The spectrum of paediatric ENT issues includes:
Hearing loss may be present at the time of birth, or may be acquired over time. There are two types of hearing loss – sensorineural and conductive. Sensorineural hearing loss is due to loss of function in the inner ear; whereas conductive hearing loss takes place when sound waves are not reaching the inner ear.
A small proportion of children are born with hearing loss. All children born in NSW are routinely screened for this at birth, but if the child was born overseas they may not have had routine screening for congenital hearing loss. The most common cause of hearing loss in young children is glue ear, which causes conductive hearing loss.
Hearing loss in children
A complication of acute otitis media, mastoiditis is an infection of the mastoid bone.
Nose bleeds, or epistaxis, is a condition whereby damage of the fragile blood vessels in the nose leads to bleeding from the nose. This damage is commonly due to injury, allergies or nose picking; but rarely may also be due to certain bleeding disorders.
OSA is a condition whereby breathing pauses in children during sleep, due to blockage or narrowing of the airway. For instance, infection of the glands or enlarged tonsils and adenoids, can result in upper airway obstruction. This can cause problems with concentration and energy but may also present with growth problems, disruptive behaviour and bed wetting; and may have other serious issues, particularly in children who have other syndromes.
Also called ‘swimmer’s ear,’ otitis externa is an infection of the external ear canal caused by bacteria or fungi.
The most common condition affecting children, otitis media is an infection of the middle ear caused by a cold, sore throat, or respiratory infection. Sometimes acute otitis media may cause perforation of the ear drum. Repeated and recurrent infections may require the placement of grommets.
After a middle ear infection resolves, fluid may remain in the middle ear, unable to drain naturally through the Eustachian tubes. Sometimes, the fluid remains for months and can become thick and sticky, thus deriving the name glue ear.
This can cause hearing loss, which resolves once the ‘glue’ resolves. If the glue doesn’t resolve naturally, grommets may need to be inserted to prevent complications and speech delay in children.
Common Childhood Hearing Conditions
Stridor is a condition whereby a high-pitched wheezing sound is produced by the child’s breathing, due to the narrowing of the upper airway. This may be due to problems at birth, infections, or trauma. Congenital (present at birth) stridor is also referred to as laryngomalacia.
Tonsils and adenoids are the glands that house immune cells. Inflammation and infection of these glands are called tonsillitis and adenoiditis. Tonsillectomy and adenoidectomy are the respective surgical procedures where tonsils or adenoid glands are removed surgically. Common reasons to perform adenotonsillectomy (removal of both tonsils and adenoid glands) are paediatric sleep apnoea and recurrent tonsillitis. There are other such clusters of immune cells along the gastrointestinal tract and removal of the tonsils and adenoids does not render the immune system weak. Nevertheless, all surgeries have risks and benefits and surgery should only be considered in patients with clear and persistent symptoms.
Tonsillitis is the infection of the tonsils, which causes pain and inflammation. Sometimes a pocket of pus may accumulate behind the tonsil called a peritonsillar abscess or ‘quinsy’, requiring drainage. Recurrent tonsillitis or the occurrence of recurrent abscesses may require tonsillectomy, which is the removal of the tonsils. Severe infections of the tonsils or extension of a ‘quinsy’ may lead to complications such as a deep neck space infection, or infection of other major structures in the head and neck such as the jugular vein.