The Children’s ENT Specialist in Singapore: When to Seek Help for Your Child’s ENT Condition

Did you know that many children often suffer ear, nose and throat problems for quite a while before their GP realises it’s time to refer them to a Children’s ENT specialist in Singapore? Some children may have had hearing loss which has gone undetected until the school decides to carry out a hearing screening test which shows that their hearing is abnormal. Other children may be suffering a persistent blocked runny nose and have been breathing through their mouth for ages, without their parents realising that hey, mouth-breathing is not normal. Some kids snore loudly and have a very disturbed restless sleep pattern, waking up a few times during the night, which means a chronic tiredness then sets in during the daytime with associated behavioural symptoms too. Well, let’s go through some very common ENT conditions which I see all the time in my paediatric ENT clinic in Singapore:

A) The Coughing Child

Some kids keep coughing and coughing until they vomit! The constant coughing, throat-clearing, stuffy nose with difficulty breathing may result in strange nasal or throat noises and recurrent sniffing tics. Can you imagine what it’s like to live with someone who doesn’t stop coughing, even at night? This disturbs the poor child’s sleep, as they may keep waking up at night to cough and certainly, if they don’t sleep well, their immune health is going to be impaired, leading to yet another bout of the flu or some other viral infection. If your child keeps coughing and he or she sleeps in the same room as you, I doubt you’ll be able to sleep well either!

B) The Child who keeps falling ill and then suffers one Ear Infection after another

Ear infections can be very painful, in fact so painful that the poor child may wake up screaming and crying in the middle of the night. It is far more likely in this case, that they are suffering from a severe eardrum infection, possibly related to a recent flu or common cold they might have had. Eardrum infections are also often the cause of a fever, whereas infections of the outer ear/ear canal, don’t usually cause such severe earache and fever. If it’s an eardrum infection brewing, your child needs to start a course of oral antibiotics as soon as possible, and giving them some Ibuprofen can also help ease their discomfort. If eardrum infections are left to rumble on, then sometimes this may lead to formation of pus (infected fluid) behind the eardrum, which may in turn lead to rupture of the eardrum due to the pressure from the excessive fluid trapped behind the inflamed eardrum.

If the trapped eardrum fluid doesn’t get better on its own, then it is not advisable to fly as it may lead to severe ear pain and eardrum perforation during the flight, typically during the landing phase due to the difficulty equalising the pressures between the eardrum and the back of the nose. In recurrent or persistent cases, the child with glue ear or otitis media with effusion, may need insertion of tiny ventilation tubes to heal drain the trapped fluid and help them hear better again.

C) The Child who keeps suffering a Blocked snotty Runny Nose

Well, don’t be surprised if your child has been mouth-breathing for quite a long time as he or she just can’t breathe through their nose. We are supposed to be able to breathe easily through both sides of our nose, so if our nose becomes blocked, then we have no choice but to breathe through our mouth. Common reasons for mouth-breathing include nasal allergies, enlarged adenoids, nasal polyps (though rare in children). Mouth-breathing is highly frowned upon by dentists as this increases the risk of abnormal teeth development, tooth decay from the reduced saliva present and may affect the growth of the jaw/mandible with subsequent changes in the child’s facial shape and development. In fact, dentists HATE mouth-breathers and will advise you to bring your child to see an ENT specialist in Singapore sooner rather than later. During the Covid pandemic, many children with mouth-breathing issues often went unnoticed because they were wearing facemasks nearly the whole time.

A tip for parents is to watch your child when asleep and see if they have their mouths open to breathe much of the time. Observe too their general sleep pattern: Do they toss and turn quite often? Are they grinding their teeth or making grunting strange noises? Do they sleep on their tummies with their faces turned awkwardly to one side with mouth open? Are their chest movements a bit laboured or taking some effort to move in and out during their breathing? Does your child wake up at night a few times, sometimes partially? Sometimes, children who are already toilet-trained may begin to wet their beds again at night when asleep, yet another worrying sign of underlying sleep-disturbed breathing problems or sleep apnea.

D) The Child who can’t seem to Hear well

Ever wondered why the TV is always turned up at a louder volume when your child is watching TV? Or why you have to keep calling them repeatedly before your child responds? Did you notice some speech disturbances or even speech delay occurring in your child? Does you child go “Huh? Huh? What did you say?” again and again to you? All these may be signs of some underlying hearing loss so it’s best to get your child’s hearing checked out with a hearing test and see your friendly children’s ENT specialist in Singapore very soon.

Top of the list of causes for children to have hearing loss is “glue ear” or fluid trapped behind their eardrums. This is in turn often linked to nasal allergies (allergic rhinitis) and enlarged adenoids (reactive lymph gland tissue found at the back of the nose) which may block off the Eustachian pressure tubes leading to your child’s ears. In the young child, we must remember that the Eustachian pressure tube is still quite immature and under-developed, actually quite short and at a flatter angle compared to the adult’s, so young children are at higher risk of getting their Eustachian pressure tubes clogged by mucus, or excess adenoid tissue. They may also tend to suffer ear infections whenever they fall ill with the flu or some viral infection, doesn’t necessarily have to be Covid infection, precisely because of their “sluggish” pressure tubes. As long as the fluid stays trapped behind their eardrums, there is a high risk that the fluid will become infected with the growth of bacteria, leading to recurrent ear infections.

E) The Snoring Child

Does your child snore loudly and repeatedly? Even louder than Daddy? Snoring usually represents some obstruction of the airway, so the turbulent airflow entering your child’s airway is causing the surrounding soft tissues to vibrate or collapse. Of course, if your child comes down with the flu with a temporarily congested nose full of mucus, then it is common to hear them snore. But they shouldn’t be still snoring even when they are well and have already recovered from their illness. Snoring in children is usually caused by 1) Enlarged tonsils, 2) Enlarged adenoids, 3) Nasal allergies (allergic rhinitis) and may be commonly associated with mouth-breathing and a blocked runny nose.

Check out our helpful blog on Blocked nose and Snoring in Children.

F) The Child with Recurrent Nosebleeds

If your child keeps getting nosebleeds, sometimes one or both sides of the nose, it is probably worth getting this checked out by your Children’s ENT Specialist in Singapore. Most of the time, nosebleeds are usually caused by overly dry sensitive skin just inside the nostril, which leads to an itchy uncomfortable sensation, again resulting in the child digging, rubbing or scratching the nose repeatedly. Such nasal trauma tends to irritate the delicate blood vessels which grow at the front part of the nasal passage so these will then bleed easily again and again. If your child often has a blocked runny nose, sometimes with sneezing and watery eyes, then allergic rhinitis or nasal allergies will tend to make their poor little nose super sensitive, leading to further inflammation of those delicate blood vessels. It may be worth considering an allergy test for your child, either in the form of a skin prick test or nowadays, a simple blood test, to look for house dust mite allergies, the Number One cause of blocked runny sensitive nose problems in both children and adults.

Simple first aid measures during a nosebleed episode are to firmly squeeze the soft part of the nose for 15 minutes without letting go and this usually helps the bleeding vessels to close off. Of course, if this doesn’t help, or if the nosebleeds keep recurring or are very heavy, then definitely bring your child to see your friendly Children’s ENT specialist to make sure there isn’t any other unusual cause to worry about as the cause of the nosebleeds. Sometimes, rare blood vessel tumours may grow at the back of the nose in children so a simple endoscopy of the nose (takes a few seconds in the clinic!) is important to exclude them.

So now you know what to look out for in your child to help them breathe well, hear well, sleep well and ultimately, grow well!

Share this blog via: