Paediatric ENT

Paediatric refers to the treatment of children, ENT means concerning the ear, nose and throat. The three make up a combined system, so it is rational to treat them as a whole.

Even as problems might be specific to just one part of one of them. It is also possible to put this more formally, otorhinolaryngology for children, but that's just stringing together the Greek for ENT. It is usual to split paediatric ENT into two, children under the age of three being treated in certain specifically equipped facilities.

While the systems of the ear, nose and throat are connected and thus studied as the one system problems can be specific. A punctured eardrum is a different problem from tonsillitis, and they are of course treated entirely differently.

Likely problems to be treated in paediatric ENT are recurrent tonsillitis, snoring and sleep disturbance, hearing loss, otitis – this being a general term for inflammation in the ear, glue ear is a type of this – holes in the eardrum and so on.

Treatments can range from endoscopic repair of such eardrum holes to the insertion of grommets for the glue ear to tonsillectomy and in general the relevant response to the underlying problem.

Children are prey to innumerable infections and little development problems. The function of much of the ENT complex – tonsils and adenoids especially – is to act as a filter, a preventative, against those infections.

The immune system is there to protect against the outside environment, but the process of priming and developing it can be messy and imperfect. There are, often enough, repeated problems for children with parts of the ENT system. Any of these should be investigated.

The most important requirement is to recall that children are, by definition, developing. Therefore, early identification of a problem and its treatment is vital. Take, for example, hearing problems. If these persist untreated, then the child may well miss out on years of vital development of verbal fluency, something that is never really caught up with.

A specific problem may be necessary to treat. The time taken to treat it is important, though, for the knock on effects upon childhood itself must also be minimised.

Repeated infections in either ears or tonsils are a prime candidate for ENT treatment. So too breathing or sleep problems, including apnoea.

Paediatric ENT treatment is dual in nature. There is the diagnostic phase, which investigates what is the specific problem. Then the treatment stage, where that can be treated. Some part of this will generally be done by a GP, some parts will require a paediatric ENT consultant.

The diagnostic stage will often work better when it is consultant led. Consistency of care, the greater experience of the specialist in paediatric ENT, mean that the exploration of the cause of the problem can often work better.

The process will involve investigating the clinical story, taking a full clinical history. The experienced consultant will arrive at the diagnosis quicker than a generalist. This enables the movement to the treatment stage to be accelerated.

This shortens the entire process, with that gain to the child's ongoing development. It is also necessary for the child to buy into the treatment, something aided by that consistency of care. The specific treatment will depend upon the underlying cause identified. Otitis, for example, is a condition, inflammation of the ear.

This can be as a result of infection, but there are other causes. Infection will be treated with antibiotics. But adhesive otitis – better known as glue ear – will likely require the insertion of a grommet to drain the middle ear. The diagnostic stage enables the differentiation to be made and thus the correct treatment applied.

Repeated infection of the tonsils might well indicate the necessity for a tonsillectomy. A hole in an eardrum needs to be repaired. The traditional treatment involves incisions to do this, the more modern technique is endoscopic – similar to but not exactly the same as keyhole surgery. This causes less damage that then needs to be recovered from.

The recovery time depends upon the specific treatment decided upon, that in turn dependent upon the diagnostic process. Most treatments are carried out under general anaesthetic and are therefore done in hospital.

Return home that day is normal for most treatments, although not for a tonsillectomy, that's usually next day. Any form of surgery will have some bruising, stitches or other minor issues that have a recovery time.

These are generally reduced in children as compared to adults. After that, it depends upon the specifics of the treatment. A tonsillectomy takes between 10 days and two weeks to fully recover from. So to the removal of adenoids, an adenoidectomy.

Grommet insertion might lead to a day or two of mild ooze or bleeding from the ear, but little more. On the other hand, the child's growth will – naturally, and this is intended – push the grommet out over time, in perhaps 6 to 12 months.

That could be described as the full recovery time. Tympanoplasty, the repair of an eardrum, might take 8 weeks to recover from – this period being substantially reduced by using endoscopic surgery.

All surgery carries some risk, and paediatric ENT treatments are no different. There are risks of bleeding, bruising, and any invasive procedure can lead to nerve damage. These risks are either manageable or rare.

The biggest risk in paediatric ENT treatment is the same as with any other paediatric treatment – delay. It can take some years for the usual system to deal with certain problems. This is, given their age, a significant part of a child's life. This is also a significant portion of the development process.

Often enough, time lost here is never made up again. Continued hearing loss for an extended period of time can, for example, lead to speech and verbalisation problems. Simply because the usual feedback system is not in place during that developmental period.

Equally, repeated tonsil infections can lead to a significant loss of schooling and other education. Delay in treating the underlying problem can – will perhaps – have knock on effects on other parts of the child's life.

There are risks to any form of medical treatment, and it is the balance of those as against the risks of no treatment that matters. With paediatric treatments, it is necessary to add the risks of time passing in childhood to the calculations of that balance.

Earlier treatment without hindrances and hold-ups reduces those effects of developmental setbacks.