3 Senses ENT Clinic (On Call)

Hi everyone,

I am Dr. Shashidhar. I am a Paediatric ENT surgeon at Artemis Hospital.i am heading the department and I am very glad to discuss you about the common things which make you come to an ENT. Number one cold in children which is often very debilitating and problematic causing you to give them a nightless sleep. Second is the allergic symptoms of sneezing running nose constant headaches and itching in the eyes and lastly, very common problem amongst most of the children and adults is snoring problem. Coming to the most common reason for recurrent colds although the most common cause is viral infection it should get alright in 4 to 5 days. But a lot of times what we see is this infection persists much much longer and that is the time you have to think that do you have to go and see an ENT because it's not a viral infection anymore, it could be the sign of sinusitis. When I say sinusitis what I want to say is the bones inside the face they are hollow so when you breathe air they circulate through these bones and they take humidity and nice moisture and they become warm the air becomes warm and then it goes into the chest.

But instead of air if these bones have pus inside them it becomes a problem because the patient will often have pain in the face congestion in the nose headache fever and constant cough and nose block. These are the symptoms of sinusitis and id they persist for more than 2 weeks we call it subacute sinusitis. Most of the time you may require an antibiotic a long course to treat these infections but sometimes you need an ENT consult because there may be an associated deviated nasal septum. The nasal bone which is separating the nose into 2 partitions if it is twisted then it is called a deviated nasal septum and this needs to be corrected. The easiest way to fix the problem non surgically is actually giving good saline nasal washes, multiple saline nasal washes 6 to 8 times steam inhalations they all go long way in helping the nose to heal itself. The 2nd problem which I was referring to is an allergic problem in children. We often are forced to do nebulization to kids and it is always a good idea to check adenoids in the kid because they all mimic the symptoms of allergy in kids.

The child may have snoring breathing difficulty and this can be adenoid. Adenoids are swelling on the back of the nose which block the nose which is due to an infection or allergies which cause adenoid to grow up and once they block the nose they cause a lot of secretion in the nose which causes severe symptoms of allergy and nasal congestion. All these steroid nebulization help a little bit but they don’t cure the adenoid. So if your child or if your adult patient has chronic nasal blockage for more than 3 weeks its time to have an ENT consult for that to check out for sinusitis or adenoids. And to keep it brief the last problem which I would like to discuss is snoring. Now snoring is not something which is normal although up to 5200 times a night one can snore if they are tired or they are very very stuffy at night someone who is snoring and also making sounds at night like kh kh kh … choking sort of a sound then it means they may be having obstructive sleep apnea. And this is a different problem than simple snoring because in this the breathing stops the oxygen level goes down and the heart rate kicks in which cause several changes in the body which may decrease the life expectancy which may decrease your performance during the day and cause you very sleepy the next day.

In children, it can cause often a very hyperactivity symptom in the day. How do you detect what is the cause of this snoring? A simple ENT examination should be done to see if there is a blockage of the nose the back of the nose nasopharynx the palate with very bulky or blocking the tongue if its bulky or falling back the tonsils and also the larynx and the hypopharynx which is the opening of the windpipe and the area near the food pipe. So they are all very important in deciding the sight of the snoring. And often we find multiple slides can be involved in causing snoring and sleep apnea. In a child, it's not a brainer that if a child has sleep apnea it is almost always tonsils or adenoids. Although you have exceptions of the squeezy windpipe which is called laryngomalacia or any obstruction downwards which is called Subaortic stenosis or retekomalacia. But all these are congenital problems that we don’t see them very often. So how do you effect snoring? Like I said the first part would be a complete assessment. And this will also include assessment of the severity of snoring or sleep apnea by a test called polysomnography or sleep study at night.

We do measure how much oxygen is dropping how your stages of sleep how much heart rate is increasing what stage of sleep you are going into what position of sleep you are sleeping into which is worsening the problem several parameters are measured. And once you do a sleep apnea we know for sure that your sleep apnea needs to be treated aggressively or only way introduction and lifestyle changes to be helpful or you hardly have any sleep apnea. So this is very important in the assessment of the sleep apnea. So to summarise nasal blockage is in recurrent colds allergies and nasal blockages causing sleep apnea all the entities are very easily treatable. Some may require lifelong medication by anti-allergic in spite of a surgery which is not a bad thing because you are symptom-free and these small medications are only going to keep you symptom-free and will prevent you from having the recurrence of symptoms.

The biggest misconception which people have is the sinus surgery should not be done because if we do it will always come back. What our experience is if we could care about sinuses and if you are doing good nasal washes and bushings are also under regular care the recurrence rates are as less as 5%. And the biggest happiness which we get is all these times when you are on medication you are actually completely symptom-free. There are several other problems which can be dealt with also by ENT which helps in the ears like otitis media. So my strong advice to you is although there is a good scope of alternative medicines and regular nasal washes and other things but if your problem is not getting sorted out you should definitely seek an ENT visit with your nearest ENT surgeon who is going to have a good look at your sinuses your nose your throat and larynx and NSAs and tell you what is the way to fix them. It does not mean you will always end up with surgery but it does mean that a potential complication is prevented by taking a good treatment at the right time and all the suffering which you undergo can be completely avoided if you have the consultation at the right time.

Thank you so much for.

Hi, I’m Dr. Shashidhar. I’m a pediatric ENT consultant and I work with a hospital called Artemis in Gurgaon. I’m going to talk about the common problems in children which is cold and why it comes again and again?  What is the solution for it?

It’s a very common problem nowadays with children going to day schools and play schools. At an early age and a lot of times, we’ve been told that this is because of the pollution or the allergies or infection from the surroundings but quite often we miss a very common cause of the cold which is what we call as Adenoids.

What are Adenoids?

Adenoids are small lymphoid tissue, the tissue that makes white blood cells in the body behind the back of the nodes. They are normal in children but sometimes they grow up in size. Like what you see here, like if this is the size of the adenoids, which should be there, is marked in violet, sometimes they grow, the bigger circle here the yellow in the back of the nose and block the nose. When this happens the common symptoms in children are snoring, breathing from mouth, restless sleep where the child is constantly turning this side and that side trying to get a good position in which he can breathe, some drooling and some coughing in the night.
More often than not we tend to miss Adenoids because we can’t see them directly and we tend to treat these conditions in terms of allergies, bronchitis and put the child in to nebulization and in unnecessary treatments.

What I’ve found in my own experience, that lot of the kids who have been told they have allergies and they have been told they have bronchitis have actually had Adenoids. So, if your child has reoccurring problems of sore throat, breathing difficulties and nose blocks, it’s worth getting evaluated for adenoids because the treatment of adenoids is very simple and often very gratifying. Which can be done with simple nasal sprays, saline washes and if it is a severer one it needs a surgical intervention to open up the nose.

Adenoids also cause recurrent ear infection, ear pain and sometimes they cause hearing disorder in children. It is quite difficult to evaluate such problem in children. You can only perceive it as, sometimes when you call them they don’t respond, their grades are falling in school and when they watch television they tend to raise the volume of the noise and this helps us to pick up the child to scream for the hearing problems because when you have adenoids you have a higher chance of getting ear infection and fluid inside the ear which is called otitis media, which can also be treated in the same lines. Rarely we need to put some grommets or some surgical intervention to drain the fluid out if we are not able to treat it medically.

Third problem which I wanted to discuss is Allergies in children. Aallergies in children can present in very wide spectrum. Sometimes they present only as cough, sometimes children get rashes on their skin, sometimes they can have allergies to food and recurrent diarrhea and other problems. So, allergies in children can be treated quite effetely with medicines and we have what we call as Immunotherapy to detect what the child is allergic to so we can specifically target that antigen and cure them for the long term. This now is the most gratifying and the latest treatment in allergies called Sublingual Immunotherapy.

With all these new, exciting treatments and if your child is not getting benefited by cold and cough routine treatment, you’re free to contact me at 3 Senses ENT Clinic which is in South City 2, Arcadia, Gurgaon. I’m also available at Artemis Hospitals throughout the week except on Sundays.

Thank you so much for your time.