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

ENT specialist Singapore – What is Paediatric ENT?

Paediatric ENT refers to medical and surgical treatment of ear, nose, and throat diseases in children. This is usually done by an otolaryngologist, an ENT specialist who practices otolaryngology.

Common Pediatric ENT conditions that are seen by Dr. Chua, ENT Specialist:

  • Allergies and Sinus Conditions
  • Ear
    1. Infections
    2. Hearing loss / Speech Delays
    3. Glue ears/ Otitis media with Effusion
    4. Ear Wax
  • Tonsils & Adenoids

Most children who have troublesome nasal congestion, sneezing and runny nose usually have allergic rhinitis rather than sinusitis. This is because the sinuses of these children are still developing and it is not common for sinusitis to occur. 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 via a painless skin prick test and allergen avoidance is the cornerstone treatment. I generally prescribe nasal sprays are used short term to help manage the condition. For other paediatric treatments, they 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. The ear canal in the pediatric patient is smaller and thus prone to ear wax impaction and outer ear infections (otitis externa).

Picture of severe otitis externa outer ear infection

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.

Treatment of otitis externa includes aural toilet (ear vacuum suctioning of the ears) to remove wax and pus. Antibiotic ear drops are given and 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. One should also keep the ears dry and avoid the use of cotton buds

Hearing and speech & language development go hand in hand. In fact, the commonest cause of speech & language delay is hearing loss. In a young child with undetected hearing loss, it can result in developmental delay. Studies have shown that even mild hearing loss in a developing child can result in speech & language delay. 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 history regarding development from the parents. I will conduct a physical examination involves checking on the ears to look for possible causes of hearing loss. This can include ear wax, ear infections or glue ears. Sometimes inner causes such as the cochlear nerve for hearing could have been affected by previous infections and thus 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 when fluid builds up behind the ear drum in the middle ear and results in hearing loss. If there is an infection, the fluid can develop into pus and the children can suffer from acute otitis media. Children usually will have ear pain, hearing loss and fever as a result.

Picture of ear with middle ear effusion

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

The 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

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 play a function in immunity under the age of 1. Beyond the age of 1, there is no function and they will disappear by the age of 12.

illustration of normal and inflamed tonsils

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

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. If there are too many infections, it can affect the quality of life of the individual. Severe infections can spread to the neck and sometimes result in a neck abscess.

When is tonsil surgery or tonsillectomy required?

Neck surgery when there is recurrent infections or obstruction to the airway resulting in sleep apnea. Tonsils have no functions after the age of 1. Neck surgery for removal of tonsils does not result in weakening of the immune system.

How is tonsillectomy performed?

This is a straightforward neck surgery under general anaesthesia. For older children, they can be performed in a day surgery setting. With advanced technology such as a plasma blade, the surgery can be done in a minimally invasive manner.

The risks of bleeding and infection are generally minimal. For big tonsils, they are usually sent off for histology testing to ensure its not a tumor.

What are adenoids?

Adenoids are “tonsils at the back of the nose”. They are lymphoid tissue and similar to tonsil play a part in the immune system below the age of 1. Above the age of 1, adenoids have no function. When these are enlarged or infected, it can result in recurrent infections, ear infections (acute otitis media) or even obstruct breathing during sleep resulting in snoring (sleep apnoea).

How can adenoids be treated?

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

For the adenoids that are still persistently enlarged and problematic, these 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. Children that have obstructive sleep apnoea are at the risk of severe medical conditions such as failure to grow, heart issues or even death. Sleep apnoea is not a joke when it relates to children.

If your child or children suffers from pauses in breathing during sleep, snoring, mouth breathing, choking or snorting during sleep, then 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?

The stage of life you are at will have different implications on the health of your ear, nose, throat. Your ear, nose and throat develops throughtout your life and certain things like tonsils which have function when you are young 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.

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