By A/Prof George Sim, Paediatric ENT Surgeon, Murdoch
Childhood upper respiratory tract infections (URTIs), especially common over the winter months, include colds, croup, bronchiolitis and pneumonia.
These infections are often viral in origin and self-limiting with supporting measures like analgesia, adequate fluid rehydration and rest. We reduce the spread of respiratory infections by handwashing, covering coughs and sneezes, face masks, limiting contact when sick and vaccinations.
However, some children will develop ENT related infections like ear infections, chronic nasal congestion and sore throats/tonsillitis. Chronic or recurrent ENT infections will affect the health of these children and their quality of life, such as missing time at school, frequent GP visits and antibiotics.
Ear infections
Otitis media (OM) can often arise in children who are frequently sick with upper respiratory issues. OM is one of the most common reasons why younger children present to GPs.
Approximately 75% of children have at least one episode of OM by school age. OM can be acute otitis media (AOM) or otitis media with effusion (OME).
AOM causes pain, fever, irritability and occasionally perforation. Initial management is symptomatic relief with analgesia and an oral antibiotic may be required if symptoms persist.
Symptoms may take one to two weeks to resolve. Recurring middle ear infections of three episodes or more in six months may warrant further assessment.
OME or ‘glue ear’ is accumulation of middle ear fluid. The fluid can be thick, hence the term glue ear. Children with glue ears have less obvious symptoms compared to AOM. Hearing loss, speech delay, learning difficulties at school and imbalance can be associated with the condition.
They may also cause mild earaches that can keep the child awake. Some younger children will pull or poke at their ears frequently as a result.
Predisposing factors include day-care attendance, frequent URTIs, exposure to cigarette smoke, bottle feeding and use of pacifiers.
Very often the care of a paediatric ear, nose and throat surgeon will be involved in children with recurrent middle ear infections. A hearing test, including an audiology and tympanometry, is usually part of the ENT assessment.
Surgery such as grommet insertion and/or adenoidectomy may be recommended.
Sore throats
Sore throats can be viral or bacterial in origin. Treatment starts with symptomatic relief with analgesia, adequate fluid rehydration and rest.
Sometimes bacteria tonsillitis occurs and needs antibiotic treatment.
Symptoms of tonsillitis can include sore throat, difficulty swallowing, halitosis, fever and cervical lymphadenopathy. If a child has recurrent tonsillitis, there are guidelines as to the frequency of tonsillitis to warrant an ENT referral.
RELATED: Unified airway disease: the role for ENT
There should also be considerations for other factors such as frequency of antibiotics, time off school and time taken off work by parents to look after their child.
Our GPs are generally an expert in ENT issues in children. However, for some children who are chronically unwell or going through frequent cycles of illnesses, a paediatric ENT assessment may be considered in their overall care.
Rhinitis/sinusitis
An URTI can cause nasal congestion and runny noses with inflamed nasal linings causing rhinitis. This often has an allergy component as well (allergic rhinitis).
Sinusitis is not common in younger children as their sinuses are usually not fully developed. Symptoms of sinusitis may include nasal congestion, discoloured nasal discharge, pyrexia, postnasal drip/cough and pain in the facial/cheek areas.
Children with allergies and large adenoids may be more prone to sinusitis. Treatment includes analgesia, saline nasal sprays/flushes, antibiotics and possibly surgery.
Snoring and sleep obstruction
Children with enlarged adenoid and/or tonsils can frequently be nasally congested with a runny nose, postnasal drip and cough. These children appear sick all the time and may have associated obstructive sleep symptoms.
RELATED: Precision medicine in paediatric ENT disorders
Obstructive sleep disorder (OSD) is a range of presenting symptoms from heavy breathing/snoring to sleep apnoea. Symptoms include mouth breathing, sleeping in unusual positions, nightmares/night terrors, bedwetting, waking up tired and also daytime issues with behaviour or concentration.
Some children can have difficulty with swallowing certain foods. The presenting symptoms vary according to the severity and also age of presentation. OSD symptoms are very often made worse in children with frequent URTIs.
Enlarged tonsils and/or adenoids are usually the main causes of OSD in children. A comprehensive history to explore symptoms with parents and a detailed examination usually suffices for diagnosis. Treatment for OSD often results in surgical intervention.
Author competing interests – nil
Key messages
- Up to 75% of children will have otitis media by school age
- Sinusitis is uncommon in children
- Obstructive sleep apnoea in children is usually due to enlarged adenoids/tonsils. Surgery is often required.
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