Children

Children

“When I approach a child, he inspires in me two sentiments — tenderness for what he is and respect for what he may become.”

— Louis Pasteur

Mr Harris sub-specialises in Paediatric ENT and he has dedicated Paediatric ENT clinics in both his NHS and private practice. A third of his patients, outpatient and surgical are children and babies. Mr Harris sees children of all ages. He has an excellent reputation for putting children and families at ease. To create as positive and safe an experience as possible for children, Mr Harris has a dedicated paediatric nurse in many of his private clinics, and a paediatric audiologist to assess hearing in a one-stop appointment in all of his clinics. Although an initial assessment can be made, children aged 3 and under may need further age-appropriate testing, called Visual Reinforcement Audiometry, which we are able to arrange for you.
 

Conditions

Glue ear
Glue ear is common. Up to eight in every ten children (80%) will have a short episode of glue ear before they start primary school. The medical name for glue ear is “otitis media with effusion”. 
 
Sometimes it follows after an ear infection, but many children with glue ear have never had an ear infection. Often, the hearing loss from glue ear is not enough to be noticed by the parents. It may be more noticeable that the child cannot hear that well in a group situation. Sometimes, in a younger child, the hearing does not seem to be a problem, but the child’s speech and language development is slower than his or her friends of the same age. Some children complain of earache because of the fluid in their ears. Some children have balance problems or poor attention as a result of glue ear. Sometimes, the only problem reported by parents or carers is behavioural problems. This is probably due to frustration on the part of the child who cannot hear properly. 
 
For most children, the glue ear will get better with no treatment. Those children who have ongoing problems may be recommended surgical treatment. This may be grommet surgery or adenoidectomy and grommet surgery. Hearing aids may be a better first treatment for some children.
Otitis media
Otitis media is an infection of the middle ear. It is common in children, particularly aged under 2. The episodes are frequently associated with a cold and present with malaise, fever, pulling at the affected ear and sometimes discharge. If very severe, there is a risk of the infection spreading to cause complications such as mastoiditis (redness and swelling behind the ear), and brain abscess.
Nose bleeds (Epistaxis)
Epistaxis is the medical word for bleeding from the nose. Nosebleeds are very common in children. Over half of children aged between 6 and 15 years old have nosebleeds regularly. Most bleeds are relatively minor and can be treated conservatively. Recurrent bleeding can often be stopped by cauterising the blood vessels inside the nose.
Adenoid hypertrophy / adenoiditis
Adenoids are lymphoid tissue (like tonsils) that arise from the ‘nasopharynx’ (the back wall of the throat where it contuse behind the nose). They are frequently enlarged in children and can sometimes block the openings at the back of the nose. They harbour colonies of bacteria that can lead to glue ear. In younger children they are there to fight germs. After the age of about three years, the adenoids are no longer needed. We only remove them (coblation adenoidectomy) when they do more harm than good. Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. They snore at night, and some children even stop breathing for a few seconds while they are asleep. 
Snoring and obstructive sleep apnoea
Large tonsils and adenoids can cause severe snoring and sleep apnoea in children. Occasionally, this may be so severe as to require urgent treatment. 
Hoarse voice
Hoarseness or Dysphonia means a change in the sound of someone’s voice. Some children develop a persistent hoarse voice, most commonly through vocal strain that will respond to specialised paediatric vocal therapy. Other causes of hoarse voice in children are laryngeal papillomas, vocal cord nodules and vocal cord polyps.
Tonsillitis
In acute bacterial tonsillitis, the child is usually unwell, with large tonsils covered in white matter called exudates, a fever and sometimes headache and swollen glands in the neck. If it is severe and frequent, coblation tonsil surgery may be discussed as a management option with you.
Sore throat
Sore throats are common and not always due to tonsillitis. Most acute sore throats are viral in origin. Most patients recover within one week. Infection with bacteria can rarely lead to complications such as quinsy, (tonsil abscess) nephritis (kidney inflammation) and rheumatic fever (heart and joint inflammation).
Snuffly Baby
Neonates do not know how to breathe through their mouths and will stop breathing rather than open their mouth to breathe. Nasal obstruction in neonates is worrying with laboured breathing and slow, difficult feeding. In most of these neonates the nose is swollen and full of secretions. This can be helped with simple nasal saline and suction. Blockage of the back of the nose (choanal atresia or hairy polyps should also be excluded)
Lumps In the Neck
Many children have small lymph nodes in the neck which increase in size with colds and sore throats. They may be tender during the illness but settle back down in size when the child gets better.

There are a number of cysts of the neck that can occur from birth. Cysts can be seen on an ultrasound which is harmless and similar to an antenatal scan.
Ear infection / ear discahrge
See otitis media and ear drum perforations for more information.
Ear drum perforations
Ear drum perforations may be caused by trauma, or otitis media, which usually heal spontaneously over days or weeks if the ear is kept dry and there is no infection. Most persistent perforations form spontaneously and present with recurrent discharge form the ear and hearing loss. A persistent eardrum perforation can be repaired by an operation called myringoplasty.
Cholesteatoma
Cholesteatoma is caused by a pocket of skin that grows from the eardrum into the middle ear, around the ossicles and into the mastoid. The pocket sheds dead skin cells which get trapped and cause erosion of the bone as it expands. It causes ear discharge and hearing loss, which can be permanent, vertigo, tinnitus or damage to the facial nerve, causing weakness in half of the face. In very rare cases, an infection can spread into the inner ear and brain, leading to a brain abscess or meningitis. The only effective way to get rid of this pocket of skin is surgery. There is a type of congenital cholesteatoma that has formed at birth that usually presents with hearing loss in children.
Pre-auricular pits
Pre-auricular pits are commonly seen dimples just in front of the ear. The form when skin gets trapped as the ear forms in the womb. Most are shallow and will not cause any problems. Some are tracts going deep into the tissues in front of the ear and can become infected, requiring surgical excision to prevent recurrent infections and scarring. Occasionally, the presence of a preauricular sinus may be associated with other abnormalities of the outer ear.
Protruding ears
Protruding ears in children can lead to a child being teased at school. It is due to a defect in part of the cartilage (gristle) of the ear, and one or both ears can be affected. An operation to correct the shape of the ears so that they protrude less can help the child become less self-conscious. Surgical correction can be carried out whenever the patient wishes, but not usually before the age of about six, because by this stage the cartilage in the ear is more mature.
Allergies
Allergies can cause inflammation inside the nose. Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control. 
Hayfever
Hayfever is the common name given to cold-like symptoms caused by inhaling plant pollens at certain times of the year. Symptoms of hayfever include itchy nose, with or without itchy ears, throat and eyes, sneezing, watery discharge from the nose and sometimes eyes and blocked nose.

Pre-operative advice and information for parents and children undergoing a general anaesthetic

Davy the Detective – Finding out about anaesthetics (PDF)
Information about anaesthesia for young people

Rees Bear has an anaesthetic (PDF)
A story for younger children about having an anaesthetic

General anaesthesia (PDF)
A brief guide for young people

Pre-operative advice for parents (PDF)
A guide for parents whose children are being admitted for ENT surgery

Your child’s general anaesthetic (PDF)
Information for parents and guardians of children

 

Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.