Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist
CHRONIC COUGH is often caused by one or moreof the following:
Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.
Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.
CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.
Look out for mouth-breathing, dry and wrinkly lips, a nasal voice, noisy nasal breathing and snoring. Gently hold the lips together when the child is sleeping and observe if he can breathe well.
SNORING & OBSTRUCTIVE SLEEP APNOEA
Snoring occurs when something (such as enlarged tonsils or adenoids) obstructs airfl ow through the airways during sleep. Many obese children snore, as neck fat “strangulates” the airway.
Up to 5% of Singaporean children have Obstructive Sleep Apnoea (OSA), where the obstruction is so severe that air to the lungs is greatly reduced. Th e heart and lung muscles work much harder for oxygen, and the lung muscles become so tired that they stop inhaling and breathing. A non-breathing period of more than 10 seconds is an “apnoea”.
OSA may cause heart/lung strain, poor brainoxygenation and troubled sleep (night sweats, bed-wetting, waking frequently, tossing and turning, gasping and sleeping in odd positions (eg sitting up or lying on his face, bottom in the air). In the daytime, the child may be tired, irritable, less attentive, hyperactive (ADHD) and performing poorly academically. Growth may be aff ected, because special growth hormones are produced during good sleep.
Chronic snoring or OSA in children may stretch upper airway tissues, leading to adult OSA and sometimes to abnormal development of jaw, teeth and cheekbones (‘long (adenoidal) face’ syndrome). Approximately 60% of a child’s face is “built” by the time he is four. Left unchecked, abnormal facial development may be irreversible.
If concerned, consult an ENT surgeon, preferably withan audio-visual recording of the child’s sleep.
MIDDLE EAR INFECTIONS Th e middle ear (behind the eardrum) can become infected. Th is area is drained and regulated by the Eustachian Tube (ET) connected to the back of the nose. Children’s ETs are very short, so infection can easily spread from nose to middle ear. Children’s ETs are immature and more horizontal (becoming more vertical as the child grows and the face lengthens) and might not drain the middle-ear fl uid properly. Acute middle ear infection occurs when the middle-ear fl uid becomes infected and develops mucopus, which (unless drained) builds up, stretching and bulging the middle ear and sometimes, even rupturing the eardrum.
When middle ear fl uid is not properly drained, the eardrum cannot vibrate properly. Th is is called glue ear and can cause hearing loss.
See if the child seems inattentive, can’t hear, speaks loudly, turns up the volume on the TV or has ear pain. Infants and toddlers may cry for no apparent reason, holding or pulling their ear, especially at night.
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