ENT diseases in children

Just like adults, children are affected by all sorts of ENT (Ear, Nose & Throat) diseases, but some diseases affect them more than adults. This may be due to the anatomical positions and involvement of some immunological factors. 

We see that, when a child starts to go to school, they are afflicted with maladies like coughs and colds. This is because they are exposed to a lot of new germs that are present in the environment. As their immune system is still weak they get easily infected. After a while, as their immune system adapts to the new environment, most children settle down and remain well. In some children we see a persistence of coughs and colds; these children need special attention as the cause needs to be established. Along with these chronic colds we see a lot of ear and throat infections. 

Anatomically the ear, the nose and the throat are very closely related as they have similar mucosal lining. If there is an infection in one area it spreads very easily to other sites. For example, if you have a sore throat, it easily spreads to the nose and the ears. The nose is also linked to the middle ear through a tube known as the Eustuchian tube. This tube drains the middle ear of normal secretions and is also responsible for the aeration of middle ear cavity. If for some reason it gets blocked then drainage stops and there is accumulation of fluid in the middle ear. This usually happens when the child has a cold, the nasal mucosa gets congested, and as a result the mucosa of ET also gets congested and blocked.  This causes earache and also deafness. Sometimes this also leads to the perforation of the ear drum and discharge. 

This kind of middle ear infection is seen more in children than adults, mainly because the ET tube in children is placed straighter than adults and it is also shorter, so any infection in the nose or throat can reach the middle ear easily.

 Another condition very commonly seen in infants is otitis media with or without discharge. This happens when the child is fed in the lying position. It can be caused by breast feeding or bottle feeding when the child is sleeping.  This may cause the liquid to go into the ears through ET tube which is straighter and shorter in children than adults. Babies should always be fed with the head placed at least at a 45-degree angle even when sleeping. The mother can pick up the child during breast feeding at night. If the child develops otitis media, they will have ear ache, be very irritable and may also have discharge from ears. All of these conditions are left untreated it can lead to hearing loss.

There are also some other reasons for blockage of ET tube. Some children suffer from tonsillitis a lot. So if the throat mucosa gets inflamed the mucosa of ET also gets inflamed. During childhood there is a lymphoid tissue similar to tonsil in the nasopharyx known as the adenoid gland. Along with tonsillitis some children will also suffer from adenoiditis. Usually we see that these children also have frequent attacks of common colds and blocked noses. The mother will complain that the child breathes through his mouth, and snores while sleeping. If this persists for a long time it affects the health and appearance of the child. The child has difficulty eating and also lack of concentration at school. When they visit the doctor an x-ray of the structures behind the nose is done. Usually we see that the adenoid glands of these children are enlarged. As this gland is located behind the opening of the nose it blocks the nasal passage when enlarged. The function of the gland is the same as tonsils as it is a lymphoid tissue. If the blockage exceeds 50% of space and also the signs and symptoms are present it will need surgical removal. This condition only occurs in children as the adenoids atrophies as we grow older and so will never affect an adult. It's very important to treat this condition as otherwise the patient will develop otitis media of different sorts along with deafness. 

Breathing chronically by mouth will give babies bad oral hygiene, malformation of teeth and change in the shape of the face. This is known as adenoid facies. When we see adenoid patients the parents usually get scared as surgery is advised and they think as the child is so young it will be difficult to manage. It's very important to remember that this is a disease of children and surgery needs to be done to avoid complications. If child is suffering from tonsillitis also and if needed, both surgeries will be done in one sitting. The surgery is done under general anesthesia and is usually very safe when done by an experienced surgeon. Recurrence of the condition is very rare.

It is also seen that children, especially very young ones, suffer from impacted wax in ears. Wax is a substance that is secreted by the ceruminous glands in the ear mixed with dust and dead skin cells. The function of the secretions is to keep the ear moist and also trap dust and other particles. 

In young children sometimes the secretion of these glands is less and children tend to play outdoors in dusty environments so the wax becomes hard. Usually wax cleans itself by movement of the jaw and also small hairs present in the EAC also helps in cleaning. The ears do not need to be cleaned by cotton buds. Actually, it's a very bad habit to insert cotton buds, clips, and pencil-tips into the ear. This can cause injury to the ear canal and the tympanic membrane. Also if a cotton bud is used it pushes the wax further into the canal and so it gets stuck there.  At some stage if there is entry of water in the ear the wax gets swollen and creates pressure on the surrounding wall causing pain and infection. When a doctor is consulted they will prescribe de-waxing drops. 

While dealing with children, parents need to keep knowledge of certain diseases that will affect them more and not get apprehensive when doctors suggest surgical procedures. It is important to get the proper information and get the appropriate treatment at the right time.

Anatomically the ear, the nose and the throat are very closely related as they have similar mucosal lining. If there is an infection in one area it spreads very easily to other sites. For example, if you have a sore throat, it easily spreads to the nose and the ears.

Another condition very commonly seen in infants is otitis media with or without discharge. This happens when the child is fed in the lying position. It can be caused by breast feeding or bottle feeding when the child is sleeping.