Paediatric otorhinolaryngology

A consultation designed for children

A paediatric ENT consultation calls for attention not only to clinical matters but also to the child’s emotional needs. The aim is to create a calm, cooperative atmosphere, explaining each step in words the child can understand and adapting the assessment to their age and individual characteristics.

Every child is different. That is why the assessment begins by listening to the family and taking a careful medical history, in order to reach the most accurate diagnosis possible.

What happens during the visit

The consultation takes place in a quiet, reassuring setting. Small, precise instruments, such as flexible paediatric fibrescopes, make it possible to examine the airways and the ear in a few minutes and without pain.

Where necessary, the visit is completed with tympanometry and a hearing test. Every treatment plan is agreed with the parents and, when appropriate, coordinated with the family paediatrician and other specialists.

Prevention and early diagnosis

Children are not always able to say clearly that they have a problem with their hearing, breathing or sleep.

Some signs deserve a closer look: a change in school performance, difficulty understanding words, habitual snoring, breathing with the mouth open. Acting early makes it possible to identify any problems and plan the most appropriate course of care.

Main conditions treated

Ear infections and other ear problems

Ear infections are very common in the first years of life: acute otitis media is the second most frequent reason for a visit to the paediatrician. When episodes recur, or fluid persists in the middle ear, it is important to assess the effect on hearing as well.

Hearing and speech development

Good hearing is essential for the development of communication and language. When hearing loss is suspected, or in the case of recurrent ear infections or difficulty responding to sounds and words, specific hearing tests may be recommended, chosen according to the child’s age.

Nasal breathing and sleep disorders

Enlarged adenoids and tonsils can cause breathing difficulties, snoring, mouth breathing, recurrent infections and disturbed sleep. An ENT assessment establishes whether medical treatment is enough or whether further investigation is needed.

A child who breathes mainly through the mouth, snores often or sleeps restlessly should be assessed: healthy breathing at night matters for the quality of their rest and for their general wellbeing.

A simple test carried out at home, overnight pulse oximetry, can show whether the child has pauses in breathing during sleep (apnoea), a condition that gives priority for surgery.

Paediatric ENT surgery

This covers operations on the ear, nose, paranasal sinuses, tonsils, adenoids and other structures of a child’s airway and hearing system.

Surgery is not always the first choice. When medical treatment is not enough, or when there is a specific indication, an operation can resolve or improve a problem that affects the child’s health and quality of life.

Care designed around the child and the family

Surgery in childhood requires specific expertise and close attention to the anatomical, functional and emotional characteristics of young patients, as well as to the child’s own experience of treatment.

That is why it is important to prepare both the child and the family, explaining simply what will happen before, during and after the operation. Parents are supported at every stage and receive clear guidance on preparation, the post-operative period and follow-up visits.

Adenoids and tonsils

Adenoids and tonsils play a part in the immune system, especially in childhood. In some cases, however, enlargement or recurrent infection causes significant problems. Adenoidectomy, tonsillectomy or adenotonsillectomy is considered on the basis of the child’s medical history, symptoms and specialist assessment.

Particular attention is given to children with:

• mainly mouth breathing
• a persistently blocked nose
• habitual snoring
• disturbed sleep
• pauses in breathing during sleep
• recurrent tonsil infections

Ear surgery

Some conditions of the middle ear can affect a child’s hearing, either temporarily or permanently. In the case of recurrent ear infections or persistent fluid in the middle ear, surgical treatment may be considered, such as the insertion of grommets (ventilation tubes).

The decision takes into account the child’s age, how often episodes occur, how long the problem has lasted, hearing function and the impact on communication and development. Operations on the ear include myringoplasty, cholesteatoma surgery and cochlear implantation for severe hearing loss.

The paediatric hearing pathway

• Early diagnosisnewborn hearing screening, followed by genetic and instrumental tests
• Minimally invasive surgerygeneral anaesthetic, about 30 minutes per ear, one night in hospital
• Activation and mappingthe implant is switched on and programmed within one month by the biomedical engineering team
• Speech and language therapyongoing care from the Hearing Rehabilitation Unit, which supports the child and family through language development

Nasal and airway surgery

Good nasal breathing is important for a child’s wellbeing. When nasal obstruction is caused by a condition that requires surgery, a specific operation may be recommended after careful assessment. Particular attention is paid to sleep-related breathing disorders, in order to identify the cause of the obstruction and the most appropriate treatment.

Before and after surgery

Pre-operative assessment

Every operation is preceded by a full specialist assessment which, depending on the child’s needs, may include:

• medical history and review of symptoms
• ENT examination
• hearing assessment
• endoscopic examination of the nasal cavities and nasopharynx
• any additional diagnostic tests
• anaesthetic assessment

The choice of operation is made after carefully weighing the expected benefits, the alternatives and the possible risks.

After surgery

The post-operative period is planned according to the type of operation and the needs of the child. The family receives personalised guidance on:

• medication and pain relief
• eating and drinking
• physical activity and returning to school
• symptoms to watch for
• post-operative check-ups

Follow-up visits make it possible to monitor the child’s progress and the outcome of treatment.