do some children get mucous in the middle ear?
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.
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
3.Sometimes the child is just irritable. It is unpleasant to have a blocked
feeling in one's ears!
happens in the long term?
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.
do we treat the condition?
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.
is a grommet?
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.
put in a grommet?
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.
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.
do some ears continue to discharge after putting in a grommet?
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.
of the long term?
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
grommets dangerous or harmful?
not. Lack of treatment may be harmful in the long term but grommets
are not harmful.
is the risk of permanent deafness?
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.
about follow up visits?
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.
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.
of other sport?
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.
OR CHRONIC SINUSITUS
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
and you should know the difference so that you can seek appropriate
are the two types?
is acute sinusitis. The second type, chronic or recurring sinusitis,
is more complex and more common.
the treatments differ?
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.
type do I have?
out whether you have acute or chronic sinusitis, simply check the
symptoms below that apply:
in only one area
- The sudden
start of pain
drainage on one side of the nose
(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.
can you be sure?
think you have acute sinusitis, you should see your family doctor.
He or she probably diagnose your condition according to the rule
area of pain
on one side of the nose
on one side of the nose
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.
does chronic sinusitis develop?
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.
will surgery do?
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.
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.
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.
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.
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
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
- 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.
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.
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.
can you expect?
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.
surgery represents the latest approach to the management of sinusitis.
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.
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.
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
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.