Child In Pain

News Article
Child In Pain
Thursday, 06 l 05 l 2010 ; Source: Mind Your Body, The Straits Times
By April Chong
Young children are most vulnerable to ear, nose and throat problems. Congestion and infection in the areas can cause breathing difficulties, restless sleep and hearing loss. Here is a look at common ENT problems in kids There can be long-term consequences for ear, nose and throat (ENT) problems in children which may affect the child’s physical and mental abilities, doctors say. The ear, nose and throat form a continuous passageway, so germs that infect the throat can also infect the sinuses and the middle ear, said Dr Nelson Chee, a senior consultant ENT surgeon at Mount Elizabeth Medical Centre. Blockage of the airways can lead to breathing and snoring problems and the infection can spread beyond the ENT system to other parts of the body such as the lungs, brain and eyes. All children will have some sort of ENT problems, said Associate Professor Henry Tan, senior consultant and head of otolaryngology at KK Women's and Children's Hospital. The flu is often the starting point of upper respiratory tract infection and many ENT complications, he added. Prof Tan said that 5 per cent of children with flu will get sinusitis – the bacterial infection of the sinuses (hollow cavities within the face). This results in headache and a stuffy nose with yellow green mucus and can last for weeks or months. Another common ENT problem is otitis media, a middle ear infection with congestion and pain in the ear. This happens when germs from the nose and throat migrate to the ear via the connecting eustachian tube. Sometimes, middle ear infections come with fluid build-up, which affects hearing. When the fluid accumulates over weeks, it becomes thick and results in “glue ear”. A 1989 United States study published in the Journal Of Infectious Diseases showed that 83 per cent of children had a middle ear infection by the time they were three years old. However, a problem like middle ear infection can go unnoticed as young children may not be able to articulate their condition, said Associate Professor Low Wong-Kein, director of the Centre for Hearing and Ear Implants at Singapore General Hospital. Parents should look out for signs such as when the child is not hearing well, tugs on the ear or even turns up the volume of the television. But not all ear aches come from an infection. A toothache can manifest itself as an ear ache due to the shared nerve network. This is known as “referred pain”, Prof Low said. Allergic rhinitis is another ENT problem that affects children, said Dr Pang Yoke Teen, senior ENT and allergy consultant at the Centre for Ear, Nose, Throat, Allergy and Snoring. This condition is due to common allergens like dust mites, pollen and food. With a runny nose and clogged airways, infection of the airways can result. Chronic rhinitis has been reported in 44 per cent of children in Singapore and 13 to 33 per cent of adults. Children more susceptible Why are ENT problems more prevalent in children? This is because they have lower immunity levels. Another reason is the immaturity of the eustachian tube. Its function of equalising pressure and draining away mucus does not work so well in a young child. Many ENT problems such as otitis media decline from age six as the eustachian tube matures, said Prof Tan. The relatively larger adenoids, or glandular tissue at the back of the nose, can also be obstructive in children. But as a child enters adolescence, the air spaces get larger and the adenoids may regress. This greatly reduces middle ear infections, said Dr Chee. In general, because of a child’s smaller airways, “it takes very little for them to jam up,” said Dr Pang. Complications When the ENT system clogs up, infections can spread and life-threatening complications can occur, said Dr Chee. These include chronic middle ear infection that can severely damage the ear and brain, and inflammation of the epiglottis – the flap over the trachea – that can block the upper airways. Long-term ENT issues have their consequences too, say doctors. Continual breathing difficulties and snoring cause a gamut of problems from slow learning and abnormal development of the face and jaw to affected organ growth because of the lack of oxygen. Dr Pang’s advice: Children who have been sniffling for more than five days should see a doctor. Treatment ranges from antibiotics for bacterial infection, inserting tiny tubes in the ear to drain out fluid, to surgery to remove affected tissue. For allergies, doctors may prescribe antihistamines and steroid nasal sprays. Newer allergy treatments include immunotherapy, which involves injections or drops under the tongue. This reduces the child’s sensitivity to the allergen and can reduce or eliminate the allergy over time. As the flu is one cause of ENT problems, good hygiene is important. Useful tips include not sharing food, keeping the child’s hands clean and sneezing into tissue paper, said Prof Tan. Jabs to prevent bacterial infections and flu are available for children. A new vaccine to combat the germs that commonly cause middle ear and ENT infections will also be here soon, he said.
SNORING May be a symptom of several problems, such as blocked airways and obstructive sleep apnoea, where breathing is affected during sleep. The child may breathe loudly or snore. Sleep is restless. Causes: Blockage of the airways by, for example, enlarged tonsils or excessive mucus. Treatment: May include oral medication to help the child breathe during sleep or surgery to remove obstructive tissue. NOSE BLEED Usually harmless and will go away when a child reaches puberty, between the ages of 10 and 17. Causes: Nose picking, injuries, sneezing and rubbing the nose because of allergies and colds. Treatment: Sit up and lean head forward, pinch the lower soft portion of nostrils for five to 10 minutes and breathe through the mouth. In severe cases, chemical or electrical cauterisation may be needed. OTITIS MEDIA Collection of fluid in the middle ear, known as “glue ear”. Leads to ear aches and hearing loss. The child may be fussy, sleep poorly, tug at his ear and do poorly in learning. Causes: Usually occurs when the eustachian tube, which connects the middle ear to the back of the nose, is blocked and cannot drain fluids from the ear. Treatment: Antibiotics, decongestants and nasal sprays. Surgery to create a hole in the ear drum to drain out fluid may be needed. Tips: Keep the ears dry as water in the middle ear increases the chance of infection. Do not allow shower sprays to be directed into the ears and wear ear plugs when swimming. IMPACTED EAR WAX Ear wax is naturally removed by the ears when the upper layer of the ear skin slowly pushes it outwards. When wax is impacted, hearing loss may occur. Water trapped inside the ear after a shower or swimming will cause the wax to expand. This can cause pain and sudden hearing loss. Causes: Overproduction of wax or attempts to remove ear wax packs it in. Treatment: Special ear wax preparations, mineral oil and glycerin to loosen or soften the wax. Tips: Do not try to remove hardened wax: It can cause abrasion and pain in the delicate ear canal. Avoid using cotton buds as they push the wax in. ENLARGED TONSILS & ADENOIDS Tonsils and adenoids produce antibodies to ward off germs that invade the nose, mouth and throat. The connected ENT network means other problems like middle ear infection and snoring can occur when these tissues are infected. Causes: Infection of the tonsils and adenoids. Some children are born with large tonsils and adenoids that obstruct airways. Treatment: Antibiotics to treat infection or surgery.