Earwax is a vital substance. The skin glands in your ears produce it to repel water and to keep your ear canal free of unwelcome foreign matter. It traps dust, dirt, bacteria, and other outside matter that could otherwise cause major damage to your eardrum. As material gets caught in it, wax builds up just a little bit, and then dries out and washes away out of the ear.

Unfortunately, we all know that too much waxy buildup in the ears can also cause some really uncomfortable problems, especially for children. When your child is sick, the ceruminous glands in their ears will tend to produce wax faster than their body can shed it, causing the ears to be plugged up with waxy buildup.

Because your child’s Eustachian tubes are more horizontal than an adult’s is, they cannot drain fluids as efficiently. This, in conjunction with waxy buildup as a result of a cold or sinusitis, can lead to very painful ear infections. Clearing out excess earwax can help your child hear better and sometimes help him or her feel better too, but you have to be very careful.

What Not to Do

You might be tempted to try to clean your child’s ears out with a Q-tip or cotton bud, but do not do this under any circumstances. In fact, do not stick any foreign objects in your child’s ear canals.

For one thing, your child’s eardrum is as thin as a tissue, and you could very easily push too far into the ear canal, put pressure on it, and cause it to burst. Second, rubbing around in your child’s ear canal with a Q-tip is likely to just pack the earwax farther into the canal, rather than extracting it. This method is not only dangerous, but it’s also very ineffective.

What You Can Do

First of all, do make an appointment with your child’s ear, nose, and throat doctor. Waxy buildup may be indicative of other problems, or may be easily mistaken for outer ear infection – otitis externa. Treatment with prescription ear drops may be needed. In any case, do not try to self diagnose your child at home.

The ENT doctor will likely manage your child’s ears under the microscope. If there is tenacious wax down deep in the ear canal, the doctor may have to carefully remove it out manually. This process is uncomfortable and sometimes painful, depending on the degree of infection. So be prepared to hold your child’s hand and to give them a big hug when it is over.

If you can’t get to the ENT specialist, you can help your child with a little bit of relief in the meantime. First, if there is any wax built up around the outside of the ear, go ahead and wipe it away gently with a warm, damp washcloth. Next, you can see your local doctor, who will be able to contact an ear nose throat specialist as needed.

After the ears are cleared, your ENT specialist may suggest maintenance with olive oil ear drops. This is a traditional remedy for removing ear wax. Use an eyedropper to squeeze about 1-2 drops of olive oil into the ear. Make sure that your child lies still for at least 5 minutes. Repeat the process for the other ear. Managing waxy ears at home is safe if you do it this way, but it should not be used as a replacement for visiting the ENT doctor. If your child’s ears are overproducing wax and causing problems, it’s time to make an appointment to treat the problem, and to also ensure that there is no underlying infection.

If you have questions about ear wax buildup or otitis externa management contact your local doctor who will arrange for you see an ear nose and throat surgeon.

Sources

• Earwax – Ask Dr Sears
• Earwax buildup | BabyCenter
• Earwax – Pediatrics – About.com

The post What to do about Waxy Buildup in Your Child’s Ears appeared first on ENT Clinic Sydney.

Lymphadenopathy is usually caused by an infection that occurs in one or more of the lymph nodes in the neck. This common childhood infection occurs in up to 45% of healthy children, and up to 90% of those aged four to eight years. The initial symptoms are swollen lymph nodes in the neck, which may or may not be tender depending on the cause.

Infection

Causes of cervical lymphadenopathy are usually viral or bacterial infection, which can include:

• Adenoid and tonsil infection
• Respiratory infections
• Rhinovirus
• Otitis media
• Epstein-Barr
• Infectious mononucleosis
• Streptococcus
• Staphylococcus

There are also other more serious infections that can cause swelling in the cervical lymph nodes. However they are uncommon. They include:

• Tuberculosis
• Fungal Infections

If your child is sick, the virus or bacteria can travel to the lymph nodes via the lymphatic system. The swelling and tenderness is the result of an inflammatory reaction that occurs when the body is trying to fight off an illness or infection.

Childhood lymphoma

Lymphomas, Hodgkin and non-Hodgkin lymphoma, are the third most common cancer in children, and NHL accounts for approximately 6-7% of cancers in children. Lymphomas are a group of malignancies in which the cancer cells originate from the lymphoid system.

The main difference between Hodgkin’s lymphoma and NHL is in the specific lymphocyte each involves. A doctor can tell the difference between Hodgkin’s lymphoma and NHL by examining the cancer cells under a microscope. Most lymphomas are NHL. 

Overall, the risk of NHL in children increases with age. Childhood NHL can cause many different signs and symptoms, depending on where it is in the body. Common symptoms include:

• Enlarged lymph nodes – seen or felt as lumps under the skin
• Swollen abdomen 
• Feeling full after only a small amount of food
• Shortness of breath or cough
• Fever
• Weight loss
• Night sweats
• Fatigue – feeling very tired

Duration of cervical lymphadenopathy

The swollen lymph nodes in your child’s neck may be classified based on how long the problem lasts. This may be acute, sub-acute or chronic. An acute condition can be defined by a short, often < 1 month duration. This usually responds well to therapy with return to normal health. Subacute is defined as within the interval between acute and chronic, so from one to three months time. A chronic condition is one that lasts 3 months or more.

Diagnosis

The diagnosis of lymphadenopathy requires a few different steps to determine the actual cause of the problem. You will need to provide a medical history for your child, as well as allow a physical exam of the head and neck area, and other areas as needed.

History

When you take your child to the doctor, you will need to be able to answer any questions concerning recent illnesses, ear nose or throat infections, insect bites, or tooth infections/abscesses. The doctor will also ask if your child is currently ill, or if they seem lethargic and fatigued. You should also tell the doctor if your child is taking any medications, or if they have recently had any immunisations.

Examination

The doctor will begin by palpating the swollen lymph nodes to see how large they are, whether they are tender to the touch, whether they move around, and whether they are soft or hard. He or she will also check for a fever or other signs of illness such as a rash or high temperature. The doctor will also assess the lungs and abdomen in the exam to make sure there is not an illness present that is affecting other organ systems. A neck ultrasound scan may also be needed.

Treatment

In most cases, acute cervical lymphadenopathy does not require immediate treatment, unless there are other signs or symptoms that a bacterial infection is present. If your child is suffering from a bacterial infection, he or she will be placed on antibiotics to treat the illness. If there are no other illnesses present, the doctor will simply keep an eye on the swollen lymph nodes to see if they change or go away on their own.

In cases where the swelling does not go away over time, the doctor may decide to run imaging tests or use a small needle to collect a sample of fluid from the node for further testing. As needed your doctor may recommend excision of the nodes for formal diagnosis by pathology.

Outcomes

In most cases, cervical lymphadenopathy in children is a benign condition. Those suffering from benign lymphadenopathy will generally see improvement within two weeks, depending on the cause. Uncommonly there are situations where the swelling may be due to cancer. In all situations the best course of action to ensure thorough assessment by your doctor, with specialist referral to an ENT surgeon or paediatrician. Follow your doctor’s advice, and make sure to keep all follow up appointments until the issue is resolved.

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We can all admit that when children snore it can be quite cute. However, a child who snores loudly and frequently may have a medical problem that needs to be addressed. This article discusses how to tell whether your little one is snoring due to a sinus infection or tiny airways, or if they have a medical problem like tonsil and adenoid enlargement, that an ear, nose, and throat surgeon can manage.

Harmless Snoring

If your child snores only when they have a sinus infection, cold, or are otherwise congested, this situation can usually be managed with medication. The snoring will usually subside once they are healthy again. This situation can usually be managed by your family doctor or paediatrician.

Understanding Sleep Apnoea

Before you become alarmed at the term “apnoea”, you should know that apnoeas are simply pauses in breathing. Almost everyone on earth experiences them from time to time during sleep. Most people are not aware of them and are not affected by them.

However, when a child experiences frequent apnoeas, and when they struggle to begin breathing again, this is called sleep apnoea. This is a serious issue. Sleep apnoea interferes with quality rest and can cause fatigue and even exhaustion. A child with sleep apnoea may have behavioural issues at school or with their parents simply because they are not well rested.

Associated Ear, Nose, and Throat Problems

There are several types of childhood infections associated with snoring, sleep apnoea, and lack of rest in children.

Sinusitis

Sometimes snoring can be a symptom of a sinus infection. If your child has had what seems to be a cold that will not go away for more than 10 days, take them your local doctor for medical review. This could be a sign of sinusitis, a sinus infection, and can usually be treated with antibiotics.

Once the infection is treated, the snoring and any apnoeas, due to nose and sinus blockage, should go away. If not, you should make another appointment with your doctor to discuss how you can help your child sleep more soundly at night.

Adenoiditis

The adenoids are a mass of lymphatic tissue positioned between the back of the nasal cavity and the top of the throat. They protect children against infection by trapping viruses and bacteria. Unfortunately, they can become infected and inflamed, themselves. When this occurs the adenoids swell and become enlarged.

Enlarged adenoids can block your child’s airways and cause breathing problems during sleep. The adenoid gland takes up space between the nasal cavity and the throat. With an enlarged adenoid, your child may be forced to breathe through their mouth while sleeping. Pay attention to how your child is breathing and if you have concerns, schedule an appointment with their ENT surgeon.

Tonsil and Adenoid Infection

The most common reason children snore (around 90%) is enlargement of both the tonsils and adenoid. Snoring is worst in children ages between 2 and 8 years. Removal of the tonsils and adenoid is usually the recommended treatment for children who have tonsil and adenoid infection, when antibiotic therapy is not effective. Removal of the tonsils and adenoid cures snoring and sleep apnoea in 85 to 90% of children.

When Infection Is Not the Cause

Other factors which may increase the risk of snoring include altered airway muscle tone, obesity and genetic factors. If your child has sleep apnoea due to one of these factors, your pediatrician will probably recommend a combination of treatments. In addition to a better diet and more activity, they may prescribe the use of a continuous positive airway pressure (CPAP) machine to allow your child to sleep better at night.

Most causes of sleep apnoea in children are manageable and can be treated by an ear nose and throat surgeon.

If you have questions about the management of childhood sleep apnoea and snoring make an appointment to see our ear nose and throat specialist.

Click here to find out more about treatment for snoring in children

References

• General sleep apnea
• Sleep Apnea treatment
• Treating sleep apnea kids improves behavior quality life
• Childrens sleep apnea

The post Treating Childhood Sleep Apnoea and Snoring appeared first on ENT Clinic Sydney.

Some children struggle with earaches off and on throughout their childhood, and chronic ear infections often become a problem enough that parents may consider treatments such as surgical insertion of tubes to allow the ears to drain. However, many parents do not have experience with earaches and may be unsure of what to do if their child becomes unwell.

What causes an earache?

In most cases, a child with an ear ache has an ear infection. However, if the child inserts something into their ear and it gets stuck, this could lead to pain as well. However, if you have ruled out foreign objects, then infection is the likely culprit.

Symptoms of an ear infection include:

• Older children will be able to tell you that their ears hurt. Babies may be more irritable or they may pull at their ears.
• Loss of appetite. Swallowing can cause more pain because of the increase in pressure in the ears. Little ones may not be interested in eating.
• Children with an ear infection may develop a fever.
• Certain types of ear infections lead to drainage from the child’s ears, including white or yellow liquid that may even be tinged with blood.
• Loss of hearing. Many times with an ear infection, the child may lose some of their hearing. This is a temporary condition caused by fluid building up behind the ear drums.

Therefore, if you notice that your child has an earache, then they likely have an ear infection as well. A doctor will need to prescribe treatment.

The facts

If your child has an ear ache, then there are some things you need to know.

• Ear infections and earaches are not usually contagious.
• Earaches and ear infections tend to develop on the third day of a common cold.
• Colds are infectious, so your child can get this virus from another child and it could potentially lead to an ear ache.
• Earaches are most common in children between the ages of six months and three years.

Since a children’s ear infection often comes along with a fever, you may need to keep your child home until the fever has cleared up.

How to ease an earache

If your child develops an earache, there are some things you can do between now and when you visit the doctor to help ease the pain.

• You can give your child over the counter pain medication as long as you choose children’s dosages.
• Apply a hot compress, heating pad, or hot towel to the ear for 20 minutes to ease the pain.

If your child has an ear ache, do not put cotton in their ears. This can actually trap any pus or drainage, and this can further irritate the ear canal, making the condition worse.

Earaches are rarely serious, but they do usually mean an ear infection, which requires a trip to the doctor for antibiotics. As long as you keep an eye on your child for severe symptoms, then an ear ache should go away fairly quickly with the proper treatment. In most cases, by the time the child is two or three years old, the number of earaches should drop significantly.

If you have questions or concerns about earaches in children contact your local doctor, who will arrange for you to see an Ear Nose Throat Specialist. 

Resources

Earaches and Your Child – HealthyChildren.org

The post What You Need to Know about Earaches in Children appeared first on ENT Clinic Sydney.

The neck carries the vital arteries transmitting blood to the brain, head and face. It also transmits the veins which drain the deoxygenated blood from the brain, head and face and return it to the right side of the heart. The neck also contains the cervical spinal cord, as well as some important cranial nerves. Some of these structures travel together in a fascial (connective tissue) sheath called the carotid sheath. The carotid sheath carries the common and internal carotid arteries, the internal jugular vein, the vagus nerve (cranial nerve X), some lymph nodes, carotid periarterial plexuses and the carotid sinus nerve.

Arterial Anatomy

The main artery in the neck is the common carotid artery, which divides at the upper border of the thyroid cartilage of the larynx (C4). The left common carotid artery branches directly off the aortic arch and extends into the neck. The right common carotid artery has a different initial course. It is a branch of the brachiocephalic trunk. The brachiocephalic trunk is the first branch of the aortic arch and it bifurcates into the right subclavian artery and the right common carotid artery. Both common carotid arteries ascend in the neck lying medially in the carotid sheath.

Near the bifurcation of the common carotid arteries, there are two important receptors, the carotid sinus and the carotid body. The carotid sinus is a baroreceptor which senses the pressure in the carotid artery system and transmits information to the brain about the blood pressure in order to maintain blood pressure homeostasis. It is located at the beginning of the internal carotid artery as a small dilatation. The carotid body is a small lump of tissue that lies on the medial side of the common carotid bifurcation. Its role is to monitor the levels of oxygen in the blood; it relays information about blood oxygen to the brain. In accordance with the changes sensed by the carotid body, the brain responds by changing the rate of breathing.

The internal carotid artery is the main supplier of blood to the brain. It arises from the common carotid artery in the neck, and courses posterior to the external carotid artery. The internal carotid artery does give off any branches in the neck. It ascends into the cranial cavity through the carotid canals in the petrous part of the temporal bone.

The external carotid artery is the other branch of the common carotid artery after it bifurcates at the upper border of the thyroid cartilage. It lies anterior to the internal carotid artery. It ascends in the neck and enters the parotid gland on the face, where it divides into the maxillary artery and the superficial temporal arteries. The external carotid supplies parts of the neck, face and scalp primarily. However, the middle meningeal artery is a branch which supplies the dura mater; the tough, outer meningeal covering of the brain. Unlike the internal carotid artery, the external carotid gives off a number of branches in the neck. Close to the bifurcation, the superior thyroid artery branches from the external carotid. It travels in an antero-inferior direction as it descends to supply the thyroid gland. The superior laryngeal artery branches off the superior thyroid artery and supplies blood to the larynx. The superior thyroid artery also supplies blood to a number of neck muscles.

Another branch which arises close to the bifurcation is the ascending pharyngeal artery. It arises from the posterior aspect of the external carotid artery and courses upwards between the internal and external carotid arteries on the pharynx (throat), which it supplies. It also supplies blood to the deep prevertebral muscles and parts of the middle ear.

The next branch from the external carotid artery is the lingual artery, which arises close to the middle pharyngeal constrictor muscle. It supplies blood to parts of the tongue, and gives rise to the sublingual artery and the deep lingual artery. From its origin, it passes upwards and anteriorly. It travels deep to the hypoglossal nerve (the twelfth cranial nerve) for part of its course.

The facial artery is an anterior branch of the external carotid artery. It usually arises above the lingual artery, but in some people, these arteries share a common origin. The facial artery gives off two important branches in the neck; the ascending palatine artery and the tonsillar artery, which supply the tonsils, the soft palate and nearby structures. It then travels underneath muscles in the upper neck and lower jaw, and pierces the submandibular salivary gland, which it supplies. It travels along the floor of the mouth, giving off the submental artery. It then passes over the body of the mandible and enters the face, where it supplies the muscles of facial expression.

The occipital branch arises from the external carotid artery at almost the same level as the facial artery; except it arises from the posterior aspect. It courses posteriorly, crossing the anterior aspect of the internal carotid artery and courses close to the posterior belly of the digastric muscle for part of its course. It ascends towards the head and passes in a space between the transverse process of C1 and the mastoid process of the temporal bone. It gives off branches to the sternocleidomastoid muscle, the auricle, mastoid process and the occipital bone.

The next branch is the small posterior auricular artery. It ascends in a posterior direction and travels underneath the parotid salivary gland towards the ear, where it then passes between the external acoustic meatus, auricle of the ear and the mastoid process. It supplies the parotid gland, some muscles and the auricle.

The two terminal branches of the external carotid artery are the superficial temporal artery and the maxillary artery. The external artery travels to the parotid gland, where it bifurcates into the superficial temporal and maxillary arteries. From the parotid gland, the maxillary artery runs forward over the ramus of the mandible and enters a space known as the pterygopalatine fossa. The maxillary artery has a number of branches which supply deep facial structures. The superficial temporal artery ascends through the parotid gland and travels over the zygomatic arch and anterior to the auricle of the ear. It then divides into two branches, the frontal branch and the parietal branch.

Another important artery in the neck is the vertebral artery. The vertebral artery is a branch of the subclavian artery, which is the main artery to the upper limb. After branching from the subclavian artery, the vertebral artery travels upwards in a space between the scalene muscles and the longus capitis and longus colli muscles. It then enters the transverse foramen of C6 and then ascends through the transverse foramina of C6 all the way through to C1. From here, the vertebral artery passes through a groove on C1 and enters the cranium through the foramen magnum; through which the spinal cord passes. Once inside the cranium, the vertebral artery gives branches to the spinal cord, cerebellum and the medulla oblongata. At the pons of the brainstem, the two vertebral arteries unite to form the basilar artery, which supplies blood to the brain. The basilar artery is part of the Circle of Willis, which is an anastomosing network of vessels which ensure a constant blood supply to the brain.

Venous Anatomy

The largest vein in the neck is usually the internal jugular vein, which drains blood from the brain, neck muscles, face and organs of the neck. The internal jugular vein commences at the jugular foramen, and is the direct continuation of the sigmoid sinus, which is a large vein draining blood from the vein. The internal jugular vein then descends in the neck as part of the carotid sheath, where it lies laterally. It passes under the sternocleidomastoid muscle for part of its course. It unites with the subclavian vein to form the brachiocephalic vein. At the inferior end of the internal jugular vein there is a valve which prevents the retrograde flow of blood.

The drainage of other veins into the internal jugular vein is highly variable. Roughly at the level of the hyoid bone, the facial vein empties into the internal jugular vein. Prior to draining into the internal jugular vein, the facial vein often receives the superior thyroid vein and the lingual and sublingual vein. However, in other people, the lingual vein (which drains blood from the tongue) empties into the internal jugular vein at approximately the level where the lingual artery arises from the external carotid artery. A venous plexus exists on the wall of the pharynx, from which the pharyngeal vein emerges. The pharyngeal vein tends to empty into the internal jugular vein at approximately the level of the angle of the mandible. The internal jugular vein also receives the inferior and middle thyroid veins. The internal jugular vein terminates by uniting with the subclavian vein to form the brachiocephalic vein.

The other key vein in the neck is the external jugular vein. The external jugular vein forms close to the angle of the mandible and near the lowermost point of the auricle of the ear. It is formed by the union of the posterior auricular vein and the posterior division of the retromandibular vein. It passes diagonally across the sternocleidomastoid muscle. At the base of the neck, the external jugular vein receives the transverse cervical vein and the suprascapular vein. It also receives the anterior jugular vein, which begins usually at the level of the hyoid bone by the union of the superficial submandibular veins. It then descends quite superficially in the anterior neck and then travels laterally in the root of the neck to drain into the external jugular vein. The external jugular vein terminates by draining into the subclavian vein.

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Ear infection in children

Children get ear infections more frequently than adults do. Popular belief is that this is because children are more exposed to germs and bacteria, or because their immune systems have not built up the same tolerances that adults have. In fact, for the most part, both these beliefs are incorrect.

Children are more prone to ear infections because their Eustachian tubes are much smaller and almost completely horizontal. As we grow and develop, the Eustachian tubes elongate and become more angled allowing fluid to drain from the ear more easily. Due to this, fluid can be trapped in the middle ear more easily, allowing bacteria to breed and grow.

If your child experiences ear infections, ear grommets can be the most reliable treatment to help prevent future ear infections and other pediatric ear conditions. However, it can be difficult to discern when the right time is to schedule your child to have ear grommets inserted in their ears.

Ear Grommets

Ear grommets are tiny tubes that allow fluid to drain from the middle ear. During this very minor, minimally invasive surgery, the doctor will insert the grommets (or tubes) into tiny incisions in the eardrums. There is no need to have them removed, as they will slowly work themselves out and fall out of the ears when the eardrums heal. By this time, the Eustachian tubes have developed, and fluid can drain on their own.

Chronic Ear Infections

If your child only gets ear infections every now and then, and they do not last for very long, grommet surgery may not be required. Unfortunately, many children will suffer from multiple, seemingly chronic ear infections. While they will eventually grow out of this phase, it can be difficult for parents to watch their child in so much pain, repeatedly.

If your child is getting ear infections frequently, talk to your pediatrician about ear grommets. The surgery takes so little recovery time that children are often back in school or daycare the next day after the procedure, and they often feel much better without ear infections to deal with.

Glue Ear

If your child’s middle ear is filling up with a thick, glue-like substance instead of fluid, this is called glue ear. In addition to excess waxy buildup, you will notice that your child has trouble hearing normal conversational tones and sounds that you would otherwise expect them to easily notice.

Glue ear is not painful, but, as we said above, it does affect your child’s hearing, and it can affect their sense of equilibrium, as well. If you notice that your child is having balance problems, in addition to difficulty hearing, it is probably time for a trip to the pediatrician.

Your doctor may recommend a period of watchful waiting before doing anything else. Glue ear sometimes goes away on its own if you do not want to perform any unnecessary medical procedures on your child. If it does not go away though, it is probably time for ear grommets.

What to Expect After the Procedure

If you decide that it is time to get ear grommets inserted in your child’s ears, you should know what to expect. As we said, the procedure has very little recovery time. However, your child may perceive that sounds are louder than they were before for a few days after. This is just an adjustment period and is nothing to worry about. Ask your doctor if you have any other concerns before or after the procedure.

Children’s ear infection and the role for ear grommet placement

Acute otitis media or middle ear infection is the most common childhood bacterial infection and may affect up to 75% of children by the age of 5 years. Otitis media with effusion, also know as glue ear, is the collection of fluid in the middle ear space. This occurs due to the negative pressure produced by dysfunction of the Eustachian tube – the passage between the back of the nose, called the nasopharynx and middle ear.

The consequences of childhood middle ear infection may include hearing loss, perforation of the tympanic membrane, delay in speech and language development, balance problems and poor school performance. Whilst chronic ear disease may affect all children, Aboriginal and Torres Strait Islander children are at particular risk. In Australia, insertion of ear tubes, also called ear grommets will usually be recommended when a child has repeated middle ear infections, or has hearing loss caused by glue ear.

Ear grommet placement is most commonly needed from the age of one to three years.

The benefits of ear grommet placement may include

• Reduced risk of future ear infections.
• Restored hearing loss caused by middle ear fluid.
• Improvement in speech and language development.
• Improvement in balance, behaviour and school performance.
• Management of the complications of middle ear infection.

If you have concerns about your child’s hearing or problems with ear infection, contact your local doctor, who will arrange for you to see an Ear, Nose and Throat Surgeon.

For more information about ear grommet placement in children click here.

References

• Glue ear grommets and other operations
• Glue ear treatment
• Does our daughter need grommets
• Understanding otitis media basics

The post When a child needs ear grommets appeared first on ENT Clinic Sydney.

What Is Sinusitis?

Sinusitis or sinus infection is a painful condition which can disrupt our daily life. For some, a sinus infection is a temporary problem which will resolve itself after a week or so. However, for others it is a chronic issue with a multitude of symptoms. The sinuses are air-filled spaces within the bones of the face.

The sinuses, also know as, paranasal sinuses, are lined with mucous membranes and have a number of proposed functions including increasing the resonance of the voice, lightening the weight of the skull, humidifying the air we breathe as well as playing a role in our defence against pathogens and foreign substances. The sinuses also act as an airbag in an accident to protect the eyes from injury.

What Causes Sinusitis?

Sinusitis is a term that refers to inflammation and/or infection of the paranasal sinuses and their mucous membrane lining. Sinus infections affect the drainage of the sinus into the nasal cavity and can be acute or chronic in nature. Acute forms of sinus infection usually last around 7 to 10 days. Acute sinus infection is generally caused by an infection with a virus, especially following an upper respiratory tract infection, such as the common cold. Viral sinus infection tends to be of self-limiting nature and will generally resolve itself without the need for intervention.

Less commonly, acute sinusitis can be caused by a bacterial infection with an organism, such as streptococcus pneumoniae, which generally causes an upper respiratory tract infection. Bacterial forms of acute sinus infection tend to last longer than viral sinusitis and may require antibiotic treatment to resolve the infection. Less common causes of sinus infection include fungal infections, infection of the teeth and chemical irritants.

Chronic sinusitis is defined as sinus infection which is more than 3 months in duration. Chronic sinus infection has a number of different causes. It can be the result of a prolonged bacterial or fungal infection, an allergic reaction, or impaired drainage of the sinuses, such as with a deviated nasal septum, as the sinuses drain into the nose. Polyps may also be associated with chronic sinusitis, especially if the inflammation is of an allergic nature. The treatment of chronic sinusitis depends on the cause.

Bacterial infections may be resolved with antibiotics; however, some instances require surgery, such as with mechanical or structural drainage problems. More conservative techniques, such as nasal sprays and irrigation may also help patients who have chronic sinusitis.

Nasal Polyps

Nasal polyps are soft, growths of the lining of the sinuses. They look like grapes. They occur in around 1 in 200 people, mostly by the age of 40 years.

Nasal polyps do not always cause symptoms. As they usually grow through the tunnel that connects the sinuses to the nose, the result is often a blocked nose. More importantly, they can block the passages connecting the nose to the sinus cavities, which can lead to sinus infections.

The cause of nasal polyps is unknown, but inflammation in the sinuses, from allergy or infection, may trigger the growth of polyps.  Sometimes sinus and nasal polyps can occur in association with other medical conditions including asthma and allergy to aspirin.

Allergy as a risk factor for sinusitis

Allergy can cause chronic inflammation of the sinuses and mucosal linings. Sinus inflammation prevents the usual clearance of bacteria from the sinus cavity, increasing the chances of developing bacterial sinusitis. If you have allergies, your doctor can advise on appropriate management. Allergy treatment will reduce the risk of developing a sinus infection. Environmental irritants may increase symptoms. People with sinus problems and allergies should avoid environmental irritants such as tobacco, smoke and odours, which may increase symptoms.

Allergy occurs when a person’s immune system reacts to substances in the environment that are harmless for most people. These substances are known as allergens and are found in house dust mites, pets, pollen, insects, molds, foods and some medicines. A substance that is an allergen for one person may not be for another – everyone reacts differently. The likelihood or risk of developing allergies is increased if other family members suffer from allergy or asthma.

When a person who is allergic comes in contact with a particular allergen, an allergic reaction occurs. This begins when the allergen, for example, polle,  enters the body, triggering an antibody response. The antibodies attach themselves to special cells, called mast cells. When the pollen comes into contact with the antibodies, the mast cells respond by releasing certain substances, one of which is called histamine. When the release of histamine is due to an allergen, the resulting swelling and inflammation is extremely irritating and uncomfortable.

The most common causes of allergic reactions in Australia are:

• Animals including cats and other furry or hairy animals such as dogs, horses, rabbits and guinea pigs
• Dust mites
• Foods such as peanuts, cow’s milk, soy, seafood and eggs
• Insect stings
• Medications
• Molds
• Pollen

Depending on the allergen and where it enters your body, you may experience different symptoms. For example, pollen, when breathed in through the nose, usually causes symptoms in the nose, eyes, sinuses and throat, allergic rhinitis. Allergy to foods usually causes stomach or bowel problems, and may cause hives (urticaria).  Allergic reactions can also involve several parts of the body at the same time.

The Ears, Nose, Sinuses, Throat and Eyes

When allergens are breathed in, the release of histamine causes the lining of your nose to produce lots of mucus and to become swollen and inflamed. It causes your nose to run and itch and violent sneezing may occur. Your eyes may also start to water and you may get a sore throat.

Asthma can sometimes be triggered during an allergic reaction. When an allergen is breathed in, the lining of the passages in the lungs swells and makes breathing difficult. Not all asthma is caused by allergy, but in many cases allergy plays a part.

Most allergic reactions are mild to moderate, and do not cause major problems, even though for many people they may be a source of extreme irritation and discomfort. However, a small number of people may experience a severe allergic reaction called anaphylaxis. It is a serious condition which requires immediate life saving medication.

Some of the more frequent allergens which may cause this are peanuts, shellfish, insect stings and drugs. If you know that you have a very severe allergy, you should have an Anaphylaxis Management Plan from your doctor, which should include an ASCIA action plan for anaphylaxis.  These are available from the ASCIA website.

Allergy Management

Effective prevention and treatment options are available. Allergen avoidance, or reduction, relies on identifying the cause of your allergy and then taking steps to reduce your exposure to the allergen. For instance, many people are allergic to dust mites, therefore reducing dust mite in the house is important.

Medications used to treat allergies include:

Antihistamines – these block histamine release from mast cells, thereby reducing many irritating and uncomfortable symptoms. Non-sedating antihistamine tablets rarely cause drowsiness and are available from pharmacies without a prescription. Antihistamine nasal and eye sprays can also be used.

Intranasal cortiocosteroid nasal sprays (INCS) – are very effective for treatment of moderate to severe allergic rhinitis (hay fever) when used appropriately and regularly. A prescription may be required for stronger dose INCS. Ask your pharmacist or doctor for advice.

Medicated eye drops – ask your doctor for advice.

Non-medicated treatments – such as saline sinus rinses and sprays are used for treating allergic rhinitis and sinusitis.

Allergen specific immunotherapy – also known as desensitisation immunotherapy, is a long-term treatment which changes the immune system’s response to allergens. It involves the administration of regular, gradually increasing amounts of allergen extracts, by injections or sublingual drops.

Adrenaline – is used for first aid emergency treatment of life threatening severe allergic reactions (anaphylaxis). Adrenaline is usually given using an adrenaline autoinjector and this can be given without any medical training.

Symptoms of Sinusitis

There are a range of symptoms associated with sinus infection. Pain, headache and feelings of increased pressure in the region of the affected sinus are common presentations of sinus infection. Many people also notice a blocked nose and production of mucus, which may be associated with post-nasal drip, which is a feeling of mucus running down the back of the throat.

Sinus infections can impair our ability to taste foods and our sense of smell. It can also be associated with pain in the teeth and bad breath. Fever and feeling run-down or unwell can also be associated with the condition. Smoking and exposure to other chemical irritants can predispose to sinus infection.

Common signs and symptoms of chronic sinusitis with nasal polyps include:

• A runny nose
• A sense of pressure over your forehead and face
• Decreased or loss of sense of smell
• Facial pain or headache
• Loss of taste
• Pain in the upper teeth
• Persistent nasal congestion
• Postnasal drip
• Snoring

Sinusitis Treatment

Sinusitis is a common condition of varying cause and duration. There are a range of treatment options available. The most appropriate method depends on the cause and severity of the condition. It is important to treat the underlying problems, such as allergy.

Examples of treatments for sinusitis include:

Steam inhalations – use a bowl of hot water with a towel over your head. This will help to thin the mucus and make it easier to drain

Salt water irrigation of the nose – use a sinus rinse bottle filled with saline, bought commercially or made with water, salt and baking soda/sodium bicarbonate – allow to cool before using. Whichever preparation is used, it is important to tilt your head forward, to the right for 10 seconds and then to the left for 10 seconds. This will assist in nasal drainage. For more information on sinus irrigation click here.

Antibiotics – if symptoms persist, appropriate antibiotics should be prescribed for an adequate duration. Often around 10-14 days treatment for acute sinusitis and 3-4 weeks treatment for chronic sinusitis.

Endoscopic Sinus Surgery – in patients with persistent disease, despite medical treatment, surgical removal of diseased sinus tissue, polyps and opening of sinus drainage passages may be required. For more informaton about nose and sinus surgery click here.

If you have questions about sinusitis contact your local doctor who will arrange for you see an ear nose throat surgeon.

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If your child has a sore throat, your first impulse is probably to pack them up and head directly to the ear, nose, and throat (ENT) surgeon. Hold on just a moment, though. A sore throat could be Strep throat, but it could also be a symptom of a cold or sinus infection. Before you make an appointment with your Local Doctor or Paediatrician, look for other symptoms and see if this is just a viral infection that can be treated with rest and lots of fluids or whether it’s time to see the doctor.

Seeing a Doctor for a sore throat in children

Sore throats can be caused by viral infections, such as a cold or cough. Your child may experience a sore throat toward the end of suffering from a cold or an allergic reaction. This happens when the sinuses are draining, and your child has swallowed a lot of mucous over a period of a few days.

If a sore throat occurs in conjunction with a cold or cough, and there is no fever, you will probably not be helping your child out with a trip to the doctor. Instead, it is time to put them to bed and make sure they drink a lot of fluid. You might want to get a humidifier for their room for this time to moisten the air they breathe as they sleep.

If your child is old enough, throat lozenges can help relieve a sore throat. Generally, if your child is 4 years old or older, you should be able to give them a throat lozenge without any problem.

Making an appointment with an ENT Surgeon

If the sore throat seems to come out of nowhere, especially if your child has a fever, make an appointment to see your Local Doctor or Paediatrician. Other signs that a sore throat is probably a bacterial infection that needs treatment (with antibiotics) include:

• A rash on the chest and/or back
• Neck pain
• Swollen lymph nodes
• Difficulty maintaining hydration
• Headache and stomach ache

If your child exhibits any or all of these symptoms, they may have Strep throat, which will not go away on its own. Untreated, Strep throat can develop into rheumatic fever, which can be dangerous. Fortunately, it can be treated with a simple round of antibiotics.

After the Doctor’s Visit

Your child will no longer be contagious after about 24 hours of taking antibiotics as directed, so you won’t have to worry about anyone else in the family catching Strep throat from them after this time.

To ensure that your child heals and recovers properly, make sure that they take the full course of antibiotics your doctor prescribes. Your child might start to feel better before all of the medication is gone, but if you stop medication at this point, you are risking a recurrence of infection down the road.

Until your child feels better, be sure to give them plenty of fluids and that they get lots of rest. Do not worry if they don’t eat a lot while they’re feeling sick, as Strep throat and other bacterial throat infections can make swallowing very painful. Feed them soft foods and allow a light diet, with lots of water, vitamin-rich juices, and milk to supplement their diet until they feel well enough to eat again.

Most importantly, pay attention to your child’s symptoms. If they persist past the regimen of antibiotics, make another appointment with your specialist to see if further treatment is necessary.

If you have questions or concerns about ear surgery contact your local doctor, who will arrange for you to see an Ear Nose Throat Surgeon.

References

• Sore Throat in Children – Group Health Cooperative
• Sore Throat | Ask Dr Sears®
• How to treat your childs sore throat – Banner Health
• Soothing Your Child’s Cold – WebMD
• Sore throat | kidshealth

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About Turbinate Reduction Surgery

The nasal turbinates are bony structures inside the nose that are covered by a mucous membrane lining, and have a rich blood supply. There are three nasal turbinates; an inferior, middle and superior turbinate. These structures are important because they act to humidify and heat the air we breathe and help to filter out dust particles and bacteria. They are also involved in our sense of smell (olfaction). The superior turbinates in particular, are covered by olfactory epithelium, which contain many tiny olfactory nerves and receptors which detect odours.

The turbinates swell and change size throughout the course of the day as part of their normal function (1). However, the turbinates can become enlarged and cause obstruction of the nasal cavity, this can interfere with breathing and cause feelings of congestion and nasal stuffiness. The enlargement can occur in both sides of the nose, or only in one side of the nose (2). If the obstruction becomes chronic this can lead to several other problems, such as sleep disturbances, dryness of the mouth and throat, nasal speech, fatigue, reduced lung volume and generally feeling lethargic and unwell (3).

There are a number of reasons as to why the turbinates can become enlarged, including:

• Hayfever and allergies
• Chronic sinus infections
• Deviated nasal septum
• Exposure to irritants including chemicals and cigarette smoke
• Colds and other respiratory tract infections
• Medications and hormones

Some of these factors only cause temporary enlargement of the turbinates, such as a cold, where they will return to their normal size once the cause is no longer present. In other cases, the enlargement is permanent. Initially, enlarged turbinates are treated with medications, such as nasal sprays and decongestant tablets. If these treatments fail to improve symptoms over an appropriate period, surgery may be indicated (3). In some individuals, long-term use of decongestant sprays can worsen the turbinate enlargement.

Surgery for enlarged turbinates is performed through the nostrils with no external incisions. Excessive tissue is removed to open up the nasal passages, this improves airflow through the nose and reduces feelings of congestion and stuffiness. The inferior turbinate is most commonly operated on. There are several different surgical procedures which can be performed on the enlarged turbinate, depending on the severity and the type of tissue which is enlarged (bone, soft tissue or both). However, surgical removal of the entire turbinate is not routinely recommended (turbinectomy) as there may be significant complications that can occur with this procedure. One such complication is ‘empty nose’ syndrome, where despite having the turbinate entirely or partially removed and the nasal passage widened, there is a persistent feeling of a blocked nose and feelings of dryness within the nose (1). Other complications following turbinate reduction surgery include bleeding, nasal dryness, crusting and atrophic rhinitis (3).

In addition, turbinate reduction surgery can help to improve breathing problems. Patients with sleep apnoea and nasal obstruction demonstrate some improvement after procedures such as turbinate reduction to alleviate obstruction of the nasal passages (4). There are numerous surgical techniques for reducing the turbinates, and each method has a different long-term outcome rate, and varying risks of complications (3). In the setting of chronic obstruction not relieved by medications and nasal sprays, surgery is indicated to improve breathing through the nose and to improve quality of life for the patient (5).

If you have questions about turbine reduction surgery or other solution a for how to improve breathing contact your local doctor who will arrange for you to see an ear nose throat specialist.

For more information about turbinate reduction or turbinoplasty surgery click here.

References

(1) Scheithauer, M. O. Surgery of the turbinates and “empty nose” syndrome. GMS Current topics in Otorhinolaryngology – Head and Neck Surgery, 2010; 9:1-28

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What Are Grommets

Grommets are small plastic tubes that are inserted into a child’s eardrum (tympanic membrane). Grommets are often used for children who suffer from persistent middle ear infections (chronic otitis media) in order to limit complications and improve hearing.

Otitis Media and Glue Ear

The ear cavity is normally filled with air, a property that is important for hearing. In otitis media, the middle ear cavity becomes infected, filling with fluid and/or pus – affecting hearing and development. The pus and fluid also put pressure on the eardrum, which may cause it to rupture. It is normal for young children to occasionally have ear infections. If a child has three or more episodes of otitis media in a six-month period, a diagnosis of chronic acute otitis media is made and may be an indication for insertion of grommets.

Another type of otitis media is otitis media with effusion, or glue ear. In this type of infection, the collection of fluid that remains after a period of weeks or months will become thick. The thick, glue-like fluid can interfere with a child’s hearing. If glue ear does not respond to other treatments or persists for an extended period of time (three-six months), the insertion of grommets may help. Otitis media can affect a child’s hearing. Hearing loss in children can adversely affect social, emotional and intellectual development, and hence, the insertion of grommets may help to reduce the impacts of hearing loss on developmental delay.

What do grommets do?

Grommets help to drain the fluid which builds up in the middle ear cavity. By draining the pus and/or fluid, the pressure in the middle ear cavity is reduced, alleviating the strain on the ear drum and improving hearing.

What is involved in the procedure?

Grommets can be inserted under local or general anaesthesia. For young children, who most commonly require grommets, the procedure is commonly performed under a general anaesthetic. This is because the patient needs to remain still during the procedure, as there is a risk of damage if the patient moves suddenly.

In most cases, there isn’t a need for surgical removal of the grommet. Eventually, the grommet will fall out of its own accord at some point. Some grommets can last up to about 4 years, whereas others will fall out anywhere between six months and two years following the initial insertion. Generally, the ear drum will heal by itself and close the tiny hole left by the grommet.

Complications

One of the main problems which can occur after the grommet has fallen out is a persistent hole in the ear drum. If the ear drum does not heal properly, another operation may be necessary to repair the hole remaining in the ear drum. Sometimes the ear drum may be affected by scarring or be thinner than normal after grommets are inserted. In most cases, this doesn’t affect hearing but may mean that the ear drum is at an increased risk of perforation. As with all surgical procedures, there is a risk of developing infection after the operation. Bleeding may also occur after surgery.

If the grommets fall out too early and otitis media is still a problem, it may be necessary to undergo a second operation to re-insert the grommets. In some cases, there may be another cause for hearing problems in the child in the middle ear or elsewhere, and the grommets may not result in hearing improvement. Once the problem is identified, the appropriate management can be implemented.

If you have any questions about grommets talk to your local doctor who will arrange for you to see an ear nose throat specialist.

For more information see our article about ear grommets.

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