Helping the most delicate ENT patients

Fevers, coughs, and runny noses were familiar territory to Susan Coulter. Even so, the young mother of four was worried about the perpetually clogged nose and chronic ear infections plaguing her newborn son, Mathew. "I could tell something was wrong," recalls the Staten Island resident. "The hard part was finding out what."

A throat specialist recommended surgery to remove Mathew's adenoids. "I didn't like the sound of it," Ms. Coulter says. "He was only four months old." She turned to Dr. Richard M. Rosenfeld, head of pediatric otolaryngology at Downstate's University Hospital of Brooklyn.

The problem, Dr. Rosenfeld found, was gastric reflux--stomach acid rising through the esophagus, irritating the throat and sinuses. To Ms. Coulter's relief, the condition required medication rather than surgery.

For young Matthew Truisi, however, surgery was the right choice. Besides chronic ear infections, the 14-month-old suffered from nasal congestion so severe he gasped and choked in his crib at night. Even feeding became difficult.

The Brooklyn resident went from doctor to doctor, each with a different diagnosis. Then she brought Matthew to Dr. Rosenfeld, who found that Matthew's infected adenoids had caused sinusitis and produced enough fluid in his ears to impair his hearing.

Dr. Rosenfeld suggested two procedures: tubes to drain the ears and surgery to remove the adenoids. Today, Matthew's hearing and health have improved dramatically.

According to Dr. Rosenfeld, the two cases illustrate a central truth for surgeons in general--and ear, nose, and throat specialists in particular. "There are three important lessons every surgeon has to learn," he explains. "Learning how to perform surgery is the easiest. Learning when to do it is a little harder. Learning when not to is the most difficult. When it comes to children, those points are absolutely critical."

Treating children is Dr. Rosenfeld's specialty. And it is the sole purpose of University Hospital of Brooklyn's Division of Pediatric Otolaryngology, which Dr. Rosenfeld founded and directs.

In only five years, the division has won a reputation as one of the best of its kind. Its extensive services include ear-wax removal, tonsillectomy and adenoidectomy, removing foreign bodies from the ears and nose, treatment for speech and hearing disorders, and surgery of the ears, nose, sinuses, and larynx. The division also performs surgery for tumors, infections, and congenital anomalies of the head and neck region.

Dr. Rosenfeld and his associate, Dr. Ari J. Goldsmith, see about 4,000 patients a year-most of them referrals, all of them under 18. "It's only in the last 20 years or so that otolaryngologists have really begun to specialize in children," Dr. Rosenfeld explains.

"Physicians and surgeons in the field have come to the realization that taking care of kids is not the same as taking care of adults."

Children-especially young children-suffer from specific kinds of ear, nose, and throat disorders, says Dr. Rosenfeld. They may be as commonplace as an ear infection, or as complex as a need for voice-box reconstruction. Treating these disorders demands specialized training, especially in terms of surgery.

"Take sinus surgery in a child," Dr. Rosenfeld explains. "That child's sinuses might be only a little over a quarter of an inch in width-50 to 70 percent the size of an adult's. A general otolaryngologist may not have the right background or equipment for that kind of surgery."

Dr. Rosenfeld and Dr. Goldsmith are fellowship-trained in pediatric otolaryngology. And both have won plaudits for their practice. New York magazine rated them among the best otolaryngologists in the city. American Health magazine ranked them among the top pediatric otolaryngologists in the entire nation.

Their division has two locations: a suite on the first floor of University Hospital of Brooklyn and an office at Long Island College Hospital in downtown Brooklyn. The affiliation provides the division with a strong medical support team. The team also sponsors a highly regarded division of communicative disorders, specializing in pediatric speech, hearing, and language.

Ultimately, Dr. Rosenfeld believes, the division's success lies in its emphasis on personal relationships.

Dr. Goldsmith agrees. "Children are not small adults," he says. "The approach has to be different. You have to consider family dynamics, the child's special emotional needs. Our goal is to make children, and their families, feel great."