Children’s ENT

What is the function of the tonsils?

Tonsils are part of the body's "Early warning system". They detect bugs in the throat.

What problems can occur in the Tonsils?

There are two main problems that may affect your child's tonsils:

1. The tonsils become too big causing snoring
2. The tonsils keep getting infected (recurrent tonsillitis)

What happens when tonsils become too big and cause snoring?

If the tonsils are very large, they can block your child's breathing passages at night causing snoring and sleep disturbance. 8-12% of children in Australia snore at night on most nights. In severe cases this can lead to Obstructive Sleep Apnoea (OSA) where your child may temporarily stop breathing at night.

Is snoring different in children and adults?

Snoring in children is very different from snoring in adults. In adults there are many possible causes for snoring. In children, 95% of snoring is due to large tonsils, large adenoids and/or large turbinates, as well as allergic rhinitis, often all four conditions.

Is snoring harmful for children?

Occasional mild snoring in children is probably harmless.

Regular snoring and sleep disturbance in children may lead to the following behaviour problems:

• Hyperactivity
• Inattention
• Aggression
• Difficulties with learning, memory and problem-solving

Very severe cases of snoring with Obstructive Sleep Apnoea (OSA) may lead to:

• Developmental delay
• Growth failure
• Lung problems

How are big tonsils with snoring and/or sleep disturbance treated?

When snoring and/or sleep disturbance is due to big tonsils, the treatment is to remove the tonsils (Tonsillectomy).

What is tonsillitis?

Tonsillitis is when the tonsils become infected.

What are the symptoms of tonsillitis?

When the tonsils are infected, the throat becomes sore and red. It becomes painful and difficult to swallow. The tonsils often swell up and become bigger. The child will often have a fever and feel unwell.

How is tonsillitis treated?

See your GP if you think your child has tonsillitis. Treatment usually consists of bed rest, plenty of fluids, pain relief and antibiotics.

What is recurrent tonsillitis?

Most children will have a few episodes of tonsillitis as they grow up. Some children get repeated episodes of tonsillitis, again and again - this is called "Recurrent tonsillitis".

Is "Recurrent tonsillitis" bad?

Yes. Recurrent tonsillitis can affect your child's health. Multiple courses of antibiotics are not a good idea. Each time your child becomes sick, both you and your child have to take time off.

How is recurrent tonsillitis treated?

Recurrent tonsillitis is treated by removing the tonsils (Tonsillectomy).

When should tonsillectomy be performed?

Official guidelines recommend that tonsillectomy should be considered when your child has the following number of episodes:

• 7 episodes in the last 12 months OR
• 5 episodes per year in the past 2 years OR
• 3 episodes per year for the past 3 years

These are the general guidelines - your child is an individual and the decision as to when to undergo tonsillectomy is based on your child's individual circumstances, your choice and Dr Singh's recommendation.

Wait! The tonsils are part of the "Early warning system". If we remove the tonsils, will my child get more infections?

No.

The tonsils are only 1 part of the "Early warning system". There is a whole ring of tissue around the throat and nose that performs exactly the same function as the tonsils. Removing the tonsils has no effect on the "Early warning system". Millions of tonsillectomy operations have been performed around the world and there is no increase in infections in children who have their tonsils removed.

How are the tonsils removed?

The tonsils are removed while your child is asleep under a general anaesthetic. The tonsils are removed through the mouth - there are no cuts made on the outside.

There are many different ways to remove the tonsils. Older style ways to remove the tonsils include:

• Blunt dissection (gouging the tonsils out)
• Sharp dissection (Cutting the tonsils out with scissors or a scalpel)
• Diathermy/ bipolar/ coagulation/ electrical dissection (Using electricity at high temperature to burn the tonsils out)

Dr Singh uses "Coblation" or “BiZact” technology to remove the tonsils.

What is "Coblation" and “BiZact”?

Coblation and BiZact are modern technologies that remove the tonsils at low temperature. The potential benefits of these technologies include less bleeding and less pain.

Where is the operation performed?

In the interests of your child's safety, Dr Singh performs children's procedures at Lakeview Private Hospital and Westmead Private Hospital. Lakeview Private Hospital is the first and only full-size hospital built and run entirely by specialist doctors, for the benefit of patients. Westmead Private Hospital is also one of Australia's leading private hospitals. It is part of the Westmead healthcare campus, the largest Hospital complex in the Southern Hemisphere. Westmead Private Hospital is also affiliated with the University of Sydney Faculty of Medicine, Australia's oldest and largest Medical School.

Please note, that we avoid performing tonsillectomy on children under 2 years of age. Children under 2 and any high-risk children who need surgery are referred to have their operation performed only at the nearby Westmead Children's Hospital.

Are there any alternatives to surgery?

Yes. Tonsillectomy is an "Elective" procedure, meaning it is your choice to have the operation performed. Alternatives to surgery include:

• Do nothing. Your child may keep getting tonsillitis or keep snoring.
• Long-term antibiotics. Sometimes, a long course of antibiotics for many weeks or months may reduce the risk of recurrent tonsillitis.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks...but we still cross the street. Dr Singh will explain the risks of your child's operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP if you think your child has big tonsils with snoring and sleep disturbance or recurrent tonsillitis. Ask your GP for a referral to see Dr Singh and call us for an appointment.

What is the function of the adenoids?

Adenoids are part of the body's "Early warning system". They detect bugs in the nose.

What problems can occur in the adenoids?

There are two main problems that may affect your child's adenoids:

1. The adenoids become too big
2. The adenoids become infected, long term

What happens when adenoids become too big?

Big adenoids can block the nose. This can result in your child breathing only through the mouth and snoring at night. Watch your child during the night (and day) to see if he or she breathes with the mouth open!

Big adenoids may also block the tube between the back of the nose and the ear (the Eustachian tube). If this tube becomes blocked, fluid may become trapped in the ear, causing hearing problems and recurrent ear infections.

What happens if the adenoids become infected?

Short-term infections of the adenoids are common and will affect most children at some stage.

Long-term infection of the adenoids may result in a more permanent collection of bugs. Children with long term adenoid infections often get recurrent sinus and ear infections and take multiple courses of antibiotics. The antibiotics only temporarily suppress the bugs. As soon as the antibiotics are stopped, the infection comes back!

How are big or infected adenoids diagnosed?

See your GP if you think your child has big or infected adenoids. Your GP will ask about your child's symptoms and examine your child. An Xray may be ordered to look at the size of the adenoids.

Your GP cannot see your child's adenoids directly as they are deep in the back of the nose.

Dr Singh uses a special super-fine flexible camera that is passed through your child's nose (after using a special numbing spray) to look directly at your child's adenoids. This avoids the need for any harmful Xrays and radiation exposure.

How are big or infected adenoids treated?

See your GP if you think your child has big or infected adenoids. Treatment options include:

• Do nothing - If the symptoms are not severe, treatment may not be necessary
• Steroid nasal sprays - These may eventually reduce the adenoid infection/ inflammation
• Long term antibiotics - These may eventually clear the adenoid infection
• Referral to Dr Singh for adenoid removal (Adenoidectomy)

When should adenoidectomy be performed?

Adenoidectomy is usually performed when the adenoids become so big that they affect your child's breathing.

Adenoidectomy may also be performed to prevent recurrent ear infections or long-term fluid in the ear (glue ear)

Adenoidectomy may also be performed to prevent recurrent sinusitis.

These are the general guidelines - your child is an individual and the decision as to when to undergo adenoidectomy is based on your child's individual circumstances, your choice and Dr Singh's recommendation.

Wait! The adenoids are part of the "Early warning system". If we remove the adenoids, will my child get more infections?

No.

The adenoids are only 1 part of the "Early warning system". There is a whole ring of tissue around the nose and throat (called Waldeyer’s ring) that performs exactly the same function as the adenoids. Removing the adenoids has no effect on the "Early warning system". Millions of adenoidectomy operations have been performed around the world and there is no increase in infections in children who have their adenoids removed.

How are the adenoids removed?

The adenoids are removed while your child is asleep under a general anaesthetic. The adenoids are removed through the mouth - there are no cuts made on the outside.

Where is the operation performed?

In the interests of your child's safety, Dr Singh performs children's procedures at Lakeview Private Hospital and Westmead Private Hospital. Lakeview Private Hospital is the first and only full-size hospital built and run entirely by specialist doctors, for the benefit of patients. Westmead Private Hospital is also one of Australia's leading private hospitals. It is part of the Westmead healthcare campus, the largest Hospital complex in the Southern Hemisphere. Westmead Private Hospital is also affiliated with the University of Sydney Faculty of Medicine, Australia's oldest and largest Medical School.

Are there any alternatives to surgery?

Yes. Adeonidectomy is an "Elective" procedure, meaning it is your choice to have the operation performed. Alternatives to surgery include:

• Do nothing. Your child may keep getting problems related to the adenoids.
• Steroid nasal sprays - These may eventually reduce the adenoid infection/ inflammation
• Long-term antibiotics. Sometimes, a long course of antibiotics for many weeks or months may reduce the risk of adenoid problems.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your child's operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP if you think your child has adenoid problems (blocked nose with mouth breathing, snoring, recurrent ear or sinus infections). Ask your GP for a referral to see Dr Singh and call us for an appointment.

What is the function of the turbinates?

The turbinates regulate the flow of air through the nose. They also warm and humidify the air that we breathe and catch small particles of dust.

What problems can occur in the turbinates?

There are two main problems that may affect your child's turbinates:

1. The turbinates become too big causing blockage
2. If your child has allergy (Hayfever), the turbinates can swell up causing blockage

What happens when turbinates become too big?

Big turbinates can block the nose. This can result in your child breathing only through the mouth and snoring at night. Watch your child during the night (and day) to see if he or she breathes with the mouth open!

How are big turbinates diagnosed?

See your GP if you think your child has big turbinates. Your GP will ask about your child's symptoms and examine your child.

Your GP may have difficulty directly seeing your child's turbinates without the right equipment.

Dr Singh uses a special super-fine flexible camera that is passed through your child's nose (after using a special numbing spray) to look directly at your child's turbinates.

How are big turbinates treated?

See your GP if you think your child has big turbinates. Treatment options include:

• Do nothing - If the symptoms are not severe, treatment may not be necessary
• Anti-Allergy treatments (Nasal Steroid sprays, antihistamines, De-sensitisation) – Daily medications may be enough to shrink the turbinates and control the nasal blockage
• Referral to Dr Singh for Coblation to the Inferior Turbinates

How are big turbinates treated surgically?

The turbinates are treated while your child is asleep under a general anaesthetic. The turbinates are treated through the nose - there are no cuts made on the outside.

There are many different ways to treat the turbinates. Older style ways to treat the turbinates include:

• Diathermy (Burning the turbinates at high temperatures)
• Turbinectomy (removing all of the turbinates – this is an outdated procedure and is no longer performed)
• Turbinoplasty (removing part of the turbinates – this is commonly performed in adults and is sometimes required in children, usually when there is a septal deviation)
• Laser (This was trialled in the 1980s, but is no longer routinely performed as it carries high risks, is not very effective and can cause serious complications)

Dr Singh uses "Coblation" technology to treat the turbinates in most children.

What is "Coblation"?

Coblation is a modern technology that shrinks the turbinates safely at low temperatures. The potential benefits of the technology include less bleeding and less pain, with much lower risk of complications.

When should Coblation to the inferior turbinates be performed?

Coblation to the inferior turbinates is usually performed when the turbinates become big enough to affect your child's breathing.

Coblation to the inferior turbinates is routinely performed at the same time as adenoidectomy and/or tonsillectomy to ensure there is no blockage to the airway.

In children with a deviated septum, Coblation to the inferior turbinates is often performed, along with adenoidectomy, as a temporary measure. This is because correction of a deviated septum is best performed when a child’s growth has slowed down (usually around age 15-16+). When the septum is very deviated in a child, inferior turbinoplasty may be required, in addition to Coblation to the inferior turbinates.

Coblation to the inferior turbinates and adenoidectomy can be safely performed from a very young age (1+).

These are the general guidelines - your child is an individual and the decision as to when to undergo Coblation to the inferior turbinates is based on your child's individual circumstances, your choice and Dr Singh's recommendation.

Where is the operation performed?

In the interests of your child's safety, Dr Singh performs children's procedures at Lakeview Private Hospital and Westmead Private Hospital. Lakeview Private Hospital is the first and only full-size hospital built and run entirely by specialist doctors, for the benefit of patients. Westmead Private Hospital is also one of Australia's leading private hospitals. It is part of the Westmead healthcare campus, the largest Hospital complex in the Southern Hemisphere. Westmead Private Hospital is also affiliated with the University of Sydney Faculty of Medicine, Australia's oldest and largest Medical School.

Are there any alternatives to surgery?

Yes. Coblation to the inferior turbinates is an "Elective" procedure, meaning it is your choice to have the operation performed. Alternatives to surgery include:

• Do nothing – Your child may continue to experience problems related to the turbinates
• Anti-Allergy treatments (Nasal Steroid sprays, antihistamines, De-sensitisation) – Daily medications may be enough to shrink the turbinates and control the nasal blockage. In general, medications should be trialled for at least 1 month before giving up.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your child's operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP if you think your child has turbinate problems (blocked nose with mouth breathing, snoring). Ask your GP for a referral to see Dr Singh and call us for an appointment.

What are Grommets used for in Children?

Grommets are used to treat 2 conditions in children:

• Recurrent Acute Otitis Media (RAOM)
• Glue ear

What is "Acute Otitis Media" (AOM)?

Acute Otitis Media (AOM) is an infection of the "Middle ear". The infection usually begins with a cold or flu which spreads into the middle ear. The middle ear is the space behind the eardrum. Normally this space contains air and the 3 small bones of hearing. When the middle ear becomes infected, this space fills up with fluid and pus.

It is normal for most children to have at least 1 or more infections of the middle ear when growing up. Typically, this occurs between the age of 6 months and 2 years.

What is "Recurrent Acute Otitis Media" (RAOM)?

RAOM means repeated infections of the "middle ear".

More than 3 infections in a 6 month period is defined as RAOM

Is RAOM bad?

RAOM can cause the following problems:

• Persistent fluid in the ears can reduce your child's hearing, which may affect speech and learning.
• Persistent fluid may temporarily affect your child's balance and co-ordination.
• Repeated infections can cause damage to the ear drums.
• Repeated infections often require multiple courses of antibiotics.

How is RAOM diagnosed?

See your GP if you think your child has RAOM. Your GP will ask about your child's symptoms and examine your child's ears. Infection of the middle ear can be seen as thick fluid and pus behind the ear drum. If the infection is severe, the eardrum may burst and discharge pus from the ears.

How is RAOM treated?

See your GP if you think your child has RAOM. Treatment options include:

• Do nothing: If the symptoms are not severe, treatment may not be necessary
• Long term antibiotics: These may eventually clear the repeated infections
• Non-surgical measures:You can try the non-surgical measures listed below. There is not much scientific evidence that these measures work well, but it may be worth trying them
• Referral to Dr Singh: for insertion of grommets

What do grommets do in RAOM?

A Grommet creates a small opening in the eardrum. This allows fluid, pus and infection in the middle ear to drain out so that the ear can return to normal.

How are grommets inserted?

Grommets are inserted while your child is asleep under a general anaesthetic. The grommets are inserted through the ear canal - there are no cuts made on the outside.

Where is the operation performed?

In the interests of your child's safety, Dr Singh performs children's procedures at Lakeview Private Hospital and Westmead Private Hospital. Lakeview Private Hospital is the first and only full-size hospital built and run entirely by specialist doctors, for the benefit of patients. Westmead Private Hospital is also one of Australia's leading private hospitals. It is part of the Westmead healthcare campus, the largest Hospital complex in the Southern Hemisphere. Westmead Private Hospital is also affiliated with the University of Sydney Faculty of Medicine, Australia's oldest and largest Medical School.

Are there any alternatives to surgery?

Yes. Grommet insertion is an "Elective" procedure, meaning it is your choice to have the operation performed. Alternatives to surgery include:

• Do nothing: Your child may keep getting problems related to the ears.
• Long-term antibiotics: Sometimes, a long course of antibiotics for many weeks or months may reduce the risk of ear infections.
• Non-surgical measures: There is not much scientific evidence that these measures work well, but it may be worth trying them. Techniques include:
  • Steam inhalation
  • Swallowing hard
  • The "Otovent" device

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your child's operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP if you think your child has ear problems (repeated ear infections, discharge from the ears, reduced hearing, poor speech development, poor co-ordination - bumping into things and falling over). Ask your GP for a referral to see Dr Singh and call us for an appointment.

What is "Glue ear"

After an infection of the middle ears, your child will be left with fluid in the ears. In most cases, this drains away by itself within 3 months of the infection. If the fluid is still present after 3 months, it is called "Glue ear". After 3 months the fluid is very thick and sticky - like glue.

Is Glue Ear bad?

Glue ear can cause the following problems:

1. Glue ear can reduce your child's hearing, which may affect speech and learning.
2. Glue ear may temporarily affect your child's balance and co-ordination.

How is Glue Ear diagnosed?

See your GP if you think your child has Glue Ear. Your GP will ask about your child's symptoms and examine your child's ears. Glue Ear can be seen as thick fluid behind the ear drum and reduced ear drum movement.

How is Glue Ear treated?

See your GP if you think your child has Glue Ear. Treatment options include:

• Long term antibiotics: These may eventually clear the fluid
• Short term steroid medications: These may clear the fluid
• Non-surgical measures: You can try the non-surgical measures listed below. There is not much scientific evidence that these measures work well, but it may be worth trying them
• Referral to Dr Singh: for insertion of grommets

What do grommets do in Glue Ear?

Grommets create a small opening in the eardrums. This allows the glue-like fluid in the middle ears to be cleaned out so that the ears can return to normal.

How are grommets inserted?

Grommets are inserted while your child is asleep under a general anaesthetic. The grommets are inserted through the ear canal - there are no cuts made on the outside.

Where is the operation performed?

In the interests of your child's safety, Dr Singh performs children's procedures at Lakeview Private Hospital and Westmead Private Hospital. Lakeview Private Hospital is the first and only full-size hospital built and run entirely by specialist doctors, for the benefit of patients. Westmead Private Hospital is also one of Australia's leading private hospitals. It is part of the Westmead healthcare campus, the largest Hospital complex in the Southern Hemisphere. Westmead Private Hospital is also affiliated with the University of Sydney Faculty of Medicine, Australia's oldest and largest Medical School.

Are there any alternatives to surgery?

Yes. Grommet insertion is an "Elective" procedure, meaning it is your choice to have the operation performed. Alternatives to surgery include:

• Do nothing: Your child may keep getting problems related to the ears.
• Long-term antibiotics: Sometimes, a long course of antibiotics for many weeks or months may clear the fluid
• Short term steroid medications: These may clear the fluid
• Non-surgical measures: There is not much scientific evidence that these measures work well, but it may be worth trying them. Techniques include:
  • Swallowing hard
  • The "Otovent" device
  • Hearing aids

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your child's operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

What should I do next?

See your GP if you think your child has ear problems (repeated ear infections, discharge from the ears, reduced hearing, poor speech development, poor co-ordination - bumping into things and falling over). Ask your GP for a referral to see Dr Singh and call us for an appointment.