Paediatric ENT problems

As an ENT specialist, Dr van Lierop is an expert in the diagnosis, treatment and management of a wide range of conditions that affect the ears, nose and throat of little ones. Knowing how to examine and treat children in a way that makes them relaxed and cooperative, Dr van Lierop is compassionate in his approach and aims to help even the youngest of patients and their families with problems of the airways, voice, hearing, speech and sinuses.

While he treats a wide range of conditions and disorders, the following common paediatric ENT conditions include:

- Glue ear
Otitis media with effusion, more commonly known as glue ear often occurs after an ear infection when the fluid has not yet cleared from the middle ear. Instead, the fluid lingers, becomes thick and sticky like glue. The middle ear becomes filled with this fluid making it difficult for the eardrum to vibrate and carry the noise vibrations to the inner ear, leading to dulled hearing and sometimes disturbed sleep.

Hearing loss for long periods can affect a child's speech and language development, so it is important to look out for this paediatric condition. Problems with hearing may present as a child seeming to ignore you, asking you to repeat yourself and mishearing things.

- Sleep-disordered breathing
Paediatric sleep-disordered breathing (SDB) encompasses any sort of difficulties your child may have with breathing during sleep. They can be caused by airway narrowing due to enlarged tonsils and adenoids, craniofacial syndromes, abnormalities in the jaw, mouth and airway or various neuromuscular deficits such as cerebral palsy. Sleep-disordered breathing in children may include symptoms of loud snoring, gasping and snorting noises, bedwetting, irritability, daytime fatigue, learning difficulties, abnormally slow growth, cardiovascular difficulties and an increased resistance to insulin.

When breathing is disturbed during sleep, the body may react by increasing the heart rate and blood pressure and dropping the oxygen levels in the blood. Since sleep is vital during childhood, you should see an ENT (ear, nose, and throat) specialist should you notice any abnormal breathing.

- Snoring
While many children may snore on occasion, snoring may be a sign that there is some blockage in the airway. While snoring is not always an indication of a serious problem, regular loud snoring for children should be considered abnormal and ought to be checked by an ENT specialist.

In some cases, snoring may be a sign of a respiratory infection, a stuffy nose or allergy, but in other cases, it may be a more serious problem leading to obstructive sleep apnea syndrome (OSAS). OSAS usually presents with loud snoring with pauses, snorts or gasps, heavy breathing while sleeping, bedwetting, restless sleep and daytime sleepiness or behaviour problems.

- Tonsillitis
The tonsils are two oval-shaped pads of tissue on either side, at the back of the throat. The adenoids are located higher in the throat, behind the nose and soft palate. Generally, the tonsil's functioning declines after puberty, but since the tonsils and adenoids play a role in the immune response, they are particularly vulnerable to infection during childhood.

Tonsillitis is an infection of the tonsils, which causes inflammation and swelling. In most cases, tonsillitis is caused by a viral infection, but it may also be bacterial. In some cases, the adenoids may also become infected. Tonsillitis typically causes young children to be unusually fussy or not want to eat. Other symptoms may include a sore throat, ear pain, difficulty eating or drinking, fever, a muffled voice, stiff neck and swollen lymph nodes in the neck.

- Stridor
Stridor is the medical term for noisy breathing. A child with noisy breathing is generally an indication that something is obstructing or narrowing the airway, causing problems with normal breathing. Depending on the location of the obstruction, there are different types of stridor. A high-pitched sound is generally heard when a child breathes in or out and may be caused by foreign bodies, trauma, certain respiratory diseases such as croup, epiglottitis, bronchitis, severe tonsillitis. Stridor may also be caused by anatomical abnormalities in the structure of the child's airway such as:

  • Laryngomalacia - in which the soft structures and tissues of the voice box cause an obstruction in breathing.
  • Subglottic stenosis – which occurs when the voice box is too narrow.
  • Subglottic hemangioma - in which a mass of blood vessels forms in the airway.
  • Vascular rings – this may cause stridor when an artery or vein compresses the windpipe.