Parents think that ear, nose and throat (ENT) problems are limited to adults, but that’s not true! In fact, ENT problems are one of the more common issues in children, especially in Singapore where our climate easily causes nosebleeds.
While most paediatricians in Singapore are equipped to handle basic problems associated with the ear, nose and throat, there are a few exceptions for when an ENT specialist should be considered.
Here are some ENT conditions that can happen in children and scenarios to look out for.
Ear infections are probably the most common among my child patients. Most of them are episodes of otitis media, an inflammation of the middle ear. Children with otitis media tend to experience restless sleep, fluid drainage from the outer ear and constantly pull on their ear. For isolated cases during the first 3 years of life, seeing a paediatrician is generally enough.
You should consider taking your child to an ENT specialist for ear infections if your child falls under the following:
- More than four ear infections a year
- Speech delay/your child with speech delay has ear infections
- Fluid in the ears for more than 3 months
- Ruptured eardrum during an infection
- Requires multiple antibiotics
- Experience allergies or symptoms like diarrhoea, nausea and vomiting from taking antibiotics
If your child is found to have chronic ear infections, inserting ear tubes can help. For ear infections that occur more than 3 times in a span of 6 months, ear tubes are necessary. An ENT specialist can better assess if tubes are needed.
Recurrent colds and infections
Apart from ear infections, children also regularly get colds or sinus, tonsillitis or sinus infections. Tonsil and sinus infections are pretty common in Singapore and seeing a doctor or paediatrician would be a good first step. But if your child gets several infections a year, has to regularly miss school and quality of life is affected by these problems, it may be time to visit an ENT specialist. Generally, I would take it as a red flag if symptoms get worse or last more than a week.
While nosebleeds are relatively common among children in Singapore, those who get nosebleeds on a regular basis without any specific incident causing them might need to be treated by an ENT specialist. An ENT specialist can help find out the cause behind the frequent nosebleeds and decrease the number of nosebleeds. You may bring your child to a paediatrician first to get comfortable with treatment, but if significant bleeding still occurs, then it’s in your best interest to bring him/her to an ENT specialist.
It’s not normal for children to snore. Keep a lookout especially for persistent snoring i.e. more than several months. I would use the chance to check in with the child too — is the snoring affecting his quality of sleep? Does he wake up frequently due to the snoring? Are you also concerned that your child might stop breathing at night? If so, a visit to an ENT specialist as soon as possible is warranted. For young children with snoring problems, I usually do a full evaluation of their airway. This includes placing a camera in their nose to study the upper airway. It’s important to seek professional help for persistent snoring in children to make sure they don’t suffer from conditions like sleep apnea, which can be dangerous.
Growths or lumps
Sometimes children develop lymph nodes to help fight infections. These lymph nodes may present themselves in the form of neck masses or lumps. If you’re unsure whether these growths should be removed, see an ENT specialist. Usually, ENT specialists remove growths if:
- The growth is progressively growing
- The growth has skin discolouration
- The growth is congenital
What does a visit to a paediatric ENT entail?
Since styles of practice differ depending on the physician and clinic, it’s hard to say exactly what each visit is going to be like. But for myself and I believe other ENT specialists, at the first appointment, usually we will look at any X-rays or scans your child may have done and ask some questions regarding your child’s medical history. These questions include when symptoms occurred, how long and if they cleared up, and any medication your child is currently taking.
Depending on the severity of the condition as well as symptoms, most ENT specialists may choose to adopt a wait-and-see approach to see if symptoms persist before deciding on surgery or other treatment options.
ENT specialists treat more than just ear and tonsil infections in children
While it’s true that many parents bring their children to ENT specialists for conditions like ear infections and tonsillitis, we can treat so much more than that! We treat everything from balance disorders, head and neck cancer, hearing loss and more.
Van Hoecke, H., Bauters, T., Coppens, M., Robays, H., Van Hoecke, E., & Dhooge, I. (2012). Basic principles for paediatric care: what ENT professionals should know. B-ENT, 8 Suppl 19, 125–131.
Nilsson, S., Ohlen, J., Hessman, E., & Brännström, M. (2020). Paediatric palliative care: a systematic review. BMJ supportive & palliative care, 10(2), 157–163. https://doi.org/10.1136/bmjspcare-2019-001934