehabilitation of hearing loss through cochlear implantation and bone anchored hearing aids; external, middle and inner ear disorders; and endoscopic sinus surgery. Special areas of clinical expertise have developed over the years, including voice and laryngeal function, laryngo-tracheal reconstruction, and complex sleeping disordered breathing and vestibular dysfunction. 

The Vertigo Clinic is part of the ENT Clinic, which provides multidisciplinary care for all types of otolaryngology cases, including complex airway cases; surgical rehabilitation of hearing loss through cochlear implantation and bone anchored hearing aids; external, middle and inner ear disorders; and endoscopic sinus surgery. Special areas of clinical expertise have developed over the years, including voice and laryngeal function, laryngo-tracheal reconstruction, and complex sleeping disordered breathing and vestibular dysfunction. 

The ability to quickly assess and treat newborn airway problems is vital to a successful outcome. The causes of neonatal airway obstruction are varied and are unique to paediatrics. The approach involves first defining the level of obstruction (where is the lesion?), and next identifying the specific pathologic entity (what is the lesion?). The assessment begins at the nose and proceeds all the way to the the chest wall. Every attempt is made to treat the primary cause in order to avoid the need for neonatal tracheotomy. 

The paediatric airway has been and still is an area of considerable expertise and innovation at The Hospital for Sick Children.

The late Blair Fearon introduced the world to laryngotracheoplasty in children in the 1970's. He also popularized the use of the CO2 laser for the paediatric airway in Canada. National as well as international fellows, residents and colleagues benefited tremendously from his unrelenting perseverance with this most difficult clinical entity. Work has continued at the hospital expanding upon his ideas.

William Crysdale performed the first anterior-posterior cricoid split in North America in 1974, as well as gaining considerable experience in the use of laryngeal stents.

More recently, Vito Forte has introduced the use of autogenous laryngeal cartilage as an alternative to rib cartilage as the graft of choice for moderately severe subglottic stenosis in the neonatal period and young child. Also he has successfully applied the principles of cricotracheal resection in adults, to children with severe subglottic stenosis.

Another area of recent innovation, developed by Vito Forte and Robert M Filler (Division of Paediatric General Surgery) has been the clinical use of the Palmaz stent for children with severe tracheobronchomalacia or collapse of the post-tracheoplasty trachea.

Also, much effort has gone into prevention of laryngotracheal problems by developing protocols for the management of the intubated and the failure to extubate neonate.

Much effort has gone into single stage reconstruction of the larynx for subglottic stenosis as well as single stage repair of laryngeal clefts in order to avoid long-term tracheotomy.

For publications related to this topic, please go to Pubmed.

As an integral part of many multidisciplinary teams working in one of the most advanced children's hospitals in the world, the department is capable of diagnosing and treating children with any disorder affecting the head and neck.

Head and neck tumours are uncommon in children. Only in a paediatric tertiary care centre, such as The Hospital for Sick Children, can enough experience amass for the development of expertise in dealing with these complex problems. The surgical concepts and techniques developed for the treatment of head and neck tumours in adults can be safely applied to the child, but special consideration must be given to future growth and developmental issues. An example of such a situation would be in the treatment of juvenile nasopharyngeal angiofibroma where surgical removal is preferred over external beam radiation for tumours which are extracranial.

For any head and neck tumour, the implications of treatment must be considered very carefully. Decisions regarding treatment are usually made at a multidisciplinary tumour board. Each specialist gives input as to the efficacy and consequences of the treatment proposed. The final decision as to what treatment is decided upon is arrived at by consensus. Progress and changes in the treatment plan are also monitored via tumour board rounds. Only with all the child's caregivers involved in the decision making process, can the best possible result be achieved.

Nasal airway obstruction is common in children. The presentation may be dramatic (obstructive sleep apnea), life threatening (choanal atresia in a newborn), or subtle (long face syndrome seen in the teenager as a consequence of long-standing nasal airway obstruction). Deviation of the nasal septum may be the cause of significant nasal airway obstruction.

Various names for congenital cholesteatoma have been proposed over the years including primary cholesteatoma (fr. Greek.chole, bile + stear, tallow, suet), true or cholesteatoma verum, primary epidermoid and genuine cholesteatom well as margaritoma (fr. Gr.margarites, a pearl), steatoma and keratoma (fr. Gr. keratos, horn). 

The diagnosis of congenital cholesteatoma has always presented some difficulty and controversy. In 1936, R.W.Teed demonstrated an epithelial thickening of ectodermal origin which developed in close relationship to the geniculate ganglion, at the dorsal end of the first pharyngeal cleft, medial to the neck of the malleus. 

Under most circumstances this structure would be expected to atrophy and become normal middle ear endothelium. When this did not occur, its continued growth could give rise to what would later present as a cholesteatoma. H. P. House is generally credited with reporting the first bona fide case of congenital cholesteatoma of the middle ear behind an intact tympanic membrane in 1953.

Derlacki and Clemis can be credited with legitimizing congenital cholesteatoma. In 1965, they simplified the classification into a) petrous pyramid type, b) mastoid type and c) tympanic type. It is now generally accepted that congenital cholesteatoma does develop from a congenital epithelial rest in the middle ear and may present at any age from infancy to adulthood; although, once the disease has attained a large size or extended beyond the middle ear it can be impossible to to establish a congenital as opposed to an acquired etiology. 

The typical patient presents with an asymptomatic discrete white lesion behind a currently intact tympanic membrane. There is no available history of significant trauma or major ear infection. The mastoid cell systems are most often symmetrically well-developed and aerated. Retraction pockets either of the attic or mesotympanum are not a feature and the Eustachian tube is apparently functional. These lesions are usually unilocular and restricted to the middle ear, presenting anterosuperiorly in the large majority of cases. When the diagnosis is early, ideally before three or four years of age, and the cholesteatoma confined to the anterosuperior quadrant of the middle ear one can expect curative removal and the preservation of normal hearing.

Dr. Paolo Campisi, Otolaryngologist; Director – Centre for Paediatric Voice and Laryngeal Function (Voice Clinic); Professor, Department of Otolaryngology – Head and Neck Surgery, University of Toronto; Director, Postgraduate Education, University of Toronto. Phone: 416-813-6558

Dr. Sharon Cushing, Otolaryngologist; Director, Cochlear Implant Program; Associate Professor, Department of Otolaryngology – Head and Neck Surgery, University of Toronto. Phone: 416-813-6558.

Dr. Adrian James, Otolaryngologist; Professor, Department of Otolaryngology – Head and Neck Surgery, University of Toronto. Phone: 416-813-6558.

Dr. Evan Propst, Otolaryngologist; Fellowship Director, Residency Site Director and Undergraduate Medical Education Site Director, SickKids; Associate Professor, Department of Otolaryngology – Head and Neck Surgery, University of Toronto. Phone: 416-813-6558.

Dr. Jennifer Siu, Otolaryngologist; Assistant Professor, Department of Otolaryngology – Head and Neck Surgery University of Toronto. Phone: 416-813-6558.

Dr. Nikolaus Wolter, Otolaryngologist; Assistant Professor, Department of Otolaryngology – Head and Neck Surgery University of Toronto. Phone: 416-813-6558.