Thomas A. Cadenhead, MD., P.A.



Misckv_2. Articles

Children ENT Problems



Children often have a significant level of Ear, Nose, Throat and Upper Respiratory problems. Because of their inability to vocalise , often the symptoms are neglected till they flare up into severe infections. While these are treated at the time, failure to address the underlying conditions may, lead to persistent or frequent recurences of the problems. My child is having a flu all the time My child needs to visit the doctor every other week; may be common comments made by parents in the play-group and kindergarten age. Hearing difficulty may be undiagnosed leading to learning impairment in this age group. Asthma cases are also higher when the recurring allergies and infections are not controlled.
At our practice, we are experienced with dealing with children and their needs. Some common symptoms affecting children are discussed below. Please feel free to contact our staff for more information.

Blocked Nose and Mouth Breathing

These are relatively common symptom. Often, the cause may be obvious such as the common cold or flu. However if this happens regularly or remains persistent beyond two weeks, an ENT evaluation may be necessary. Long-term mouth breathing in a child can lead to delayed mid face development which is permanent.

Possible Causes

  • Allergy
  • Sinusitis
  • Swollen Turbinates
  • Enlarged Adenoids or Tonsils
  • Runny Nose

    The most common cause for a runny nose is the common cold or flu. This typically increase in severity over 2 to 3 days often associated with a cough or fever. It runs its course and recovery is expected within a week.
    If symptoms persist beyond a week, sinusitis will need to be excluded especially if the discharge is thick and discoloured.
    If the discharge is clear and there are morning symptoms of sneezing and congested nose, the most likely cause is allergy. Allergy can be triggered by the environment or diet. There is an increase risk of asthma if the allergy is not well controlled. With proper diagnosis and treatment, cure is possible for allergy.

    Chronic Cough

    Chronic cough may be caused by allergy or sinusitis resulting from a post-nasal drip. Chest infection and asthma are the other causes. A persistent cough is not normal and needs to be evaluated by a doctor. In the event where all the routine tests were not helpful; allergy workup, in particular, food allergy may reveal the cause.


    This is the infection of the sinuses. The predisposing cause is a common cold, which has affected the sinuses. Often one would require antibiotics. Failure to eradicate sinusitis will lead to a chronic condition in which surgery may be necessary. Individuals with allergies will tend to have more persistent symptoms. Again accurate diagnosis is the key


    Pharyngitis and tonsillitis are common causes. Usually this starts as a viral infection in which antibiotics is not necessary. If the sorethroat worsens, and phlegm develops, a course of antibiotics is helpful. Tonsillitis is often associated with high fever in a child. If this is happening regularly, then a visit to the ENT doctor would be helpful. The best time to bring your child to the ENT doctor is when your child is having the acute infection as this would allow a more accurate assessment. If in doubt call our staff for advice.


    Adults snore but some children snore like adults. Regular loud snoring and noisy breathing should be assessed to exclude blocked nose, allergies, enlarge adenoids and tonsils. Sleep Apnoea can occur in which the child can become lethargic, with lack of energy and disinterest in his environment. Correction of the underlying condition will reverse this and return the child to his normal self.

    Hearing Loss

    A child that has delayed or inaccurate speech needs to have their hearing assessed. Similarly for the child that does not respond to the environment, parents, teachers or misinterpret commands will need to a hearing check. Diminished hearing affects learning ability, which is critrical in our highly competitive environment. The cause is usually in the outer or middle ear. In rare situations the hearing loss is a result of a nerve condition.


    Snoring & Sleep Apnoea

    Laugh and the world laughs with you, snore and you snore alone”; Mark Twain

    Whilst snoring may be a social nuisance, it may indicate an obstuctive sleep apnoea (OSA)

    Symptoms of OSA include

  • Loud Snoring
  • Feeling of fatigue despite adequate sleep
  • Falling Asleep in midst of routine activities like reading, watching TV
  • Dozing off in meeting or in the theater / cinema
  • Sudden awakening from difficulty in breathing or gasping for air
  • Deteriorating attention span and failing memory
  • Morning Headaches
  • Frequent nocturnal trips to the toilet
  • OSA has been linked to high blood pressure, heart disease, strokes, diabetes, obesity and increased risk of death.
  • Early diagnosis and treatment can prevent complications from arising.

    What you need to do?

    If you have the above symptoms, contact an ENT physician who has an interest in sleep disorder.
    The spectrum of treatment ranges from medication for reversal of allergy and nose disease, to treatment of the palate and tonsil.
    With modern technology, procedures under local anesthesia with minimal downtime and discomfort. These procedures are especially suitable for snoring, mild and moderate sleep apnoea.

    Procedures include:
  • Radiofrequency Stiffening of the Palate
  • Radiofrequency Reduction of Turbinate
  • Radiofrequency Reduction of the Tonsil
  • Radiofrequency Reduction of the Tongue Base
  • Laser treatment to the Palate
  • Reshaping of the Palate using RF
  • Pillar Implant to Stiffen the Palate

    Many of the procedures that require general anesthesia that can be performed as a day surgery.

    These include:
  • Tonsillectomy (Removal of Tonsils)
  • Uvulopharyngoplasty
  • Repose Tongue Suspension
  • Hyoid bone suspension

    Devices such as dental appliances and CPAP may be suitable in some patients.
    Weight management and life style modifications will complement the above treatments.


    Understanding Allergies

    What are Allergies?

    Allergy is an abnormal reaction of the individual to substances in the environment. The incidence of allergy is reaching epidemic proportion affecting up to 40% of the population

    What’s in a name?

    Allergy manifests in various forms and can affect different body systems concurrently. They are called by different names and treated by different specialists causing confusion to patients and doctors alike.

  • Allergy of the nose: Allergic Rhinitis/ Sinus
  • Allergy of the eyes: Allergic Conjunctivitis
  • Allergy of the lungs: Allergic Asthma
  • Allergy of the skin: Ezcema, dermatitis, contact dermatitis, hives, and urticaria
  • Allergy of the gut: Manifests as colic, bloating, diarrhoea
  • Middle Ear Fluid: Otitis Media
  • Non Specific Symptoms: Fatigue, hyperactivity, headaches, depression.

    It is therefore critical in the treatment of allergy that the patient is managed in a holistic fashion rather than compartmentalisng the symptoms.

    Causes of Allergies

    This is predominantly caused by what we breathe: inhalant allergy; and what we consume: food allergy.

    Inhalant Allergy

    Inhalant allergy is well recognised. Dust mite, pollens (hay fever) and animal danders are all common contributors.

    Food Allergy

    Food Allergy presents in two forms:

    The Immediate Allergy

    This form presents no difficulty in diagnosis as a reaction like rash occurs immediately on food consumption such as peanut or shellfish allergy.

    The Non-Immediate Allergy

    The reaction appears much later and specialised tests become necessary for diagnosis. Symptoms caused by food allergy include eczema, chronic cough, nasal polyps, phlgem (in the absence of infection), chronic headaches, etc. Often the symptoms are non-specific and statistics have shown that typically the sufferer would have sought numerous medical opinions without relief.

    How are allergies diagnosed?

    For allergies to be appropriately treated and controlled, it is important that the specific allergen(s) causing the allergic symptoms be identified. The first step is a detailed history and physical examination to confirm the symptoms of allergy. The methods of assessment include using skin tests and or blood tests. These tests will help determine the mode of treatment for the allergies.

    How are allergies treated?

    Treatments of allergy include avoidance, medication and immunotherapy.</P>

    1. Avoidance

    In most instances, the cause of symptoms can be avoided or removed. For example, a particular food that causes the allergic reaction can be avoided, or a pet can be removed from the home or kept away from the sleeping area. Some causes of symptoms cannot be eliminated but exposure may be reduced.

    2. Medication

    Medication is frequently used to decrease or eliminate allergy symptoms. These include steroid nasal sprays, steroid tablets, creams and antihistamines. While they are effective in controlling symptoms, they do not provide a cure.<BR><BR><B>

    3. Immunotherapy (Desensitisation)

    Immunotherapy is the only means of curing your allergies as endorsed by the World Health Organisation (WHO). The program allows for desensitisation against the substance you are allergic to. For example, if you are allergic to dust mite, then immunotherapy can prevent you from reacting to dust mite after an appropriate time of treatment. The immunotherapy benefits can last up to and beyond ten years. Both adults and children from the age of 3 can benefit from it. Immunotherapy will also help in reducing the development of new allergies. It has been used successfully for allergic rhinitis and asthma with excellent results.

    In the past, immunotherapy was only available in injection form. Now an oral preparation called Sublingual ImmnoTherapy is available. Accurate diagnosis is essential for treatment. Trained allergist and ENT doctors with a subspecialisation in allergy provide this treatment.

    Allergy in ENT

    An otolaryngologist is a doctor who specialises in ear, nose and throat problems. Chronic nasal congestion and postnasal drip are commonly related to allergy. This may be further complicated by chronic sinus disease and middle ear disease. The otolaryngologist who specializes in allergy will be able to provide comprehensive diagnosis and treatment.

    Allergy problems in Children

    These are often neglected as the children do not complain or the allergy is not recognised. Allergy manifestations change as the child grows. The type of allergens that can affect the child also changes. For instance, babies are more troubled by gut problems and ezcema. The main cause is food related. As the child grows, the problems of rhinitis and asthma become more prevalent and the ezcema may subside. Environmental exposure to dust, pollens, pets and diet play a part in the change. There is now an increasing trend of allergy in children.

    Allergic rhinitis when left untreated leads to increased risk of asthma. The child that has recurrent colds, flus, runny nose, sneezing, glue ears and ezcema should be evaluated for allergy. Successful management of the child’s allergy will lead to a better quality of life with less frequent concomitant medical problems.
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