Diseases of the ears, nose and throat make up about 60% of Paediatric practice! Few parents can deny their child ever having a sore throat or ears. Fortunately, children are remarkably resilient, and most of the time, recover without incident. Often, no treatment is required! However, for those children who do have persistent tonsillitis for example, help is at hand!
Tonsillitis and Adenoiditis
The tonsils are the two balls of lymphoid, or “gland” tissue that can be seen at the back of the throat. The adenoids are similar tissues, but situated behind the nose, and so are generally not visible except with the use of special instruments. The tonsils and adenoids help with your child’s immune system as he grows up, and can be seen as the first line of defense against infection. The tonsils and adenoids vary in size, and usually shrink as the child gets older. It is important to realise that the size of the tonsil, in itself, is not important. Only when they become regularly infected, or cause difficulty with breathing or swallowing, are they considered a problem.
Tonsillitis is an infection of the tonsils, usually caused by bacteria. The main symptoms of tonsillitis are a sore throat, fever, difficulty swallowing, ear pain and sometimes even vomiting. The tonsils will be red and swollen and can even have spots or patches of white on them. Tonsillitis can sometimes complicate by developing into an abscess, but this is rare in children, especially when treated promptly with antibiotics.
Recurrent infection of the tonsils and/or adenoids may require surgery. It is the commonest surgical procedure performed worldwide, and usually is uneventful. Children recover extremely quickly, provided the parents follow the post operative advice given by the doctor! Certain cases require more attention, such as children with Down’s Syndrome or Obstructive Sleep Apnoea; your doctor will provide more information in this regard, if required.
Middle Ear Infections.
Middle ear infections are also known as otitis media. It is a common childhood disease, especially today when most children attend creches. It is estimated that 5 out of 6 children will have had an ear infection by the time they are 3 years old. They are caused by viral or bacterial infections that affect the middle ear, the area behind the eardrum. Middle ear infections can be quite painful due to inflammation and the build-up of pus or fluid in the middle ear. This fluid or pus will also cause a conductive hearing loss (meaning that sound has a hard time getting to the “inner ear”, where it is translated into electrical impluses).
Since these ear problems often clear up on their own, treatment may vary. An ear infection can resolve spontaneously without antibiotics, and in fact up to 80% of them do. As such, most of the time only painkillers and fever medicine, such as Paracetamol, are required. In certain instances, however, antibiotics may be prescribed. Antibiotic resistance is becoming a worldwide problem, and doctors are increasingly cautious about prescribing antibiotics unnecessarily. There are certain long term problems that can occur due to ear infections, like persistent fluid in the ear (glue ear) with hearing problems. In such cases, further management with eg grommets may be required.
“Glue Ear” Otitis Media with Effusion (OME)
Sometimes, an ear infection does not clear up completely, and some fluid gets left behind. This fluid becomes sticky, and gums up the tiny bones that vibrate in the ear, very similarly to a car engine that has sludge build up. When this happens, the patient may not hear well, and may occasionally have pain. In children, who cannot communicate such symptoms effectively, this is manifest as an irritable child, or constant pulling on the ears.
Sometimes there is no ear infection before a glue ear, but a bad cold or sinus infection affects the function of the Eustachian tube, which is a tube that runs from the back of your nose to your ear and is responsible for ventilating your middle ear and constantly equalising the air pressure. If the tube is damaged, fluid can build up in the middle ear and cause the same symptoms as mentioned above.
If the fluid in the ear is persistent and causes hearing loss, a grommet or ventilation tube can be inserted in the eardrum.
Children are, by nature, curious. Unfortunately, this means that, sometimes, their curiosity can result in unforeseen consequences, such as beans in the nose, or batteries in the ear! Removal of these can be challenging, especially in an uncooperative child, or if removal has been unsuccessfully attempted before. In such cases, a general anesthetic may be required to remove the object safely.
There are many different airway problems that may exist in children, and two of the common terms used here are stertor (or snoring) and stridor.
Stridor is a high-pitched, musical sound that usually is a result of an obstruction in the lower airways, around the voicebox and windpipe, but not the lungs.
The most common cause of this in neonates is laryngomalacia. This condition starts a few days after birth, worsens and peaks at nine months and usually resolves by two years of age. The cause of Laryngomalacia is not clear, but a neuromuscular imbalance is most likely. Certain population groups are at higher risk, such as blacks and Hispanics. The problem in laryngomalacia is that excess tissue in the voice box flops into the airway when the child breathes, causing an obstruction. This usually improves when the child is quiet, and if he lies on his stomach. In ninety percent of cases, no surgery is needed, but the problem can get worse in times of an upper respiratory tract infection. It is best to seek help if you are unsure about your child’s breathing.
Another cause of stridor is croup. Most veteran parents are familiar with the condition. This is a viral infection of specifically your voicebox (larynx), windpipe (trachea) and bigger lungpipes (bronchus) areas, and thus is also called laryngo-tracheo-bronchitis. These children can be severely ill, with high fevers and a ‘barking’ cough. Although most cases resolve spontaneously, croup can be a life-threatening condition, and you should seek medical help urgently if you are at all concerned.
Stertor / Snoring
Snoring is the noise that occurs when there is a blockage in the upper airways of a child, usually in the nose but sometimes in the mouth as well. The term “snoring” can be used for anything from simple, soft snoring every now and then to severe breathing obstruction every night.
There are a few areas in the nose and mouth that can be the site of obstruction, but the most common cause in children is enlarged adenoids. Sleep apnoea is diagnosed if the obstruction is so bad that the child stops breathing for a few seconds. This can have serious complications by causing severe strain on the heart that can lead to heart failure, and a snoring child should thus be assessed by a medical professional. Sleep apnea can also impact on children’s energy levels, performance at school, and moods.
Although enlarged adenoids are the most common cause for snoring in children, in some cases other problems like nose allergies or abnormal anatomy in the child’s nose can be the reason. It can even be a combination of several factors, and it is best to have your ENT specialist try and find out which applies to your child.
Some children outgrow their snoring as they get older and their airways develop and enlarge.
Wheezing refers to a whistling sound usually originating from the small airways within the lungs. The commonest cause is Asthma. ENTs do not usually deal with wheezing, and referral to a paediatrician/pulmonologist is appropriate.
Neck lumps in children are usually simple “glands” or lymph nodes. Because children are exposed to such a vast variety of viruses, bacteria and other micro-organisms, their immune system has to work overtime to learn how to cope with all the bugs! The body does this by developing antibodies. In the process of developing antibodies, the lymph nodes enlarge. However, persistently enlarged nodes, or nodes that get larger with time, can be a sign of more serious disease, and you should consult a doctor. Any neck lump that causes difficulty breathing, or is unusually painful, or causes gross distortion of the child’s appearance should be assessed without delay.
Hearing and speech disorders
Children learn by hearing, seeing and touching. Any impairment in hearing can thus be seriously detrimental to a child’s development. Equally, speech development is heavily dependant on normal hearing. An ENT can assist with identifying hearing loss, and remediation thereof.