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Sunday, January 21, 2018

Gentle lessons to protect ears, nose and mouth

Authors Richard Jacobson (left) and Jerald S. Altman, MD. Photo by Daniel Friedman.

Last August, an Oklahoma family drove all the way to Phoenix, not realizing that their 8-month-old child’s life could be in danger.

They knew something wasn’t right. The child couldn’t cry. He wasn’t babbling like babies so often do. Before leaving for their trip, they took him to a local emergency room. Doctors examined him, listened to his chest and couldn’t find anything wrong. So the couple went ahead with their travel plans.

The child’s symptoms hadn’t changed by the time they got to Phoenix, and his parents were still worried. So they Googled “ear nose throat specialists” and found Jerald S. Altman, MD, an otolaryngologist/head and neck surgeon who practices with Valley ENT, P.C. of Glendale.

Altman inserted a fiber-optic nasopharyngoscope through the child’s nose and into his throat to examine his larynx, or voice box, and immediately found the problem: A prickly burr from a bush in the family’s backyard had lodged in the boy’s vocal chords. He couldn’t make regular baby sounds because his vocal chords could not come together. (Think about the way a balloon will whistle and shriek when you hold the edges together while allowing air to escape.)

Altman referred the family to Mesa pediatric ENT Nathan Page, MD, who performed a direct laryngoscopy to remove the offending burr. The child made a full recovery.

Altman still has a picture of the burr on his cell phone. But the incident was more than a medical story with a happy ending. It became the inspiration for a newly released children’s book, Don’t Stick Sticks Up Your Nose! Don’t Stuff Stuff In Your Ears!

At about the same time, Altman and his wife Lisa, who have two teenage daughters, were in the midst of life-changing transition. On July 4, 2012, after a 30-month journey of ups and downs, they welcomed 1-year-old Ethiopian-born Eli Alemu Blum Altman to their family.

One day, while Altman was reading the book Five Little Monkeys Jumping on the Bed to his new son, the idea for Don’t Stick Sticks came full circle.

“It’s such a gentle reminder not to jump on the bed—you could hit your head!” he says. “I thought, ‘Let’s write a book telling kids not to put things in their ears, nose or mouth.’”

Altman had written scholarly pieces for peer-review journals but he’d never written a book, and certainly not one for children. But he had 14 years of experience treating children who had put everything from buttons and rocks to candy and raisins into orifices above the neck. He mentioned the idea to his wife’s cousin, Valley landscape architect Richard Jacobson, who loved the concept. Jacobson brought the missing element because he’s “more creative,” says Altman.

The two settled on a format of four lines per page and Jacobson got to work.
“He did the first draft, and then it was back and forth every two nights for four months,” Altman said. “We rewrote it a million times.”

They sought illustrations through crowdsourcing (soliciting services from an online community). Eighteen artists competed for the job. To get help marketing the book, Altman established an internship for an upper-level student at ASU’s Barrett, The Honors College.

The 22-page book is recommended for ages 2 to 6 and is written in a tone both humorous and instructional:

No beehive in your ears,
No chopsticks up your nose,
Even though it’s tempting,
That’s not where that stuff goes.

Though the book has a light touch, there are serious implications for children who do not heed its lessons.

The Oklahoma child was lucky he inhaled a burr instead of something more solid. The tiny spaces between each of the burr’s many thorns allowed enough air through so the child could still breathe. Had his airway been blocked completely, he could have died.

Altman tells of a 4-year-old patient who had a foreign body in his nose for six months, leading to infection that could have spread to his brain.

“There is no question that parents need to be more aware,” he says. “It’s usually a simple thing to come to our office and have us pull it out, but you’re paying for the doctor’s office visit. For more complex cases, you’re looking at operating room and hospital fees.”

The book retails for $12.50 ($9.50 per book for orders of 10 or more) plus shipping. dontstickdontstuff.com.

What parents need to know

By Jerald S. Altman, MD

The best thing to do when discussing ear and nose foreign bodies is to understand how to prevent them. It’s important to try to identify potentially risky situations ahead of time. This includes minimizing your child’s exposure to small objects that could be dangerous.

Diligent supervision is important, especially when your kids are young. Using common sense and following safety precautions are the best ways to prevent foreign objects from going into someone’s nose or ear.

Parents and grandparents should toddler-proof their homes as best as possible, storing magnets and small button-type batteries in a locked cabinet. Proper disposal of used batteries is also important, so they are not in a location where curious preschoolers can pull them out of garbage can.

Education and direct supervision of kids while they play outdoors is the best way to avoid seeds, plant material, pebbles, sand, and other small outdoor objects from finding their way into their ears or noses.

Objects to avoid

Children under 4 are most at risk of inserting or swallowing small objects. Here are some things to keep out of reach to try to keep your child safe:

  • foods such as popcorn, dried peas, watermelon seeds and chocolate with nuts
  • marbles, magnets, buttons, beads and pen lids
  • polystyrene balls found in bean bags and stuffed toys − additionally, these can be inhaled and don’t show up on x-rays
  • coins
  • small batteries, which can leak acid and cause injury if placed in the ear or nose
  • toys with removable eyes, noses or other small parts
  • needles, pins and safety pins. Use pins with a safety catch, and keep them closed when not in use. Also avoid placing safety pins in your mouth, because your child might copy you.
  • pebbles, rocks, seeds, dirt, sand, sticks, pits from fruit

Preventing objects from being swallowed, inhaled or inserted

  • Supervise toddlers and small children while they eat − they like to experiment and play with food, which can lead to injuries. Encourage your child to sit quietly when eating and drinking.
  • Avoid giving your child popcorn or nuts (especially peanuts) until he’s at least five years old. A thin layer of peanut butter or hazelnut spread on bread is a good alternative.
  • Cut all food into small pieces, and remove sharp or small bones from fish, chicken and meat before giving them to your child. Preboned fillets can be a good option.
  • Try to wait until your child is 4 years old before letting her eat small lollies, even as a treat.
  • Avoid glitter, glue and small beadwork.
  • Teach older siblings that a baby’s ears and nose are delicate, and that they’re not for poking things into.
  • Check the floor and low tables for pieces of jewelry, button batteries, magnets, dried peas and other small objects.

Signs your child has a small object stuck somewhere

NOSE: Your child might:

  • complain of pain in their nose
  • have a smelly discharge from one nostril
  • bleed from the nose
  • have bad breath

EAR: 
Your child might:

  • complain of ear pain, though sometimes an object in the ear may not cause pain
  • have a smelly drainage from the ear
  • have bloody drainage from the ear
  • have redness of the ear or around the ear
  • have reduced hearing in one ear
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Karen Davis Barr

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