Paediatric ENT – What is ear, nose and throat ENT for children?

The most common paediatric ENT condition is allergic rhinitis, often mistaken for sinusitis. Allergic rhinitis is commonly associated with troublesome nasal congestion, sneezing and runny nose. It is not common for sinusitis to occur in children as children do not have fully developed sinuses yet. For children with big adenoids (“tonsils in the nose”), they can have an adenoid infection with yellow nasal discharge, blocked nose and sneezing.

More otolaryngology information on allergic rhinitis can be found here.

It is important to ascertain the potential allergens that trigger allergic rhinitis. To do this, a painless skin prick test is required. Once the allergens are identified, avoiding them is the cornerstone treatment. I generally prescribe nasal sprays to help manage the condition. For other paediatric treatments, patients will need to visit an ENT (ear nose and throat) specialist, who will be able to perform more advanced treatments.

Outer ear infections can result in hearing loss and pain or smelly discharge from the ear. As the ear canal in the pediatric patient is smaller, it is more prone to ear wax impaction and outer ear infections (otitis externa).

Picture of severe otitis externa (outer ear infection) with complete blockage of the ear canal. This patient had hearing loss as a result. Ear, nose, throat conditions are all often linked and infection at the ear can often lead to complications around the nose and throat.

What are some treatment options?

Treatment of otitis externa includes aural toilet (ear vacuum suctioning of the ears) to remove wax and pus. Antibiotic ear drops are given but are only effective when the pus and wax are removed. It is important to apply a tragal massage to the ear during the application of the ear drops to ensure it enters the ear canal completely. Try to also keep the ears dry and avoid the use of cotton buds

Hearing and speech & language development go hand in hand. In fact, the most common cause of speech & language delay is hearing loss. When a young child has undetected hearing loss, it can result in developmental delay. Studies have shown that even mild hearing loss in a developing child can affect in speech & language development. Early intervention is important to treat this condition.

How can I get hearing loss in my child checked out by an ENT specialist?

Dr. Dennis Chua, an ENT specialist, will take a detailed look at the patient’s development and history. I will conduct a physical examination to look for possible causes of hearing loss. This can include ear wax, ear infections or glue ears. Sometimes the cochlear nerve, which is responsible for hearing, could have been affected by previous infections. This will thereby result in hearing loss.

If a child is older than 4 years old, a hearing test (audiogram) performed in a sound booth can be done in my clinic. For younger kids, an auditory brainstem response can be performed under sedation to assess the inner ear and brainwaves.

Some ENT Treatment options available for children:

• Cleaning the wax and treating the ear infections
• Treating any glue ear (middle ear effusion) present
• Hearing Aid
• Hearing implant surgeries

Glue ears/ Otitis media with Effusion

Middle ear effusion is more common in the pediatric children population. This condition happens when when fluid builds up behind the ear drum in the middle ear, resulting in hearing loss. If there is an infection, the fluid can develop into pus and the infected child can suffer from acute otitis media, resulting in ear pain, hearing loss and fever.

Picture of ear with middle ear effusion. This has resulted in hearing loss for the children. It can also be painful during a flight.

Treatment of middle ear effusion is targeted at the nose with nasal sprays and a course of antibiotics. No ear drops are necessary. This is because the correct way for the fluid to drain out of the middle ear is through the eustachian tube at the back of the nose.

Picture of ear drum with pus noted. This child experienced fever with ear pain. It is important to treat this condition urgently as it the pus can sometimes burst through the ear drum resulting in a hole in the ear drum.

Tonsils are 2 oval-shaped structures at the back of the throat. They provide immunity for children under the age of 1. Beyond the age of 1, there is no function and will disappear by the time children turn 12.

Tonsils can be graded based on size- 1-4. The bigger the tonsils (grade 3 or 4) the more problems it can cause. Common problems include tonsillitis (infection of tonsils) or obstruction (possible resulting in sleep apnea)

What is tonsillitis?

Tonsillitis is an infection of the tonsils. It can be acute tonsillitis where the patient experiences pain, fever, sore throat and difficulty in swallowing. Sometimes pus can be seen on the tonsil.

Picture of tonsillitis with pustules. The patient is in significant pain and required intravenous hydration

What is recurrent tonsillitis or chronic tonsillitis?

When infection happens several times a year, it is known as recurrent tonsillitis. Recurrent tonsillitis can be extremely damaging and it can affect the quality of life of the individual. In severe cases, the infection can spread to the neck and sometimes result in a neck abscess.

When is tonsil surgery or tonsillectomy required?

Neck surgery is required when there are recurrent infections or obstructions to the airway causing sleep apnea. With that said, neck surgery for the removal of tonsils does not result in weakening of the immune system.

To ensure big tonsils are not a tumour, they usually sent off for histology testing.

How is tonsillectomy performed?

This is a straightforward neck surgery under general anaesthesia. For older children, tonsillectomy can be performed in a day surgery setting. Thanks to advanced technology these days, the surgery can be done in a minimally invasive manner with the use of a plasma blade.

The risks of bleeding and infection are generally minimal.

What are adenoids?

Adenoids are tonsils located at the back of the nose. They are lymphoid tissue and similar to tonsils, play a part in the immune system of children below the age of 1. For children above the age of 1, adenoids have no function. Adenoids that are enlarged or infected can result in recurrent infections, ear infections (acute otitis media) or even sleep apnoea.

How can adenoids be treated?

ENT medications including nasal sprays can be used to control the size of adenoids. Many enlarged adenoids are associated with allergies and these should be treated under ENT allergy treatment methods.

Persistent adenoids that are enlarged and problematic can be removed in a painless and minimally invasive manner via endoscopic reduction of adenoids with a plasma blade.

Are children susceptible to ENT conditions like obstructive sleep apnea?

Obstructive sleep apnea in children is rare but still exists, especially if the child is overweight and has issues with his/her tonsils. However, if it does occur, it has very serious and has to be managed.

Children that have obstructive sleep apnoea are at the risk of severe medical conditions such as failure to grow, heart issues or even death.

If your child suffers from pauses in breathing during sleep, snoring, mouth breathing, choking or even snorting, they might be suffering from obstructive sleep apnoea. If you suspect your child has sleep apnoea, bring them to see a paediatric ENT specialist at a medical centre that has an otolaryngology department.

Why is Paediatric ENT different from ENT for adults?

Implications for your ear, nose and throat differ depending on the stage of life you are at. As your ear, nose and throat develops throughout your life, certain things like tonsils which used to have function when you were younger will lose their function as you grow older. ENT doctors are experienced in treating all forms of ENT conditions, but it is also important to note that paediatric ENT specialists might be more well versed at treating children than a regular ear nose throat ENT specialist. A medical centre with otolaryngology and ENT related departments will likely be good places to bring your children for a checkup.