Ears, nose and throat

It's winter, and you know what that means — ears, noses and throats will be on everyone's health radar. Tiffany Brown shares what you need to know about common complaints.

Why do kids get sick more often in the cooler months? Colder temperatures drive us inside, creating a closed circuit for bacteria, dirt, dander, and germs, and putting us at increased risk of infection. Ear, nose, and throat (ENT) complaints are some of the most common for children in winter.

 

Ears

Ear infections are very common in children, often occurring during or just after a cold. Germs which travel from the upper respiratory tract up the eustachian tube infect the middle ear, the space behind the eardrum. The resulting inflammation causes the tube to become blocked, meaning air cannot reach the middle ear. Fluid collects there and the eardrum becomes enlarged, causing pain and sometimes fever.

Pain usually comes on quickly and resolves within 24 hours. Older children will complain of ear pain or trouble hearing and may feel generally unwell, while younger children and babies may be feverish, distressed, unsettled, listless, vomit, or lose their appetite.

If the ear drum bursts, you’ll see snot-like pus coming out of the ear and your child may feel better from the pressure relief. A burst ear drum usually heals without treatment or other problems, but you should see your GP if this happens.

Glue ear occurs when the middle ear becomes filled with thick, sticky fluid, causing hearing difficulty in one or both ears. Hearing loss during the early years can affect speech and language development. Children with glue ear are not usually unwell, but they may ask you to repeat things, fail to answer you, want the television volume louder, or mishear things.

 

Grommets

Children with frequent ear infections or glue ear may need grommets. An operation to insert tiny plastic tubes in the ear drum to maintain normal air pressure in the middle ear, grommets allow air into the space and prevent fluid build-up. The short procedure involves a general anaesthetic by a specialist ENT surgeon and is a temporary measure to buy your child time while their eustachian tube develops properly.

 

Noses

Blocked and running noses are the hallmark of winter’s virus-induced colds, and while there’s no magic cure, there are some ways to ease discomfort for your child.

• Raise their head when they sleep to help the blood flow away from their head and reduce inflammation. Prop up the head-end of their mattress with a pillow placed underneath. Caution: Only do this for older children, as it’s not safe for babies. Do not place pillows in cots with babies.

• Keep up fluids including water, breast milk, formula or warm herbal teas for older children.

• Use a vapour rub on their chest and back. Peppermint- infused salves or mentholated ointments create a cooling sensation that can provide congestion relief.

• Saline drops and sprays can help clear stuffy noses.

Stuffy or runny noses may also be due to sinusitis following a cold. Fever five to seven days after a cold is the most common symptom of sinusitis, along with fever, worsening congestion, bad breath, dental pain, ear pain, or tenderness in the face.

 

Throats

Most sore throats are caused by virus- induced colds. Discomfort ranges from a scratchy feeling to severe pain which usually gets better without specific treatment over about a week.

Around 10% of sore throats are caused by bacteria, mainly Streptococcus (commonly referred to as strep throat). Left untreated, a strep throat can result in rheumatic fever. Sore throats may also be caused by tonsillitis or glandular fever.

Symptoms of a sore throat may also include difficulty swallowing, redness at the back of the throat, cold or flu symptoms (note these are not usually present with strep throat), a fever, swollen glands, headache or stomach pain. Gargling with warm salt water (one teaspoon of salt per glass) or drinking warm herbal teas or honey and lemon drinks can ease throat discomfort.

 

Rheumatic fever

Rheumatic fever is a serious illness that starts with strep throat and can lead to heart damage if untreated. Your child is more likely to get rheumatic fever if they have had it before, if someone else in their household has had it, or if they are of Maori or Pasifika ethnicity, are aged over three, and/ or they live in overcrowded or substandard housing conditions. If your child is in this high-risk category, you should check every sore throat with your GP.

See your GP if your child’s ear, nose, or throat symptoms persist, if fever doesn’t abate within 24-48 hours, if they are lethargic, not feeding/eating properly, become less responsive, or if you are concerned.

Help prevent infections by encouraging children to blow their nose when needed, cough or sneeze into their elbow, and wash their hands afterwards. Keep unwell children at home until they recover, and isolate the infected child from others.

 

Expert advice

Paediatric Ear, Nose and Throat specialist Graeme van der Meer of Auckland Children’s ENT shares his expert tips for surviving winter bugs.

Smash the bugs! Use the COVID-19 experience to make regular handwashing (at least four times per day), staying home when sick, and coughing into your elbow part of your kids’ routine.

Smash the veg! Eat the rainbow of colourful, in-season fruit and vegetables. The more colours, the better. The only vitamin recommended to supplement routinely is Vitamin D.

Most winter illnesses don’t need antibiotics, but other medicines (such as nasal saline or decongestant drops and paracetamol) go a long way to making your child feel better.

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