Children & ENT

1. Hearing tests/hearing screening after birth (Mutter Kind Pass)

2. Speech development disorder

3. Recurrent infections

4. Otitis media with effusion ("fluid in the ear") and middle ear infections

5. The snoring child - adenoid vegetations or "nasal polyps"

6. Enlarged tonsils and recurrent tonsillitis

7. Surgical interventions on children

 

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Hearing tests/hearing screening after birth (Mutter Kind Pass):

 

As part of the mandatory Austrian Mutter Kind Pass examinations, the gross hearing performance of each child in is also checked. The otoacoustic emissions (OAEs) are tested immediately after birth. These are acoustic signals that are emitted from the inner ear back into the environment after previous external stimulation. The great advantage of these OAEs is that they are an objective procedure. The

newborn does not have to actively participate. If these emissions are received/derived with a special device, the screening is considered normal. Moderate to profound hearing loss can be ruled out. The presence of low-grade hearing loss is still theoretically possible.

I would like to emphasise that a one-off negative result should not immediately lead to great concern. There are numerous reasons why an examination may not work the first time (e.g. amniotic fluid in the middle ear, earwax in the ear canal, a restless child, etc.). However, the examination should then be carried out again in approximately 2 weeks. However, if the results are repeatedly negative, a newborn should definitely be examined audiologically by the 3rd month of life. This is usually carried out at a larger clinic specialising in this field.

 

I am happy to offer newborn screening in my practice and advise you on specific issues.

 

 

Speech development disorder:

 

Time and again, families come to my practice and ask me to clarify a possible speech development disorder.

 

Here are a few milestones in language development:

 

The lingual phase begins around the end of the first year of life with the first word.

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• 10-12 months: the first word

• 12-18 months: one-word sentences

• 18-24 months: two-word sentences

• 24-36 months: multi-word sentences

• 36-60 months: more complex sentences

• >60 months: perfecting

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Language is learnt particularly quickly in the first 4-5 years. This is also referred to as the sensitive phase of language development. Regular language development is then completed at around 13 years of age.

 

Vocabulary:

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• 18 (24) months: approx. 50(30) - 100 words (from around 18 months there often is a vocabulary explosion)

• 3 years: 1000 words

• 4 years: 2000 words

• 5 years: >2500 words

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It must be said, however, that the statements and guidelines in the literature diverge considerably here.

 

Children who have not reached the 50-word limit by the age of 2 or who do not form two-word sentences are considered "late talkers".

Of these, one third achieve completely normal language development, one third become linguistically weak and "only" one third develop a language development disorder.

If a speech development disorder is suspected, the hearing and the ears should always be assessed initially. For example, an otitis media with effusion (fluid in the middle ear) can have a negative effect on hearing and thus influence speech development. With regard to hearing testing, it should be noted that pure-tone audiometry is only useful from around 3 years of age, as the child's co-operation is crucial here. However, there are alternatives for younger children, such as the derivation of OAEs (see above), free-field and play audiometry and reflex measurements in the brainstem area. Certain examinations can certainly be carried out in a regular ENT practice. However, in the case of special issues, children are better off at a centre with trained phoniatrists (a subspeciality in ENT medicine), paediatric audiologists and people with special knowledge of neuropsychological development

              

Together we will examine your child and decide whether further diagnostics and therapy are necessary.

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Recurrent infections:

 

Who hasn't experienced this? Children start kindergarten and during their first year - especially during the cold season – it seems that they are more often sick than healthy. Parents themselves also go through a few infections again.

However, these infections are part of growing up. The immune system comes into contact with first germs (mainly viruses, but sometimes also bacteria) and really has to put up a fight. Coughs, colds and recurring fevers are a weekly companion. It is important to support the child as much as possible and prevent unnecessary suffering. With certain household remedies, serious infections can be partially prevented and not every night has to be characterised by little sleep.

Most infections in the first few years of life are viral and do not require antibiotics. In this case, the focus must be on adequate pain and anti-inflammatory therapy and appropriate accompanying measures. However, antibiotics are sometimes necessary.

In order to prevent unnecessary medication and, in selected cases, to use antibiotics, I can offer you age-appropriate examinations and will be happy to discuss the next steps with you.

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Otitis media with effusion ("fluid in the ear") and middle ear infections:

 

Respiratory infections often affect the ears as well, in particular the middle ear. Due to anatomical reasons, the middle ear is generally more susceptible to recurring infections up to school age, as passive ventilation through the Eustachian tube is not yet optimal.

Once again, it should be emphasised that the majority of infections are caused by viruses, meaning that no antibiotics are required. However, in the case of bilateral purulent middle ear infections or perforated middle ear infections (where increased pressure in the middle ear has caused a hole in the eardrum), an antibiotic should not be dispensed with. As earache is very unpleasant, great importance should be given to adequate pain and anti-inflammatory therapy. Decongestant nasal drops or sprays are usually also used.

More than 90% of children develop temporary otitis media with effusion by the time they start school. This is often referred to as "fluid in the ear". Technical terms include tympanic effusion or seromucotympanum. The effusion usually causes a mild to moderate reduction in hearing ability of 15-30dB (sometimes even more), leads to increased susceptibility to middle ear infections and children sometimes complain of a feeling of pressure in the ear and even earache. However, these effusions usually disappear after a few weeks.

 

Parents should therefore not be overly concerned when the condition is first diagnosed. As described above, significantly more than half of children develop recurrent Otitis media with effusions before school age. However, it is important to be aware of the problem and to keep monitoring until the effusion disappears.

 

Due to the age-related hypofunction of the tube (responsible for ventilating the middle ear), chronic, i.e. permanent middle ear effusions can also develop. This is referred to as chronic seromucotympanum. In this case, it cannot be expected that the problem resolves itself. In addition to the negative consequences for speech development, there is also an increased risk of suffering from chronic middle ear diseases in later life (e.g. development of a so-called cholestatoma).

Therefore, any chronic otitis media with effusion that persists over a longer period of time (usually 3 to 6 months) should be treated surgically. Opening the eardrum and aspiration of the fluids is the standard of care. In selected cases, it makes sense to insert a so-called tympanic tube into the eardrum in order to ensure the regeneration of the chronically altered soft tissue If the child is more than 4 years old, it can be discussed whether the pharyngeal tonsil (adenoids/adenoid vegetations) should also be removed as part of the procedure.

If surgical treatment for chronic otitis media with effusion is rejected, treatment with a hearing aid should be discussed, as the effusion can otherwise lead to hearing loss and consequently to problems with speech development.

 

Nasal sprays, cortisone or medication against allergies have shown no benefit in large studies and should therefore not be used routinely.

 

At around 8 years of age, the tube function is usually so mature that chronic effusions in the middle ear only occur in special cases

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The snoring child - adenoid vegetations or “nasal polyps”:

 

The enlarged pharyngeal tonsil is referred to as adenoid vegetations. Many people in Austria (including doctors) use the term "nasal polyps in children", even though these are not actually true polyps. The pharyngeal tonsil is located directly behind the nose on the so-called nasopharyngeal roof. They usually recede during adolescence. This is why the peak of the disease in childhood is between 1 and 6 years. The adenoid tissue consists mainly of lymphatic tissue and helps in the defence against viruses and germs.

If the adenoids are enlarged, nasal secretions can no longer drain properly via the throat and this leads to increased inflammation/infection. This leads to further enlargement of the adenoids - a vicious circle. Children find it increasingly difficult to breathe through their nose. As a result, they breathe more through the mouth and develop a typical facial expression (facies adenoidea)

Increased snoring (even outside of an infection) reduces the quality of sleep for children (and parents). If the symptoms are severe, it can even lead to the so-called paediatric sleep apnoea syndrome.

Chronic inflammation of the upper respiratory tract can in turn lead to recurrent bronchitis. This should be avoided at all costs. In addition, pharyngeal tonsil hyperplasia can favour chronic tube dysfunction and problems with the middle ear (effusion, hearing loss, recurrent inflammation; see above).

 

The diagnosis is usually made on the basis of the child's medical history and clinical appearance. Most children (especially younger ones) will not tolerate a detailed examination of the adenoids. However, an attempt can be made to inspect the nasopharynx with a flexible camera.

 

So what should be done if an enlarged adenoid is suspected?

 

Initially, a nasal spray containing cortisone can be tried. If the symptoms persist, surgical removal of the pharyngeal tonsil is necessary (the so called adenotomy/adenectomy). Chronic tympanic effusions of the middle ear (see above) are often also treated as part of this procedure and enlarged palatine tonsils are also reduced in size if necessary (see below).

Many children really "blossom" after such an operation. Improved sleep quality, less susceptibility to infections and better hearing have a positive effect on the child's general development.

In some cases, the adenoids may become enlarged again. This occurs if they have not been completely removed during the initial operation. During the operation, the surgeon must also weigh up the benefits (removal of all the tissue) against the risks (bleeding, post-operative haemorrhage, infection) of an extensive operation.

In many cases, however, general body growth and more favourable anatomical conditions prevent the need for a second operation.

 

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Enlarged tonsils and recurrent tonsillitis:

 

In combination with enlarged adenoids (see above), many children also present with enlarged palatine tonsils. A so-called "tonsil hypertrophy" is not pathological per se and can simply be left as it is, if there are no symptoms. Sometimes, however, the enlarged tonsils lead to a narrowing of the airway. Although the tonsils are located in the oral cavity, nasal breathing is usually restricted initially. This is because the tonsils close the nasopharynx backwards and upwards when the child is lying down (supine position). This results in increased breathing through the mouth, snoring and sometimes sleep apnea.

The only therapeutic option is the surgical reduction of the tonsils (so-called tonsillotomy). This procedure is often performed together with the removal of the adenoids (adenotomy; see above).

 

Just as with recurring middle ear infections, parents are also frequently confronted with recurrent tonsillitis in their children. This usually manifests itself in swallowing difficulties, sore throat, fever and a general feeling of illness. Here too, viral pathogens are by far the most common cause and treatment is focused on symptom relief. Antibiotic therapy is not generally indicated.

Responsible viruses are usually non-specific. In some cases, however, tonsillitis also occurs in the context of the hand-mouth-foot disease, herpes diseases or Pfeiffer's glandular fever (also known as infectious mononucleosis or kissing disease).

 

Bacterial colonization of the tonsils can also be the cause of the inflammation. The experienced (ENT) doctor usually recognizes this from the clinical picture and usually does not require any further blood tests or swabs. In addition to symptom-relieving pain medication, an antibiotic is used as a standard of care - usually a classic penicillin.

 

If a diagnosis of bacterial tonsillitis has been made, it is important that children take it easy physically for at least 10 - 14 days. Otherwise there is a risk of infectious colonization of the heart muscle, including the heart valves, or the development of rheumatic fever.

 

In rare cases, the antibiotic may need to be changed due to lack of success. The correct dosage (short and intensive rather than long and underdosed) can significantly reduce your child's suffering.

 

Sometimes a banal tonsillitis can also develop into an abscess. This should definitely be treated surgically. Fortunately, this is the exception in children.

I am often asked whether children's tonsils should be surgically removed. This is called tonsillectomy. There are relatively clear guidelines that should be followed. A tonsillectomy is not a trivial procedure and should be carefully considered.

I will be happy to look after your child in the event of acute symptoms, advise you on a possible reduction or surgical removal of the tonsils and, if necessary, perform this procedure myself.

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Surgical interventions on children:

 

I have many years of experience with surgical procedures on children and regularly perform the following operations:

 

• Adenectomy/Adenotomy: Removal of the pharyngeal tonsil

• Tonsillotomy: Reduction of the palatine tonsils

• Tonsillectomy: Removal of the palatine tonsils

• Paracentesis: Tympanic membrane incision with tympanic aspiration

• - possibly also with insertion of a tympanic tube (tympanic drainage)

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I will be happy to provide you with more detailed advice and care, if necessary.