All Stuffed Up


Did you know that if Junior has a blocked nose, his ears and throat may be affected as well? Read on to find out more about child ENT complaints.

Your little one has been complaining of ear pain (often in the middle of the night). He has a slight fever and also a runny nose so you take him to see the doctor. Turns out, it was an ear infection but why the runny nose and fever? A few months down the line, another ear infection crops up and he’s crying in the middle of the night. This time, you look for an ENT specialist to pinpoint the problem.

Turns out, it’s a middle ear infection called otitis media but there’s no guarantee it won’t occur again. Otitis media along with a few other conditions are common complaints especially among children. Assunta Hospital’s Consultant General and Paediatric ENT Surgeon, Dr. Lim Wye Keat, uncovers common ENT complaints among children.

Know your nose

Know your nose

Nose allergies are prevalent in 30 to 40 percent of people and these allergies are associated with eczema, asthma and also allergic conjunctivitis. Oversanitisation can cause a higher chance of developing a nose allergy. “A common misconception is that allergies are caused by a weak immune system but that’s not actually the case. An allergic reaction happens because the immune system is too active and attacks otherwise harmless particles that we breathe in, such as dust,” explains Dr. Lim. He notes that food doesn’t have an impact on nose allergies.

Symptoms of a nose allergy are a runny nose with clear discharge, facial pain, headaches and occasionally, nosebleeds. Treatment includes antihistamines in the form of syrups or tablets, or nasal steroid spray. These forms of treatment can only help the symptoms but not cure allergies.

Nose infection or sinusitis (sinus infection) is another condition that crops up often in children. Sinusitis occurs when the cavities around the nasal passages become inflamed. Sinus infections can be caused by either viral or bacterial infections. According to Dr. Lim, bacterial sinusitis is when your phlegm turns green. Treatment includes antibiotics (if it’s bacterial), decongestants, painkillers and sometimes saline douches. Recurrent cases of sinusitis may be treated with nasal steroid sprays.

Pain in the ear

Pain in the ear

According to Dr. Lim, children are commonly affected by otitis media (acute, effusion) and ear wax impaction. “Middle ear infections are the ones that are past the eardrum, in the middle ear. These infections can be both viral the usual cough and cold or bacterial which originates from the nose,” Dr. Lim explains that bacteria will usually linger in the nose and because the nose and ear are connected via the Eustachian tube, bacteria can travel to the middle ear and spark an infection.

Symptoms of acute otitis media include feeling pain in the, especially at night, experiencing hearing loss, fever, a runny nose and also a sore throat. “Pain from the ear infection is due to the build-up of pus in the middle ear which pushes against the ear drum. The increased pressure on the eardrum may cause it to rupture,” says Dr. Lim.

If the pain persists after 72 hours or there’s discharge from the ear it is probably a bacterial infection and the child will be prescribed antibiotics and painkillers. However, Dr. Lim explains that he will also make sure by checking for a ‘creamy’ eardrum (pus in the middle ear) or take a swab of the discharge from the ear to check if it is a bacterial infection.

In cases such as chronic suppurative otitis media (hole in the ear drum with active bacterial infection in the middle-ear), ear drops will be prescribed because the perforation is large enough for the drops of medicine to get to the middle ear. If the perforation is deemed to be too small, oral antibiotics will be given instead.

Dr. Lim says that most cases of otitis media are outpatient cases but there are some cases where the pain (caused by pressure on the eardrum) is too intense that minor surgery may be performed. The child will be put under general anaesthesia and then a small hole in the eardrum will be created in order to drain the pus. This lessens the pressure and also gets rid of the pain.

Other than otitis media, wax impaction is also a common complaint among children although adults who are overzealous with ear cleanliness, can also end up with this condition. “Ear wax is actually a natural product of the body which is made up of a mixture of sebum (skin oil) and dead skin,” says Dr. Lim.

This wax is naturally expelled out of the ear canal but this does not happen, in some cases. Attempting to remove wax using cotton buds is also a reason why wax impaction occurs. Doing this can cause poor hearing and sometimes, pain. For wax extraction, always go to a professional such as an ENT doctor in order to prevent any damage to the ears. The process of removal involves softening the impacted wax with eardrops and then having it suctioned out.

Say ahhhh...

Say ahhhhh…

“The tonsils and adenoid (lymphatic tissue in the back of the nose and throat) are connected to immune responses. Germs are taken there to be recognised and then the body will take action,” says Dr. Lim. He adds that in children, the tonsils could increase in size to the point of affecting their swallowing and speech along with causing sleep apnoea (airway obstructed which causes infrequent breathing during sleep).

Tonsilitis can be caused by viral or bacterial infections and its symptoms are sore throat, fever and painful swallowing. Frequent occurrences of tonsillitis may require a removal of the tonsils because it becomes a repository for bacteria which could cause recurrent infections. Usually, if the tonsils are removed, the adenoids will be removed as well.

Dr. Lim says that removal of the tonsils should only be done if it is truly necessary because it can be very painful for the patient, post surgery and will continue to be painful for about three weeks. Simple actions such as eating, talking, yawning and coughing can prove unbearable and patients are often forced to subsist on porridge to avoid additional discomfort.

Dr. Lim advises parents to look for a second opinion if they’re not sure about their child’s ENT condition. He says it is always best to consider surgery as a last resort because there are risks associated with this course of action. Always speak to your medical provider of you have any doubts or concerns about your child’s health.

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