What are adenoids?
Adenoids are lymphoid tissue in the nasopharynx region, which, like the tonsils, function as a filter, and usually shrink by the age of 10 years.
How do they affect the ears?
The orifices of two tubes, called the Eustachian tubes, which significantly regulate the operation of the ear, are located next to the adenoids. When the nasal adenoids are very large or frequently lead to inflammations, the ears are greatly affected.
What symptoms do adenoids cause in children or adults?
They can cause symptoms such as:
- pain (acute otitis media)
- hearing impairment (secretory otitis)
- heavy breathing
- easy fatigue
- snoring
- apnoea (breathing interruptions)
When should children be examined by an ENT Surgeon?
Children presenting often the above specific symptoms need to be monitored, apart from the paediatrician, by a surgeon otolaryngologist too.
In this way, surgeons can decide whether and when there is an indication for surgery.
What does adenoid removal and potential placement of eardrum drain tubes imply?
It is an operation performed under general anaesthesia and through the mouth, without incisions. The incision is made with a microscope and the surgeon decides, depending on the findings, whether to place a drain tube in the eardrum. Hospitalisation lasts 24 hours, while the possible complications include the intraoperative or postoperative bleeding, which is controlled.
The drain tube falls out on its own within about a year and during this period time water ingress in the child’s ears should be avoided. The only caution to be taken for a child with drain tubes, is to avoid the contact of ears with water.
Introducing otitis
Otitis externa
What is otitis externa
Otitis externa is an inflammation of the external auditory meatus with oedema, otorrhoea, redness, severe ear pain and itching.
What can it be due to?
It is usually caused by an injury (use of cotton swabs or other foreign body). Other predisposing factors are the narrow external auditory meatus and dermatological diseases (eczema, seborrheic dermatitis).
How is it treated?
The treatment includes 1)cleaning of the external auditory meatus 2)administration of topical antibiotic drops 3)avoidance of moisture.
Acute otitis media
What is acute otitis media
Acute otitis media (AOM) is an inflammation of the middle ear that is characterized by the presence of pus in the tympanic cavity with swelling of the tympanic membrane.
What are the potential symptoms?
Earache, conductive hearing loss, fever and +/- otorrhea. It is very common in infancy and early childhood.
What can it be due to?
Predisposing factors are respiratory infections (especially in winter), kindergarten -where there are many children with different viruses, non-breastfeeding -because breast milk contains antibodies necessary for babies – and smoking. Other factors are genetic, immunodeficiency and congenital anomalies (cleft palate).
The AOM is initially caused by a viral infection of common viruses (respiratory syncytial virus, influenza, parainfluenza virus) and is then contaminated by bacteria (Strept. Pneumoniae, Haemophillus Inlf.,Moraxella Catar.).
How is it treated?
Antibiotics are immediately administered to children under two years old to avoid possible complications (mastoiditis, meningitis, epidural or brain abscess), while in older children we should wait for two days and administer antibiotics only in there is no improvement.
Secretory otitis
What is secretory otitis
Secretory otitis is the relatively asymptomatic presence of fluid in the middle ear, without signs or symptoms of acute inflammation such as in acute otitis media. It is very common in children aged 2 to 5 years, decreases with age and is the most common cause of hearing loss in children.
What can it be due to?
The exact aetiopathogenesis of secretory otitis is unclear. It often follows an episode of acute otitis media, while it may also develop without prior acute otitis media, by a chronic bacterial antigenic stimulus.
What are the potential symptoms?
Secretory otitis occurs with hearing loss, sense of fullness in the ears, feeling, autophony, tinnitus, squeaky sound in the ear when swallowing, yawning or sneezing. Coexisting imbalance may be noted in chronic cases.
Children are usually asymptomatic and it is discovered either by their teachers who notice that the child cannot hear well or has a delay in speech development or accidentally during clinical examination.
How is it treated?
It is initially treated with conservative treatment with the Valsalva manoeuvre and in children, with insufflation devices with balloons or by chewing gums. Usually it automatically resolves within 3 months. If not resolved and the hearing loss is> 40 dB surgical intervention is required to restore hearing (delay of speech in children) with incision of the tympanic membrane and placement of eardrum drain tubes to provide adequate ventilation in the middle ear and adenoidectomy.
In adults the oropharynx should also be examined, either by posterior rhinoscopy or CT scan to exclude the presence of a mass.
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