Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis. A large proportion of infection, 70%, is virally mediated. However the bacterial Streptococcus tonsillitis will need antibiotic treatment due to the risk of rheumatic fever, and glomerular nephritis in some children. If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils. Tonsillitis mostly occurs in young children and can be a recurrent condition (it keeps coming back). If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer. If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered. Tonsillar enlargement can cause difficulty in breathing and swallowing. Children often snore loudly, some have obstructive breathing when they sleep. Poor quality sleep can result in a child with poor learning, irritability, hyperactivity, behavioural changes and lethargy. A sleep study or Oximetry study can be useful to assess the significance of obstruction. Tonsils and Adenoids (PDF, 701.7 KB) Tonsillectomy (PDF, 707.2 KB) Tonsil and Adenoid Surgery (PDF, 748.6 KB) Tonsil Removal and Immune Impact (DOCX, 52 KB)

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear. Inflammation and infection of external ear canal (space in front of ear drum) is known as otitis externa. Acute Otitis Media This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma. The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children. The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly. Otitis Media with Effusion (Glue Ear) Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids. Chronic Otitis Media If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain. If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues. Otitis Externa Otitis externa is inflammation of ear canal - usually caused by bacteria and sometimes fungi. Children with ventilation tubes have a 3% chance of having repeated OE. Topical antibacterial drops/antifungal and aural suctioning usually resolve this rapidly. OTITIS MEDIA PATIENT INFO (PDF, 458.7 KB)

In children growths, lumps, tumours or masses on the head and neck are largely benign (noncancerous) and rarely cancerous and these can originate from in the tonsils, lymph glands, larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face or skull. Tests to diagnose a mass may include: Full clinical history and examination of the upper aerodigestive tract is mandatory Ultrasound exam is often the first line as it is non invasive and children don't need a GA (general anaesthetic) MRI – magnetic resonance imaging uses magnetic fields and radio waves to give images of internal organs and body structures CT Scan – computer tomography combines x-rays with computer technology to give cross-sectional images of the body Biopsy – a sample of tissue is taken for examination under a microscope. COMMON MASSES IN CHILDREN ARE Enlarged Lymph Nodes Lymph nodes in the neck often become swollen when the body is fighting an infection. This is often the commonest mass in children. Benign Lesions Noncancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck. dermoid cyst thyroglossal duct cyst branchial cyst pilomatrixoma preauricular cysts salivary gland swelling THYROGLOSSAL DUCT CYST (DOCX, 220.8 KB) Thyroglossal duct cyst is one of the common midline neck lumps in children Preauricular cyst and sinus (DOCX, 6 MB) DERMOID CYST (DOCX, 12.4 KB)

When snoring is interrupted by episodes of totally obstructed breathing, it is known as obstructive sleep apnoea. The obstruction is caused by the relaxation of muscles that support the soft tissues at the back of the throat such as the uvula, soft palate, tongue and tonsils. These tissues then collapse and momentarily block the airway. Episodes may last 1-20 seconds or more and may occur hundreds of times per night. While you are not breathing, the levels of oxygen in your blood drop which causes your blood pressure to go up and adds strain to your cardiovascular system. In addition, you are likely to feel overly tired during the day and your work, driving and overall performance may be affected. In children tonsil and adenoid enlargement account for 75% of the OSA. Others are due to obesity, craniofacial abnormalities, maxillary mandibular malalignment, or due to syndromes. Your ENT surgeon and respiratory physician can advise on this further. The usual treatment for children should be adenotonsillar removal ( 75-80% curative) followed by further investigations to exclude other causes of OSAS. Like in adults in some children OSA can be treated with a CPAP mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway Pressure (CPAP).

Snotty nose and sinusitis are common in children especially due to our urban living and daycare attendance. It's normal for a child aged 2-5 yrs to have 2-3 colds per year. Often snotty nose resolves within 5-7 days. However prolonged infection or repeated > 5 x episodes are deemed abnormal. Sinuses: in the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings. This is known as sinusitis. Sinusitis can be: acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction. chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection. Sinusitis can be a recurrent condition which means it may occur every time you get a cold. Symptoms of sinusitis in children include: post nasal drip and cough nasal congestion (blocking)/snoring discoloured nasal discharge bad breath fever. Treatment for bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove abnormal or obstructive tissue thus restoring movement of air and mucous between the nose and the sinus. In children adenoidal tissue causes >50% of chronic snotty nose/sinusitis symptoms. The rest are due to a multitude of factors including anatomic obstruction, allergy and immune deficiency.

There are three large pairs of glands (parotid, sublingual and submandibular) in your mouth that produce saliva which helps break down food as part of the digestion process. If the duct or tube carrying saliva from the gland to the mouth becomes blocked, the gland will swell. The glands can also swell as the result of mumps, bacterial infections and certain other diseases. If the duct is blocked by a stone, it can sometimes by squeezed or pulled out but may on occasion require surgery to remove it.

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the flow of air through the back of the mouth and nose becomes partially blocked and structures such as the tongue, soft palate (the back part of the roof of the mouth) and uvula (the tag that hangs at the back of the mouth) strike each other and vibrate. Causes of snoring include: nasal polyps; a bend in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, obesity, smoking, excess alcohol. Surgical treatment of snoring involves the removal of excess loose tissue in the throat or soft palate. Diagnosis, investigation, treatment of obstructive sleep apnoea video here.

Hoarseness can be described as abnormal voice changes that make your voice sound raspy and strained and higher or lower or louder or quieter than normal. These changes are usually the result of disorders of the vocal cords which are the sound-producing parts of the voice box (larynx). The most common cause of hoarseness is laryngitis (inflammation of the vocal cords) which is usually associated with a viral infection but can also be the result of irritation caused by overuse of your voice e.g. excessive singing, cheering, loud talking. Other causes of hoarseness include: nodules on the vocal cords – these may develop after using your voice too much or too loudly over a long period of time smoking gastro-oesophageal reflux disease (GERD) – stomach acid comes back up the oesophagus and irritates the vocal cords. This is a common cause of hoarseness in older people allergies polyps on the vocal cords glandular problems tumours. Diagnostic tests may include viewing the vocal cords with a mirror at the back of your throat or by inserting a small flexible tube with a camera on the end (endoscope) through your mouth. Sometimes tests may be done to analyse the sounds of your voice. Treatment depends on the cause of the hoarseness and may include resting your voice or changing how it is used, avoiding smoking, medication to slow stomach acid production and sometimes surgical removal of nodules or polyps.

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose. Rhinitis can be: allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets. infectious – e.g. the common cold non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. Treatment of allergic rhinitis involves avoiding the allergen if possible, but if not possible then corticosteroid nasal sprays and antihistamines are the usual medications prescribed.

Audiometry is the electronic testing of hearing ability. You will sit in a special room wearing earphones and be asked to respond when you hear a noise through the earphones. These tests can measure your hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise. Hearing tests can be performed for any child even a newborn. There are specialised tests for younger children which require one or more audiologists. Tympanometry uses sound and air pressure to check middle ear function. A small, soft probe is placed in your ear for a few seconds and a computer measures your ears response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear.

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures). Conductive hearing loss is often reversible and can be due to: blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid. Sensorineural hearing loss is generally not reversible and can be caused by: genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss) head injury tumours infections certain medications exposure to loud noises the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years). Some of the signs you might notice that indicate you have a hearing loss include: having to turn up the volume on the TV or radio finding it hard to hear someone you are talking with finding it hard to hear in a group situation where there is background noise e.g. in a restaurant having to ask people to repeat themselves you find people's speech is unclear - they are mumbling Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears. Treatment Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle. If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

If you find it difficult to pass food or liquid from your mouth to your stomach, you may have a swallowing disorder or dysphagia. Symptoms may include: a feeling that food is sticking in your throat, discomfort in your throat or chest, a sensation of a ‘lump’ in your throat, coughing or choking. A disorder may occur in any part of the swallowing process such as the mouth, pharynx (tube at the back of the throat that connects your mouth with your oesophagus), oesophagus (food pipe that takes food to your stomach) or stomach. Causes of dysphagia include: the common cold, gastro-oesophageal reflux, stroke or a tumour. Diagnosis may be by examination of a mucous sample or by viewing the pharynx, oesophagus and stomach using a small, flexible tube with a tiny camera on the end that is inserted down the back of your throat. Treatments for dysphagia depend on the causes, but may include: medication – antacids, muscle relaxants or medicine to slow down stomach acid production changes in diet and/or lifestyle surgery e.g. stretching or releasing a tightened muscle