When throat problem causes deafness in children

Ear diseases like Otitis media are associated with a fluctuating hearing loss that can adversely affect a child’s learning and behavioural development. Experts warn that in children, it could be a manifestation of a hidden problem at the back of their nose, reports Sade Oguntola.

It all started with what Kenny’s mother thought was a throat infection. But it turned out the day after that four-year old Kenny, had difficulty hearing with his left ear. At the hospital, the doctor who examined him said Kenny had developed otitis media, an ear infection that is commonly experienced by children of Kenny’s age group.

Middle ear infections — what doctors call otitis media — lead to millions of visits to the doctor each year, and they are a common reason for prescribing antibiotics to children.

Children commonly develop otitis media, an inflammation of the middle ear or ear infection, another cause of acquired hearing loss that can be temporary or permanent.

The small size and shape of the passage from the middle ear to the back of the throat in children is easily blocked and can retain fluid, which can lead to infection.

Moreover as Dr Adekunle Daniel, a consultant Ear, Nose, Throat (ENT) Surgeon, University College Hospital (UCH), Ibadan, Oyo State stated, in some children, when the tonsils grow really big, blocking the opening of the ear drum, hearing loss can occur.

The tonsil is the body’s first line of defence against disease-causing germs or dirt trying to invade the body. It is found from the back of the nose down to the back of the throat.

In Nigeria, the tonsil starts to get bigger in children between 12 and 18 months till about five years when it then starts to go down. However, Dr Daniel said: “when it grows like that, it can block the nose from the back, and usually what the parents will notice is that the child starts to breathe with the mouth and also start having a lot of catarrh or runny nose.”

Basically, the ear is made up of three parts: the outer, middle, and inner ear. The outer ear is the part of the ear that people can see. It is separated from the middle ear by the eardrum.

Nonetheless, when the tonsil starts to grow bigger at the back of the nose, there is a tendency that it can block the opening of the middle part of the ear that opens into the nose and thus result in hearing loss. This is quite common in children.

Unfortunately, Dr Daniel said, hearing loss may be the only complaint in some children with such big tonsils, adding, “the parents usually complain that when talked to, they seem not hear; we have to raise our voices to ensure that they hear.”

Although hearing loss could be due to myriads of problems, he stated that parents could suspect enlarged tonsils when a child has continuous runny nose, often breathing through the nose; snores a lot when sleeping or has difficulty hearing.

However, he declared that although the tonsils at the back of the tongue may also grow big, it does not really affect hearing

“It is the enlarged tonsils at the back of the nose that will affect hearing, although this cannot be seen when you open the mouth of the child to examine it with the naked eye,” he added.

Howbeit, Dr Daniel said it is possible for some children with recurrent ear infections that bring out pus too, also end up with hearing loss.

The treatment depends on the seriousness of the problem. “If the symptoms are mild, this is treated with medication, but if the runny nose which is usually watery becomes mucus, we know that there is also a bacterial infection, and then we can give a nasal decongestant and probably an antibiotic.”

Given that heavy snoring can have terrible effects on the heart of the child, and the heart can fail if left unattended to in time, he said, some children with enlarged tonsils might need to have this corrected surgically.

“It is not very common for children to snore at that age. But if you see a child snoring, breathing through the mouth, perpetually with a runny nose and occasionally having difficulty with hearing, that child probably has tonsils or adenoid enlargement.

“Its treatment is the commonest surgical operation that we do in our speciality in children. There is hardly any week that we do not carry out two or three of such surgeries; it is just that people are not aware.

“If a child is born with difficulty hearing and cannot speak, that is different. Hardly will this adenoid enlargement prevent the child from hearing and speaking. The only thing is that the child may not pronounce some words very well because the way he hears them is different.

“When that structure blocks the middle part of the ear that opens into the nose, fluid will accumulate inside the child’s ear. The way they hear is similar to how people hear when they are under a water surface. If you want to experience how the child hears, just immerse yourself in water and let people be talking to you. It will be muffled.

“So, the treatment is medical; and when medicine does not work, we have to operate.”

Dr Daniel said cases of otitis media in children when identified by a general medical practitioner, are best referred to an ENT medical specialist.

He said runny nose arising from conditions such as respiratory tract infection (catarrh), allergic reaction and asthma need to be ruled out before the child is suspected to have an enlarged adenoid and referred to the ENT medical specialist.

Meanwhile, experts believe that the incidence of middle ear infection is declining because of the introduction of pneumococcal vaccine.

The vaccines protect children and older adults against bacteria that cause pneumonia, meningitis and ear infections.

What hasn’t changed significantly, however, experts say are the risk factors for acute otitis media (AOM). They found that being male, day-care attendance, and family history of AOM were associated with increased risk of the ear problem. However, exclusive breast-feeding was a protective factor.