Rhinitis (Sensitive nose)
What is Rhinitis (Sensitive nose)?
Frequent clear runny nose, blocked nose, sneezing and itchy eyes? Chances are your child is likely suffering from Rhinitis (sensitive nose) Rhinitis is inflammation of the nasal cavity. Majority of the time, Rhinitis is allergic when it is triggered by exposure to a substance known as allergen (most commonly House Dust Mites). Sometimes, Rhinitis is non-allergic and can be triggered by cigarette smoke, temperature changes, strong odors, hormonal changes and dietary factors.
Rhinitis is diagnosed based on a combination of clinical history, physical examination and occasionally in children, a flexbile nasoendoscopy. In some children, a skin prick test or blood tests may be performed to better understand the reason for the sensitive nose.
Majority of the time, Rhinitis can be treated medically with a combination of allergen or “trigger avoidance” (if possible), nasal steroid sprays (Figure 1) and antihistamines. In suitable children with Allergic Rhinitis, immunotherapy (often called “Allergy Shots”) to desensitize the patient to the allergen may be indicated. If your child continues to suffer from persistent or troublesome blocked nose despite maximal medical treatment, procedures to reduce the size of the inferior turbinate may be indicated (see section on “Inferior Turbinate Hypertrophy”)
What is an Impacted earwax?
Earwax in small amounts is good for the ear. It protects the ear by gathering dead skin, hair and dirt as it moves from the inside of the ear outwards. Hence it is a natural cleanser for the ear. It also has antibacterial and antifungal properties. Earwax will move out of the ear on its own as we chew or talk. The jaw is located below the ear canal and movement of the jaw will help move the wax outwards.
However, sometimes, earwax can block up the ear canal. Earwax buildup (Figure 1a-d) that fails to clear on its own is usually due to these reasons:
- Ear digging with a cotton bud or an ear pick
- Excessive earwax production
- Dry skin in the ear canal
- Small ear canal
- Frequent wearing of hearing aid or ear plugs
Many people have the habit of cleaning the ear canal with a cotton bud. This should not be done. The cotton bud is designed to clean or dry up fluid outside the ear canal (Figure 2a). It is not meant to be inserted into the ear canal (Figure 2b). The cotton bud is too big for the ear canal and insertion into the ear canal will only push the earwax and debris deeper against the ear drum. When this happen, the earwax will be jam-packed against the ear drum (Figure 3a) and the self-cleansing mechanism of the ear will fail. In some cases, patients may scratch the lining of the ear canal resulting in an ear infection, puncture the ear drum (Figure 3b) or even have the tip of the cotton bud stuck in the ear canal.
If you have an impacted ear wax, you may have decreased hearing level in that ear, ear discomfort or pain or a secondary ear infection. You should get your ear examined by a doctor and you may benefit from removal of ear wax under microscope guidance.
What is Hearing loss?
Normal hearing is especially important in children for normal speech and language development. Hence, if there is any suspicion of hearing loss or signs of speech and language delay in children, early assessment and intervention is of paramount importance.
The ear can be divided into outer, middle and inner ear. The cause of hearing loss can be broadly divided into conductive or sensorineural causes (Figure 1).
Conductive hearing loss is due to a problem with sound reaching the inner ear. Most of the time, conductive hearing loss is reversible. Hearing is usually restored when the cause is successfully treated. Some of the common causes of conductive hearing loss include:
- Impacted ear wax
- Ear infections
- Fluid in the middle ear (Figure 2)
- Foreign body in the ear canal
- Hardening or stiffening of the hearing bones
Sensorineural hearing loss is due to a problem with the inner ear structures (cochlea – which is the hearing organ or vestibular nerve – which is the hearing nerve). Unfortunately, most of the time, sensorineural hearing loss is permanent or irreversible. If the hearing loss is significant, these children usually require a hearing aid (conventional or implantable). Some of the common cause of sensorineural hearing loss include:
- Genetic causes
- Regular and prolonged exposure to loud noises
- Viral infection of the inner ear structures (labyrinthitis)
- Certain medications (ototoxic drugs)
For assessment of hearing loss, your ENT Specialist will take a full clinical history, conduct a physical examination and likely perform a hearing test (audiometry). The management of hearing loss depends on the cause of hearing loss.
What are Ear infections?
Otitis externa is infection and inflammation of the ear canal (Figure 1a&b) . This occurs more often in patients who dig their ears frequently and in regular swimmers. These patients usually experience ear pain, ear discharge and sometimes hearing loss. Treatment includes cleaning of the ear (aural toilet under microscope guidance), antibiotics ear drops and keeping the ear dry till the infection resolves. Sometimes, the infection may start off from an infected hair follicle, like a pimple or boil on the skin (Figure 2a&b) .
Middle ear infections (Otitis media) are more common in children due to their immature Eustachian tube (the tube that connects the middle ear to the back of the nose) and in adults with Eustachian tube dysfunction. Eustachian tube dysfunction results in inadequate ventilation of the middle ear. Patients with middle ear infection usually experience ear blockage, ear pain and occasionally, ear discharge (if there is a hole in the ear drum). In children, they may also have fever, become restless or agitated and have significant hearing loss that may affect their speech and language development. The hearing loss is usually due to accumulation of fluid behind the ear drum (otitis media with effusion – Figure 3a). Most middle ear infections settle with a course of antibiotics and treatment of the nose if required. In patients with fluid behind the ear drum that does not resolve after a period of watchful waiting or after a course of antibiotics, a grommet tube can be placed in the ear drum to drain the fluid (Figure 3b).
Frequent tonsil Infections (Recurrent tonsillitis)
What is Frequent tonsil Infections (Recurrent tonsillitis)?
Tonsils are two oval-shaped cluster of tissues located at the back of your throat (left tonsil and right tonsil)(Figure 1).They are part of your immune system that protects you against infection and illness. Although the tonsils are part of your immune system, they play a very small part. Other parts of the immune system such as the lymphatic system, bone marrow, spleen and thymus are the main parts of the immune system.
Tonsillitis is an infection of the tonsils (Figure 2). Children with tonsillitis will experience severe sorethroat, painful swallowing and fever. During an active infection, the tonsils are swollen, inflamed and may have patches of white pus. The treatment of tonsillitis involves adequate rest, hydration, antibiotics (in cases of bacterial tonsillitis), pain relievers and mouth gargle and lozenges.
Some children are prone to getting frequent tonsil infections. The reason for this is unknown. If your child experiences frequent severe tonsil infections requiring significant amount of time from school or requiring frequent hospitalization, you should consider having your child’s tonsils removed (procedure is known as Tonsillectomy). Removal of the tonsils does not weaken your child’s immune system nor does it make your child more susceptible to infections. There are many studies that have shown that tonsillectomy has no clinically significant negative effect on the immune system
Enlarged lymph nodes (Cervical lymphadenopathy)
What are Enlarged lymph nodes (Cervical lymphadenopathy) ?
Lymph nodes in the neck are part of your immune system and can be enlarged when your immune system is fighting a threat in the body (e.g. by infection, inflammation or cancer). Majority of the time, lymph nodes in the neck are enlarged due to an infection. They usually resolve or become smaller after the infection settles.
Assessment of a child with enlarged lymph nodes in the neck includes a thorough clinical history and physical examination. If the lymph node does not resolve or has worrisome signs (e.g. hard consistency, does not move easily, is in a location just above the collar bone in the neck or is bigger than usual inflammatory or infective lymph node) or is present in other parts of the body, your doctor may perform a fine needle aspiration and cytology (FNAC). FNAC involves sticking a needle into the lump (like a b to collect some cells from the lymph node for testing. If the result of the test is inconclusive, a biopsy of the lymph node (either removal of some tissue or the whole lymph node) may be required.In some instances, further investigations such as blood tests and imaging (Chest X-ray & Ultrasound or CT scan of the neck) may be required.