Why do some children get mucous in the middle ear?

The middle ear is normally an air containing cavity and gets its air through a tube, the Eustachian tube, which opens the back of the nose at the level of the palate and in the area of the adenoids. Sometimes the tubes get blocked as a result of infection, allergy, adenoid enlargement or reasons unknown to us. We then get an absorption of the air in the middle ear and a negative pressure develops. Next the goblet or mucous secreting cells, which are present in small numbers to provide slight moisture, start to increase in quantity and size. What happens? They secrete more and more mucous until the middle ear cavity is filled with mucous.

What happens then?

1.We have a hearing loss - not too bad but it can hamper schooling. The child can    understand you when you speak directly to him but when occupied he tends to ignore you. Naughty? NO. Absorbed? NO. He just cannot hear you!
2.We have recurrent infections developing in the middle ear with earache and occasional discharge.
3.Sometimes the child is just irritable. It is unpleasant to have a blocked feeling in one's ears!

What happens in the long term?

1.If left alone a certain percentage of these children will improve spontaneously and    the normal avenues of ventilation will reopen. No damage is done and the condition clears the hearing returning to normal. This should occur within 4 to 6 weeks.
2.Sometimes it does not clear. Recurring infection causes bad scarring or permanent damage to the eardrum. In the old days we saw many problems and called the condition chronic adhesive deafness.

How do we treat the condition?

Firstly we try and get the natural ventilation system cleared. We use antibiotics if there is an infection and decongestants to reduce swelling and open up the Eustachian tubes. If we fail, we need to provide artificial ventilation which is done by inserting grommets.

What is a grommet?

It is a minute metal or plastic tube inserted through the eardrum. At the time of the procedure we suck out much of the mucous. This is done under a short general anaesthetic as an out-patient procedure. The child usually can hear normally promptly, and feels much more comfortable.

Why put in a grommet?

By allowing air back into the middle ear the crop of mucous secreting goblet cells will again reduce in number and the lining gradually returns to normal. In many cases the Eustachian tube opens during this period and we should have cured the condition. Sometimes the Eustachian tubes have not yet opened and mucous can recur with the need to have the grommet replaced.

What happens to the grommet?

It's usually pushed out into the ear canal within 4 to 6 months. The drum heals and with luck one should have no further trouble. Very occasionally we need to remove a grommet.

Why do some ears continue to discharge after putting in a grommet?

A good question. The answer is that the vast number of abnormal goblet cells do not stop secreting mucous overnight. The discharge is not dangerous and no harm is taking place. In these troublesome cases we can use drops and medication to hasten recovery but rest assured that the problem is not serious.

What of the long term?

A child's blocked Eustachian tubes will in most cases eventually open up. Sometimes it takes months and sometimes years. We believe it is important to keep an avenue of ventilation open by means repeated grommets if necessary, until the natural avenue, the Eustachian tube, is functioning again.

Are grommets dangerous or harmful?

Definitely not. Lack of treatment may be harmful in the long term but grommets are not harmful.

What is the risk of permanent deafness?

In a very small percentage of cases we seem to lose the battle and a small residual hearing loss could result from a chronic blocked Eustachian tube condition. In the vast majority of children, even if we have to treat them on and off for several years and put grommets in on multiple occasions, we end up with normal hearing, and there is no further trouble. The long term outlook for the properly treated child is therefore excellent. We do, however, need to be patient.

What about follow up visits?

I like to see the child 1-2 weeks after surgery and then at 3-4 monthly intervals until i am satisfied that the ears have returned to normal. Naturally if you are worried about anything you must phone me. I might need to clean the ears by suction or prescribe some medication.

What about swimming?

Ideally, one should try and keep water out of the ears. Often water will cause no harm whatsoever but occassionally it can set up a slight infection. This can easily be cleared using drops. Swimming is therefore permitted. Earplugs of some sort can be used but diving should be avoided.

What of other sport?

No problem.


The problem may take a long time and a lot of attention before we are out of the woods completely. Rest assured the chances of permanent damage or disability are very, very small.


The sinuses are air-conditioning spaces in the front of the skull and in the bones of the face. The most important sinuses lie above and below the eye socket and behind the bridge of the nose. They are lined by a moisture producing mucous membrane. Moisture normally drains unnoticed from the sinuses into the back of the nose and down the throat; this may amount to a quart or more a day. The purpose of the sinuses are to help moisturize and humidify the air we breathe. Through frequently blamed, the sinuses usually are not the cause of nasal stuffiness and headache. The older the child or adult may complain of pain over an infected sinus and ache in the back of the eye or pain in a tooth. Infections of the ethmoid sinuses cause swelling of the skin around the eye or nose. Anyone who seems to have one cold after another or a continuous cold may be suffering from a chronic sinus infection which flares up from time to time. The flare-ups may be triggered by chilling, swimming, fatigue, weather changes, or contact with allergens. With treatment, the nasal congestion and other symptoms should improve gradually over the next 14 days. A doctor may choose to culture the mucous. Sometimes an x-ray of the sinuses is made in problem cases. In some stubborn instances, the mucous in the sinus is too thick and may be washed out.
 What is sinusitis?

Sinusitis, the inflammation of the mucous membranes in the sinuses, is a very common disorder. In general, it is caused by infection, allergies and irritation from toxic substances in the air. There are two types and you should know the difference so that you can seek appropriate medical treatment.

What are the two types?

The first is acute sinusitis. The second type, chronic or recurring sinusitis, is more complex and more common.

Do the treatments differ?

Acute sinusitis responds well to antibiotics and decongestants. If there is pus within the sinus cavity it must be drained. Fro chronic sinusitis, medication may be temporarily effective. If symptoms recur or persists, then a more detailed assessment is required to determine whether surgery is needed.

What type do I have?

To find out whether you have acute or chronic sinusitis, simply check the symptoms below that apply:

      • Pain in only one area
      • The sudden start of pain
      • Discoloured drainage on one side of the nose
      • Congestion (stuffiness) on one side of the nose
      • Frequent and sometimes severe headaches
      • Pressure in the head that may be intense

If you have the first four symptoms only, you probably have acute sinusitis. If your symptoms are those in the second half of the list, you probably have chronic sinusitis.

How can you be sure?

If you think you have acute sinusitis, you should see your family doctor. He or she probably diagnose your condition according to the rule of one:

      •  One area of pain
      • Drainage on one side of the nose
      • Stuffiness on one side of the nose

 If you think that you have chronic sinusitis, you should see a specialist, who will probably diagnose the problem with the help of a CT scan of the sinus cavity.

How does chronic sinusitis develop?

 Chronic sinusitis usually develops when the inflamed mucosal lining obstructs sinus drainage. The body constantly produces mucous as a lubricant. In the sinus cavities, the lubricant is moved across tissue lining toward the opening of each sinus by millions of hair-like cilia. If one of these openings is already narrow, inflammation can cause it to swell completely shut and block the movement of mucus. Surgery may be needed to correct the problem.

What will surgery do?

 Surgery to correct chronic sinusitis performs two functions. First, it enlarges the natural opening. Since the cilia move mucous in only one direction - toward the natural opening in each sinus - creating a second opening that is not at the natural site would not help, because the cilia would simply ignore it.
Second, it leaves many cilia in place. Procedures that reduce the number of active cilia, whether by creating holes or scar tissue, block the movement of mucous and are less effective.
Endoscopic sinus surgery is the most effective procedure because it restores the flow of mucous by removing areas of obstruction. This permanently restores the normal flow of mucous and air through the natural sinus openings.

What can you expect from surgery?

A simple procedure is usually performed under general anaesthesia, with patients returning to normal activities within a few days, and complete recovery taking about four weeks. Procedures for more complex cases can however, last longer under general anaesthesia, with the recovery process taking longer. The physician can follow up as needed according to the type and complexity of surgery.


What are tonsils?

The tonsils serve as filters to produce antibodies directed at specific germs. Like all filters, once they clog up they spill into the system. This is what happens to chronic tonsillitis. This manifests as a recurrent sore throat, poor appetite and recurrent pain. Another feature could be that of bad breath.

When are they removed? 

At one stage we removed tonsils at the drop of a hat. We then went to the opposite extreme and removed no patient's tonsils, based on some studies showing higher prevalence of some diseases afterwards. This is proved to be a wrong decision. We now seem to have got it right and have specific indications for the operation.
These are: 

      • Recurrent attacks of tonsillitis - this means more than 4 attacks in the preceding year. What this means is that every 3 months antibiotics are prescribed for the condition. This is now felt to be unacceptable and removal is warranted. Most people fit into this category.
      • If the tonsils are so large that they obstruct breathing and eating. Here the child will have symptoms of breathing difficulties at night, usually snoring, and is always accompanied by an enlargement of the adenoids. The latter are tonsils at the back of the nose and enlarged in response to chronic infection, this causes snoring and can also be responsible for recurrent middle ear infections.
      • If one tonsil is larger than the other. Removal here is for the purpose of examination under the microscope to exclude certain illness.
      • A tonsil abscess - Quinsy. This condition is not seen often today due largely to the use of antibiotics. These constitute the major indications for tonsillectomy.

You or your child will fit into one of the above categories. 

Admission to hospital 

As anaesthesia has become safer over the years, this operations is now being done on children worldwide as a day clinic case. Your child will be admitted in the early morning, usually by 07h30 having nothing to eat for at least 6 hours prior to surgery. This is absolutely vital for if this is not adhered to, the surgery cannot be performed. If a child awakes during the night it is advisable to give him water to drink until approximately until 04h00.

The operation is done first thing in the morning and usually takes about 20 to 30 minutes. The child remains in the clinic until 16h00. If all has gone well during the day you may take your child home. If I am at all unhappy then an overnight stay will be arranged. While in the clinic the child's condition will be monitored by the nursing staff and should any problem arise they will be in touch with me.

On the day of the operation I allow a soft floppy diet. However breakfast the next morning I regard as the most important meal. If you can get your child over this meal then it is plain sailing from here. You will be given a pain killer medicine (usually Stopayne) which you must use liberally as prescribed. Give it about half an hour before meals. Encourage your child to chew. Most of the pain is due to muscle spasm and chewing a chip or chewing gum and biltong will help break the muscle spasm and relieve pain.

What problems can you expect? 

Usually none, but one of the greatest concerns is bleeding. If noted please contact me immediately. I can always be contacted at home or through medical emergencies. Helps is always available, please use it. Ear ache is a common complaint and is usually due to referred pain from the tonsil bed. Should this persists then it is worth while me checking over. Speech is affected for a few days due to pain and swelling, it settles after about a week. The patient will be seen by again ten days post operatively.

What about adults?

This is more difficult and complicated procedure. Admission to the hospital at least overnight is needed. It is more painful and require greater attention to chewing vigorously post operatively. Again the problems are as for children and all the same rules apply. 


A great deal of trepidation is experienced by children going to hospital and especially the thought of going to theatre. I would suggest you spend time with him or her explaining to them what is exactly going to take place and please emphasize that at no time any injection will be given to them or anything done to hurt them. An informed child is co-operative child, which makes it a far less frightening experience for him or her. Should there be any other queries or questions that you have please feel free to contact me and we will answer them for you. 



The surgery you have had, or contemplating having, is an endoscopic endonasal "functional" operation to your nose and sinuses.

This surgery represents the latest approach to the management of sinusitis.

In the past, surgery was to some extent destructive and often aimed to "ridding the patient of disease". Today's surgery is based on philosophy of encouraging optimal intranasal condition, to enable the disease to settle down over a period of time. The object is to allow better ventilation of the sinuses.

Surgery is often the first step in the management and control of sinusitis.

To achieve the desired goal your co-operation will be needed. You will need to be patient during the post-operative period. Whilst you should notice an immediate improvement of some of your symptoms, others may take a while to settle. Some aspects of the disease may take 4-6 months to settle down. In case of ploypoidal disease and allergy, you may subsequently need to use a nasal spray for a prolonged or indefinite period in an attempt to control the factors that led to the disease in the first instance. Occasionally, chronic sinusitis cannot be "cured" and we will aim for an improvement and long term control.

Your operation will usually require an overnight stay in hospital. This first night may be spent with small "sinuspacks" placed high up in each nostril. These are quite comfortable and painless. In fact, the operation is surprisingly painless. Bruising and swelling of face does not occur.

Try to be diligent about the use of your post-operative medications, which includes a nasal douche.

Your post-operative care is most important and if omitted, can in fact jeopardize the end results. I will need you to return on scheduled days for nasal toilet and examination. The cost of 3 months follow-up management is included in your initial surgery costs, so don't feel embarrassed to return.

On matter of costs, you will need to realise that modern sinus surgery is a highly skilled operation done under specially controlled anaesthetic conditions. It is not "cheap" surgery, but i am sure you will agree that the benefit derived will be well worth the outlay.