Common Pediatric ENT Problems

1. Acute Otitis Media (AOM) – Middle Ear Infection

सबसे common pediatric ENT problem – लगभग 80% children को 3 years की age तक कम से कम एक episode होता है।

Why So Common in Children?

• Eustachian Tube Anatomy: Children में यह shorter, more horizontal, और wider होती है → bacteria easily middle ear तक पहुंच जाते हैं
• Immature Immune System
• Frequent URI: Daycare, school exposure
• Enlarged Adenoids: Block Eustachian tube opening

Clinical Features:

• Infants/Toddlers:
  • Irritability, crying
  • Ear tugging
  • Fever
  • Poor feeding, sleep disturbance
  • May have ear discharge if drum perforates
• Older Children:
  • Ear pain (can localize)
  • Hearing loss (temporary)
  • Fever, malaise

Diagnosis:

• Otoscopy: Red, bulging eardrum
• Pneumatic Otoscopy: Reduced drum mobility

Treatment at Prime ENT Center:

Observation (Wait and Watch):

• Mild cases in healthy child >2 years
• Symptom relief (pain management)
• Follow-up in 48-72 hours
• Many resolve without antibiotics

Antibiotics:

• If <6 months (always)
• Severe symptoms
• Bilateral infection
• Ear discharge present
• Duration as prescribed (complete course important)

Follow-up:

• 2-3 weeks after treatment
• Check for resolution
• Persistent effusion common (can take 3 months to clear)

2. Otitis Media with Effusion (OME) – “Glue Ear”

Middle ear में fluid without active infection।

Causes:

• Post-AOM residual fluid
• Eustachian tube dysfunction
• Enlarged adenoids
• Allergies

Why Important?

• Hearing Loss: Mild-moderate conductive loss (20-40 dB)
• Impact:
  • Speech and language delay (critical age 0-3 years)
  • Learning difficulties
  • Behavioral issues

Symptoms:

• Often asymptomatic
• Hearing loss – child doesn’t respond promptly
• Delayed speech
• TV volume high, asks “what?” frequently
• Balance issues (rare)

Diagnosis:

• Otoscopy: Dull, retracted drum; fluid level visible
• Tympanometry: Flat curve (Type B)
• Audiometry: Conductive hearing loss

Treatment:

Observation:

• If <3 months duration
• No significant hearing loss
• Speech development normal
• Many resolve spontaneously

Medical:

• Treat allergies
• Nasal decongestants (short-term)
• Autoinflation exercises (older children)

Surgical – Grommet (Ventilation Tube) Insertion:

Indications:

• OME >3 months with hearing loss
• Speech delay
• Recurrent AOM (≥3 in 6 months या ≥4 in 12 months)
• Structural damage to drum

Procedure:

• Myringotomy – tiny incision in drum
• Fluid aspirated
• Tiny tube inserted in drum
• Allows ventilation, fluid drainage
• Day care procedure, quick recovery

Post-Grommet Care:

• Keep water out of ears (earplugs while bathing, swimming)
• Regular follow-ups
• Tubes usually fall out on their own in 6-12 months
• Drum heals naturally

3. Tonsillitis & Adenoid Hypertrophy

(Detailed in separate tonsillitis article – summary here)

Recurrent Tonsillitis:

Impact on Child:

• Frequent school absences
• Repeated antibiotic courses
• Poor growth (not eating well due to throat pain)
• Behavioral issues (chronic discomfort)

Tonsillectomy Indications (Paradise Criteria):

• 7+ episodes in past year, या
• 5+ episodes/year for 2 years, या
• 3+ episodes/year for 3 years

Adenoid Hypertrophy:

Problems Caused:

• Nasal Obstruction: Chronic mouth breathing
• Snoring, Sleep Apnea: Serious complication
• Recurrent OME/AOM: Blocks Eustachian tube
• Chronic Rhinosinusitis
• Adenoid Facies: Facial growth changes
  • Long narrow face
  • Open mouth posture
  • High arched palate
  • Dental malocclusion

Adenoidectomy Indications:

• Chronic nasal obstruction
• Recurrent OME/sinusitis
• Sleep-disordered breathing
• Adenoid facies development

4. Obstructive Sleep Apnea (OSA) in Children

Adenotonsillar hypertrophy children में OSA का most common cause (90%)।

Recognition Important:

Untreated OSA serious consequences:

• Neurocognitive: Poor concentration, ADHD-like symptoms, learning difficulties
• Behavioral: Hyperactivity, aggression
• Growth: Failure to thrive
• Cardiovascular: Hypertension, cor pulmonale (rare but serious)

Symptoms:

• Night:
  • Loud snoring
  • Observed apneas (parents see breathing stops)
  • Restless sleep, frequent waking
  • Unusual sleeping positions
  • Sweating
  • Bedwetting (secondary enuresis)
• Day:
  • Mouth breathing
  • Excessive daytime sleepiness या paradoxical hyperactivity
  • Morning headaches
  • Poor school performance

Diagnosis:

• Clinical history (parents’ observation crucial)
• Examination: Large tonsils/adenoids
• Polysomnography (Sleep Study): Gold standard, quantifies severity

Treatment:

Adenotonsillectomy: First-line, curative in most cases

5. Foreign Body (FB) in Nose and Ear

Very common in toddlers (2-5 years) – age of exploration!

Common Objects:

• Nose: Beads, peas, beans, small toys, eraser bits, paper pieces
• Ear: Beads, insects (cockroaches!), cotton wool, seeds

Nasal FB:

Symptoms:

• Unilateral nasal discharge (foul-smelling, blood-tinged)
• Nasal obstruction (one side)
• Foul breath
• May be asymptomatic initially

Complications if Delayed:

• Aspiration risk (if pushed back)
• Rhinolith formation (FB gets calcified)
• Sinusitis

Ear FB:

Symptoms:

• Ear pain, discomfort
• Hearing loss (if blocks canal)
• Discharge (if secondary infection)
• Insects: Severe pain, buzzing sound (very distressing)

Complications:

• Trauma to canal/drum (during removal attempts)
• Infection
• TM perforation

Management at Prime ENT Center:

⚠️ Important – Home Removal Attempts Dangerous:

• Can push FB deeper
• Cause trauma, bleeding
• Perforate drum
• Parents should not try – bring to ENT immediately

Professional Removal:

• Cooperative Child:
  • Endoscopic guidance
  • Appropriate instruments (hook, forceps)
  • Quick, gentle removal
• Uncooperative Child या Difficult FB:
  • Short GA may be needed
  • Safer for child
  • Prevents trauma
• Live Insect in Ear:
  • First kill insect (oil instillation)
  • Then remove (less traumatic)

6. Hearing Loss in Children

(Detailed in hearing loss article – pediatric aspects here)

Why Critical to Detect Early?

• First 3 years critical for speech/language development
• Undetected hearing loss → permanent delay
• Even mild loss impacts learning

Types:

• Congenital: Present from birth (genetic, TORCH infections, prematurity)
• Acquired: Post-natal (meningitis, ototoxic drugs, chronic ear disease)

Newborn Hearing Screening:

• Universal screening recommended
• OAE test: Quick, non-invasive
• Timeline:
  • Screen: By 1 month
  • Diagnose: By 3 months
  • Intervene: By 6 months (hearing aids)

Red Flags at Different Ages:

0-3 Months:

• No startle to loud sound
• Doesn’t wake to noise

3-6 Months:

• Doesn’t turn to sounds
• No babbling

6-12 Months:

• No response to name
• No meaningful words by 12 months

12-24 Months:

• Limited vocabulary
• No 2-word phrases by 24 months

Older Children:

• Frequent “what?”
• TV volume high
• Poor school performance
• Behavioral issues

Management:

• Early Hearing Aid Fitting: Don’t delay
• Speech Therapy: Intensive
• Cochlear Implant: For profound loss, ideal age 1-3 years
• Educational Support

7. Chronic Rhinosinusitis in Children

Special Considerations:

• Often associated with allergies
• Adenoid hypertrophy contributes
• Can affect facial growth if severe, chronic

Treatment:

• Medical management first line
• Adenoidectomy often helps
• FESS rare in children, only if medical management fails

Child-Friendly Approach at Prime ENT Center

Creating Comfortable Environment:

• Child-Friendly Clinic:
  • Colorful, welcoming décor
  • Toys, books in waiting area
  • Minimize wait time
• Gentle Approach:
  • Talk to child at their level
  • Explain procedures in simple terms
  • Let child see instruments
  • Use distraction techniques
  • Praise cooperation
• Parent Involvement:
  • Parents present during examination
  • Clear communication
  • Explain diagnosis, treatment options
  • Address concerns

Examination Techniques:

• Quick Assessment: Children have limited patience
• Painless Methods: Gentle otoscopy, nasal endoscopy with topical anesthesia if needed
• Cooperative Approach: Make it a “game” if possible

When to Bring Your Child to ENT?

Immediate (Emergency):

• Breathing Difficulty: Stridor, severe airway obstruction
• High Fever with Ear Pain: Especially if lethargic
• Severe Throat Pain with Drooling: Possible peritonsillar abscess
• Foreign Body: In nose या ear
• Sudden Hearing Loss

Soon (Within Few Days):

• Ear pain, discharge
• Persistent nasal obstruction
• Recurrent throat infections
• Snoring with restless sleep

Routine Visit (Schedule Appointment):

• Speech delay
• Hearing concerns
• Frequent colds/ear infections (prevention counseling)
• Chronic mouth breathing
• Persistent hoarseness

Parental Guidance – Prevention Tips

General Ear Care:

• No Cotton Buds: Outer ear only
• Dry Ears: After bathing, swimming
• Prompt Treatment: Don’t ignore ear pain

Preventing Ear Infections:

• Breastfeeding: At least 6 months (protective)
• Avoid Pacifier: After 6 months
• Upright Feeding: Don’t bottle-feed lying flat
• Avoid Smoke Exposure: Passive smoking increases risk
• Vaccination: Pneumococcal, influenza vaccines
• Limit Daycare: If possible (less URI exposure)

Promoting Healthy Development:

• Monitor Milestones: Speech, hearing
• Reading, Talking: Language stimulation
• Limit Screen Time
• Regular Checkups