Videos: Children's ENT

Glue Ear:

Otitis media with effusion (OME or Glue Ear) is a very common childhood condition. It can cause hearing loss which may first come to the attention of parents or health care providers because of poor speech and language development.

It can also cause recurrent middle ear infections which are distressing for both the child and the parents. These infections can sometimes lead to a perforation (hole) in the eardrum as the infection in the middle ear cavity builds up pressure and bursts through the ear drum.

There are various options for managing a patient with OME. These include a ‘watch and wait’ approach, hearing aids, and surgery. For recurrent infections, some people advocate long-term, low dose antibiotics.

The insertion of ventilation tubes, or ‘grommets’, is a surgical treatment for OME which acts as a temporary fix. This buys time for the patient’s middle ear function to develop sufficiently that they no longer develop OME. Sometimes a patient may require more than one set of grommets.

Not infrequently, children may also require removal of their adenoids to help with their middle ear problems, as these are thought to provide a source of infection which spreads through the Eustachian tube into the middle ear.

How a Grommet is placed:

How a Tonsillectomy is performed:

Tonsillitis is a very common condition affecting children (it also causes problems for many adults). The most common symptom will, of course, be a sore throat, but a high fever and sometimes breathing problems may accompany it.

The tonsils are a pair of ‘lymphoid organs’ which are designed to trap micro-organisms as they enter the body. In so doing, not only do they remove these micro-organisms, but they enable to body’s immune systems to learn to recognise them more quickly in the future. As a result, they contribute to the development of a child’s immunity.

Parents sometimes worry that removing the tonsils will affect the development of this immunity, but actually, there is a lot of lymphoid tissue scattered through the mouth and throat, as well as other parts of the body, and there is no evidence that removal of the tonsils impairs immunological development.

Snoring before and after Adenoidectomy and Tonsillectomy:

Children can develop snoring at a very young age, and it may even be present from birth. In patients with certain syndromes, it can be due to anatomical restrictions in the airway caused by a receding jaw or weak muscles/tissues in the throat. However, in most children, it can be due to enlarged tonsils and adenoids.

These same patients may also develop sleep apnoea which occurs because of intermittent complete obstruction of the upper airway during sleep, due to similar causes as above. The parent/carer will notice the child stop breathing for a few seconds after a period of snoring/noisy breathing. The child will then suddenly start breathing again.

In many cases, removing the tonsils and/or the adenoids could be the best treatment for this. If the child has a syndrome, then occasionally further investigations (eg. a sleep study) or a referral to a specialist centre may be appropriate.

How to treat nosebleeds in children:

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Otology (ears, including perforated ear drum repair, cholesteatoma, mastoid surgery, hearing loss and ossiculoplasty, discharging ears, laser stapedectomy for otosclerosis, ear microsuction for ear wax removal); Rhinology (nasal disorders including acute or chronic rhinitis and sinusitis, blocked nose, deviated septum, polyps and septal perforation); Sinus procedures (endoscopic sinus surgery/ FESS, balloon sinuplasty); Rhinoplasty (functional and cosmetic) and Facial Plastics/ skin lesions; Paediatric ENT (tonsillectomy, adenoidectomy, grommets for glue ear, cautery for nosebleeds/ epistaxis, tongue tie, pinnaplasty); Neurotology (including tinnitus, dizziness/vertigo, acoustic neuroma, glomus tumours); Laryngology (including swallowing problems); Voice disorders (including vocal cord polyps/ nodules, laryngopharyngeal reflux (LPR)); Neck lumps; Salivary gland disorders (including submandibular stones or gland enlargement); Allergies; Snoring (Evaluation and advice, Uvuloplasty, UVPPP)

© Mr Sanjay Verma, The ENT clinic Leeds 2009