In any medical examination, patients have a feeling of fear, as they are essentially exposed, are laid – literally and metaphorically – bare. This is because during thorough history-taking – which is a key element of the examination – they are called to reveal a lot of personal information, beyond the symptoms of the condition that led them to the clinic. So imagine how much more stress this process causes to a child.
Children are a special population group. Thus, the doctor’s communication with the child should take place in a context that combines immediacy, a warm and friendly attitude and playing as the main approach, in a pleasant and familiar environment.
The correct approach to a child ensures its trust and cooperation, often to a greater extent than with an adult. Furthermore, the correct method of examining a child and its familiarisation with the clinic creates excellent future patients, willing to cooperate with their doctor.
Common Otolaryngology Problems
Otitis in children
Children can present ENT problems as early as infancy or early childhood. Regarding the ears, a very common condition is otitis. Because of their anatomy, which is different to that of adults and especially because of the position of their Eustachian tube, children are predisposed to viral or bacterial infections in the middle ear.
The Eustachian tube is a “tube” connecting the ear to the nasopharynx and allows the proper ventilation of the ear and the removal of secretions. In children, its position is more horizontal than in adults, so, in the event of infections, mucus and secretions are harder to remove, “stagnate” in the middle ear and lead to otitis, which may be secretory or acute otitis media.
Another important factor contributing to the appearance of otitis and of upper respiratory system infections in general is going to kindergarten. Children come into contact with other children suffering from various viral infections; this age group presents numerous and easily relapsing viral infections because the children’s immune system is not fully developed and does not provide adequate defence against pathogens.
Therefore, otitis is one of the most frequent childhood infections. Early diagnosis and treatment are very important in order to avoid possible complications. Another important reason is that hearing properly in these age groups is a determining factor in the development of speech.
Another organ that very often presents problems in children is adenoids. Their inflammation can lead to inflammation of all neighbouring organs, such as the ears, nose, maxillary sinuses, tonsils and lower respiratory tract. Furthermore, often, while the adenoids may not be inflamed, their large size may lead to heavy snoring, or even apnoea, with all the known consequences for the child’s overall development.
Tonsillectomy in children
Another common problem in children is tonsillitis, which may be of bacterial or viral origin and is usually associated with tonsil hypertrophy. Recurrent tonsillitis is an indication for surgery, as is hypertrophy, since it prevents the child from breathing normally, causes sleep apnoea, especially if combined with adenoid hypertrophy, and, in general, impedes the child’s normal development.
There are many views on whether tonsils should be removed in childhood. In any case, the decision is individualised, taking into account the child’s overall medical history.
When should they be removed?
1.When the tonsils are very large and cause trouble in breathing or cause snoring
2.When a child frequently suffers from tonsillitis with fever
3.When there is a high ASTO value, indicating streptococcus in the blood. If it is high, it can also affect other organs
The surgery is performed under general anaesthesia and bleeding is minimal. The new tonsillectomy methods, using radio frequencies, help in this.
Paediatric rhinitis and sinusitis
Very often, sinusitis is not diagnosed in time in children, as its symptoms are almost identical to those of a common cold (obstruction, runny nose and cough, or exacerbation of allergic rhinitis). Today, thanks to endoscopic testing, after a simple preparation of the nose, we can have a full diagnosis regarding the maxillary sinuses, the adenoids and the entire upper respiratory tract easily and painlessly at the clinic.
From the moment that parents observe problems such as fever, pain in the ears, continuous sore throat, tonsillitis or atypical symptoms such as cough, easy fatigue and dizziness, it is necessary to contact an otolaryngologist along with the paediatrician. This will allow a complete diagnosis, always followed by a targeted and effective – conservative or surgical – treatment.
Choanal atresia is a rare congenital anomaly that occurs in 1:5000-8000 births. It may be unilateral or bilateral and is twice as common in girls than in boys. Bilateral atresia is incompatible with life, as neonates are obligate nasal breathers. The patients present marked difficulty in nasal breathing and continuous unilateral nasal secretions. It is treated with endoscopic surgery.