Children

Glue Ear (Otitis Media)

Glue ear occurs when the middle ear is unable to drain properly and it fills up with fluid. Over time this fluid thickens to form a glue-like consistency. If this glue persists it can cause hearing loss. Over time, this hearing loss can lead to problems with speech and language development or recurrent infections.

Young children with glue in their middle ears can present with frustration, irritability and delayed speech development. It can also affect balance and walking.

Unfortunately there are no medicines that are proven to fix this problem. If a child has persistent fluid in the ears for 3 or more months or is exhibiting speech delay it can be useful to obtain a hearing test and an opinion from an ENT specialist.

Grommets

These are small plastic tubes that help ventilate the part of the ear under the eardrum (middle ear). They are sometimes placed for children or adults with recurrent ear infections, hearing loss or both. Young children have under-developed middle ear drainage tubes (Eustachian tubes) which occasionally get blocked and lead to fluid build up with subsequent pain, infection or hearing loss.

The condition is less common in adults but can occasionally occur. In those kids with a blocked or snotty nose in conjunction with blocked ears, adenoidectomy is sometimes performed at the same time as grommet insertion. A hearing test is needed prior to tube placement to help ascertain if there is any hearing loss. Tubes are placed in the ear drums under general anaesthetic using a microscope. The procedure is quick and relatively pain-free and can be done as a day procedure. Most patients are "back to normal" in a day or two.

While grommets can let fluid drain out and air in, water can also occasionally cause concern in those with grommets.

Snoring and OSA

Simple snoring is common amongst both children and adults but it is important to recognise that it can sometimes be harmful.

Snoring occurs when the tissues at the back of the throat become relaxed during sleep and collapse on inspiration. The air flowing through the narrow throat passage makes the tissues vibrate and the breathing becomes audible. Sometimes it can be very loud.

Occasionally the airway completely blocks when the child inspires, causing them to pause in their breathing and wake momentarily. This frequent waking occurs to protect the child from significant drops in oxygen. This condition is called obstructive sleep apnoea (OSA), and can occur many times during the night.

If your child suffers from OSA they may not be having any restful sleep and this can have a negative effect on their energy levels, their concentration and their ability to learn.

What can be done about Obstructive sleep anoea?

There is a large body of evidence that supports removing obstructive tissue from the throat (tonsils) and the back of the nose (adenoids) in children with obstructive sleep apnoea. Of course, not all children who snore require surgery and it is important that parents observe their children closely (and even make video recordings) before making an appointment to see a surgeon.

With a thorough history and comprehensive examination, an ENT surgeon can assess the benefits of surgery and discuss the options and the risks to the parents so they can make an informed decision.

Sleep studies will occasionally be used to assess the severity of obstructive sleep apnoea, though this investigation is usually reserved for children with more complex medical issues.

Adenoids

These are glands that live at the back of the nose and are usually present between early childhood and adolescence. They are probably a useful part of the immune system in early infancy but there is no evidence they possess any useful immunological role beyond that time.

If they become too large or infected, adenoids can be quite a burden – leading to nasal obstruction, nasal discharge and snoring. Infected adenoids are a common cause of recurrent childhood sinusitis and post-nasal drip. Longstanding nasal obstruction due to enlarge adenoids can also effect growth of the upper teeth and lead to orthodontic issues.

Adenoidectomy

This may be done on its own, or combined with tonsillectomy, grommets or other nasal surgery. If the enlarged adenoids block the openings to the drainage tubes from the ears (Eustachian tubes), ear infections and hearing loss can sometimes happen (see grommets above). Adenoidectomy is performed with a small curette (through the mouth) or with a precision electrocautery device. Recovery is usually a day or so and the procedure is usually done as a day procedure.

Tonsillectomy

This common operation is performed for kids or adults who suffer many bouts of tonsillitis or in those where the tonsils get so large they block the throat and cause difficulty with eating, breathing and sleeping. Tonsillectomy used to be done very routinely but we are more selective nowadays, and take many different factors in the history and examination into account before recommending surgery. Most tonsillectomies are done in little kids aged 3-7 and in young adults aged 16-20. Occasionally people over 30 or under 3 need tonsillectomy. The surgery is done using very precise instrumentation and is very safe. Blood loss is usually less than a routine blood test and local anaesthetic put in during surgery makes the recovery well tolerated. The team at ENT Victoria have performed well over 5,000 tonsillectomies.

Most kids and adults stay overnight after surgery but some fit and well adolescents do very well going home on the same day as the operation. Prior to planning any surgery the risks and the expected course of recovery will be explained to the patient and/or their parents.

Otoplasty

Some children are born with ears that protrude more than they would like and can be a significant source of source of unhappiness and teasing. Otoplasty refers to the surgical procedure involved in pinning back ears that stick out too far. This procedure is usually considered in children around the age of 5 and is generally well tolerated. The procedure is conducted under a full general anaesthetic and takes about 1 hour. The operation is performed from behind the ear and there are no visible scars. Bandages are worn over the ears for a day and then changed over to new ones to ensure proper healing. The ears will be a bit puffy for a few weeks and then return to a normal shape and position.

If you are concerned about the appearance of your child’s ears, ask your GP for a referral to see one of our ENT specialists. With the use of photos and diagrams our surgeons would be happy to explain the steps involved as well as the risks and benefits of the procedure.