Ear-Nose-Throat : What all parents need to know

Health Professional Profile: ENT

Otolaryngologists or ENT’s (Ear-Nose-Throat Specialists) are expected to be in increasing demand. In America alone, 35 million people suffer from sinus infections. Furthermore, as the ageing population continues to increase, there will be an increased demand for professionals who manage and treat hearing loss and other age-related needs (Gapmedics Blog).

The following is an interview with Dr. Murtaza Najmi, an ENT based at the King’s College Hospital, Dubai, UAE. This post is targeted towards all parents and health care professionals. Find out how to manage the health of your children's ears, noses, and throats.

What is an ENT?

ENT simply stands for ear, nose & throat, and that’s the job description of an ENT specialist - identifying & treating disorders of these parts of patient bodies medically & surgically.

What is it about the work that you do that motivates you everyday?

Being altruistic really motivates me at work. I make sure to go through the feedback forms from the patients I see on a daily basis. You won’t believe how satisfying it is to reach a conclusive diagnosis & then provide focused treatment. My values are to be truthful, smart, professional, and to the point with my patients and my medical team.

What are common early childhood ear, nose, and throat difficulties that a parent should be aware of?

If you have a little one you are likely to visit your doctor frequently with one of the following most common ENT ailments:

1. Recurrent ear infections/glue ear

2. Obstructive sleep apnea (when breathing is interrupted during sleep) due to hypertrophied Tonsils & Adenoids

3. Recurrent Tonsillopharyngitis/Adenoiditis – inflammation caused by infection of the adenoids and tonsils.

4. Rhinitis – irritation inside the nose. Symptoms include runny nose, stuffy nose,

post-nasal drip, sneezing

5. Foreign bodies that may get stuck in the ear, nose, or throat.

What are some red flags that indicate that a parent should seek advice from an ENT?

  • Persistent High-grade fever due to infection

  • Ear Pain/drainage

  • Noticing impaired hearing or inappropriate reaction to sounds

  • Balance problems

  • Clumsy behavior

  • Excessive crying

  • Loud snoring, mouth breathing, breathing obstruction during sleep

  • Exudate over tonsils (infected tonsils)

  • Stridor – high-pitched wheezing sound caused by disrupted airflow.

What are some general preventative measures to ensure children are effectively monitored for ENT issues? E.g., regular ear screenings etc.,

  • Mandatory New born Hearing screening

  • Monitor language milestones from 0 to 18 months

  • Correct vaccinations on time

  • Keep an eye on academic performance

  • Encourage frequent hand washing. This can help keep your child from catching a cold or the flu.

  • As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.

  • The risk of developing ENT disorders, specially ear infections is less in children who live in homes free of cigarette smoke and who are breast-fed.

When should my child’s ears be screened?

Hospitals routinely perform hearing screening on infants in the first 24-48 hours after birth. If an infant fails the initial screening, he or she is usually scheduled for a second screening a few weeks later. However, sometimes infants who pass the hearing screening at birth may exhibit signs of hearing loss as they age.

General Guidlines:

  • Mandatory new born hearing screening – within few weeks after birth for early detection & treatment

  • From 9 months to 2.5/3 years of age – a hearing test should be arranged if parents have concerns

  • At around 4 or 5 years age most kids are evaluated for hearing while

  • admitting into school.

Can there be fluid in my child’s ear without any symptoms?

Yes, this is possible. Fluid in the ear generally causes mild hearing loss, but no other symptoms. An older child might comment on this as a feeling of fullness in the ears. A younger child might shake his head, tug ears or give no sign at all. Hearing loss caused be fluid in the ears, can affect a child's speech and language development.

If fluid is found in my child’s ear what is the protocol for monitoring?

  • Glue ear peaks at ages 2 - 5. It often resolves spontaneously. 50% will be better in 3 months time with no intervention. Look for impairments of hearing/speech/language/behavior

  • Watchful waiting for 3 months

  • Tube placement/Grommet insertion is recommended for most children, in any case, if fluid is still present after 4 to 6 months

  • Another consideration is that if hearing loss > 25-30db or significantly impacts development / education, consider grommet (ear tube) insertion

What does an open mouth posture indicate? Why is breathing through the nose so important?

The natural position for healthy breathing is always with a closed mouth, inhaling and exhaling through the nose. It may seem like a silly thing to be concerned with but mouth breathing may be associated with underlying serious health issues. By closing the mouth and breathing through the nose, the negative growth patterns associated with teeth/facial growth & speech development can be prevented.

When air passes through nose it gets humidified and warm before it gets to your lungs. The nose chamber has many small hairs. These hairs act as a filter, removing dirt and particles before the air enters the lungs.

An open mouth posture indicates that your child is not getting sufficient air through the nose owing to obstruction most commonly due to enlarged adenoids, chronic colds, stuffy nose etc. It is therefore recommended to seek guidance from an ENT if your child is a mouth breather.

What does snoring indicate?

Although, snoring may not appear to be harmful, it can lead to medical and developmental consequences. It may indicate sleep apnea, or it may indicate a milder condition called Upper Airway Resistance. If your child snores, it is best to seek guidance from an ENT.

What is sleep apnea? How do I know if my child has it? What should I do about it?

  • Any child who snores may have obstructive sleep apnea and may not be getting adequate sleep. In kids, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids, which may have become larger due to allergies or repeated URTI (Upper Respiratory Tract Infections)

  • Large tonsils & Adenoids can block off the air & food passage behind the nose and throat. This usually exhibits itself in children and could cause persistent obstruction of the nose and persistent breathing through the mouth. The most important problem with the blockage occurs at night when the patient’s wind passage could block off completely for few seconds. This is never serious at the time it occurs but could cause significant problems if persistent for few a months or years without treatment, mainly by affecting the heart & the lungs.

  • You can look for some of the following signs in your child while sleeping: Restless sleep, sleep in unusual position, stops breathing for very short periods during sleep, snores loudly & often, bed-wetting after age 5, cranky/irritable and behavior problems at school, falls asleep or daydreams at school

  • Snoring or any of the above symptoms if you notice should be brought to the attention of your doctor or specialist immediately. You might want to record a video that would help the physician to reach a conclusion. In addition, to a clinical examination your doctor may order an overnight sleep study (also called polysomnography or PSG) that often reveals the full extent of the medical problem. Based on the clinical evaluation & workup, further course of management is decided upon. The most common fix for sleep apnea in kids is the removal of enlarged tonsils and adenoids that are causing the problem. Surgery will be evaluated and performed by an ear, nose and throat specialist under general anesthesia.

What are adenoids and tonsils and why do some children have to get them removed?

  • Tonsils and adenoids are basically lymph nodes that are located in the back of the throat (tonsils) and in the back of the nose (adenoids). They are not different from any of the hundreds of lymph nodes that are located in the neck, chest, abdomen, and groin. The size of the tonsils & adenoids fluctuates dramatically depending on the age of the patient and in the presence of an infection.

  • As mentioned above, large tonsils & adenoids can block off the air & food passage behind the nose and throat resulting in breathing difficulties during sleep -medically termed as obstructed sleep apnea. This is never serious at the time it occurs but could cause significant problems if persistent for few months or years without treatment, mainly by affecting the heart & the lungs.

What is the protocol if my child has a tongue-tie and it is affecting speech development?

Tongue Tie / tethered tongue is a problem which means that the tongue is more tightly attached to the bottom of the mouth than normal thereby restricting its free movement in & around the mouth. Tongue-tie can interfere with the ability to make certain sounds. If the Speech-Language Pathologist thinks that it is interfering with child’s speech development than it is better to have the tie snipped, which is a very simple, safe, brief procedure devoid of any complications.

What are some reasons for my child’s voice quality to change?

  • Voice disorders are fairly common in children. Their voice may sound: harsh or hoarse, too high or too low, too loud or too quiet, or they may have lost their voice entirely or sometimes as though they are speaking through a blocked nose.

  • The reasons for voice quality affection may be excessive shouting or loud talking, excessive use of harsh voice sound effects during play, & common childhood infections.

  • Other environmental factors that contribute towards affecting voice quality include smoky, dusty and polluted environments, children not drinking enough fluids, excessive coughing and throat clearing, increased stress/anxiety

What are vocal nodules and are they common in the pediatric population? How do I know my child has nodules? What can be done about it?

  • Children can and do get vocal nodules. Vocal cord nodules are also known as calluses of the vocal fold & they appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped. Lesions are thought to arise following heavy or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, screaming or yelling, or using the voice excessively while sick.

  • A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion

  • If your child has a hoarse voice that is getting worse or not getting better, you should seek a physician’s advise. Your child may be referred to an ENT or Speech-Language Pathologist for further evaluation & management. The ENT specialist can examine your child's vocal folds and make a proper diagnosis of the problem. Once the vocal nodules have been confirmed, he would help you plan the most effective treatment for your child.

  • In most cases they are harmless and disappear on their own through conservative management and guidance from specialists e.g., Speech-Language Pathologists. Encourage your child to rest their voice by not shouting or talking loudly and keeping their throat moist by frequently sipping on fluids (especially after an infection), but if the trauma occurs repeatedly, then treatment will be required but most of us believe not to offer surgical treatment until they cross adolescence.