Online Exclusive: Back to School ENT Health
By Dale Tylor, MD, for the Media and Public Relations Committee As summer winds down, families complete preparations for the transition of returning to school. While it can be easy to focus on purchasing the necessary back-to-school supplies and clothing for the child, families should be educated about a number of otolaryngologic health considerations that can help ensure a successful and safe year ahead. Hearing Loss and Hearing Screening Fortunately, most newborns undergo hearing screening evaluations, but this does not guarantee that hearing will remain within normal limits as they age.1 Hearing loss in children may be associated with issues of speech, even if the loss is unilateral.2 Clues to hearing impairment include complaints from the family or teacher that they have to repeat themselves to be understood by the child, or the child preferring to watch television at volumes that are excessively loud. Parents should ask their pediatrician or otolaryngologist about hearing testing if they have any concerns about the child’s hearing, language development, or ability to concentrate at school or home. These children may require a formal audiogram with an audiologist. Ultimately, issues of conductive or sensorineural hearing loss or central auditory processing disorder and a variety of medical and surgical managements can help to address the spectrum of diagnosed hearing disorders. Speech Delay The ability to communicate effectively is vital to scholastic and occupational success.3 Children with delayed speech development are at a severe disadvantage in school. If parents are concerned about the child’s language development or articulation, they should ask their doctor if the child might benefit from a formal evaluation with a speech-language pathologist and subsequent speech therapy. An otolaryngologist can also help assess medical causes of speech impairment, including ankyloglossia, palatal anomalies, or tonsil hypertrophy. Sleep Disordered Breathing Children who snore or have witnessed apneic pauses, gasping, or choking can be paradoxically hyperactive during the day with impaired behavioral and neurocognitive function.4 The poor quality sleep experienced by children with obstructive sleep-disordered breathing can lead to short-term consequences, such as diminished attention spans, headaches, hypersomnolence or hyperactivity, and enuresis, and longer-term health effects on the heart, lungs, brain, and other body systems. Parents who notice their child snoring or not getting restful sleep should discuss this with their physician, as the child may require a sleep study or other evaluation. Children with suspected attention deficit hyperactivity disorder and concomitant symptoms of sleep-disordered breathing might be evaluated by an otolaryngologist to rule out sleep apnea before commencing prescription medication for the ADHD. Often medical or surgical management of sleep apnea can significantly improve the child’s quality of life. Facial Trauma/Sports Facial fractures are fairly common in active children, and care should be taken during higher risk activities to minimize the risk of trauma to the craniofacial skeleton. Protective sports gear (helmets, facial visors, mouth guards) should be worn when appropriate. Children with suspected nasal or facial fractures, auricular hematomas, or concussions should be evaluated expeditiously after an injury, as some of these conditions are best addressed in an immediate fashion. Recurrent Upper Respiratory Infections During the cooler months at school, children are more likely to be indoors and in fairly close quarters. This leads to increased risk of acquiring upper respiratory infections like the common cold, and other subsequent infections of the upper aerodigestive tract, including otitis media, sinusitis, and tonsillitis. Parents should be reminded that the average child suffers with 20 viral upper respiratory infections by the age of 12,5 the vast majority of which do not benefit from the administration of antibiotics or treatment other than conservative care. Children should be taught to wash their hands frequently, to cough into their sleeve, and how to use nasal saline irrigations. If the child has repeated episodes of acute otitis media, tonsillitis, or sinusitis that are affecting quality of life, or has chronic symptoms of these infections, it is reasonable for the parents to request evaluation with an otolaryngologist–head and neck surgeon. References: Lü J, Huang Z, Yang T, Li Y, et al. Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening. Int J Pediatr Otorhinolaryngol 2011; 75(8):1045-9. Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics 2010; 125(6):e1348-55. Muir C, O’Callaghan MJ, Bor W, Najman JM et al. Speech concerns at 5 years and adult educational and mental health outcomes. J Paediatr Child Health 2011; 47(7):423-8. Landau YE, Bar-Yishay O, Greenberg-Dotan S, Goldbart AD, et al. Impaired behavioral and neurocognitive function in preschool children with obstructive sleep apnea. Pediatr Pulmonol 2012; 47(2):180-8. Grüber C, Keil T, Kulig M, Rolls S, et al. History of respiratory infections in the first 12 years among children from a birth cohort. Pediatr Allergy Immunol 2008; 19(6):505-12.
By Dale Tylor, MD, for the Media and Public Relations Committee
As summer winds down, families complete preparations for the transition of returning to school. While it can be easy to focus on purchasing the necessary back-to-school supplies and clothing for the child, families should be educated about a number of otolaryngologic health considerations that can help ensure a successful and safe year ahead.
Hearing Loss and Hearing Screening
Fortunately, most newborns undergo hearing screening evaluations, but this does not guarantee that hearing will remain within normal limits as they age.1 Hearing loss in children may be associated with issues of speech, even if the loss is unilateral.2 Clues to hearing impairment include complaints from the family or teacher that they have to repeat themselves to be understood by the child, or the child preferring to watch television at volumes that are excessively loud. Parents should ask their pediatrician or otolaryngologist about hearing testing if they have any concerns about the child’s hearing, language development, or ability to concentrate at school or home. These children may require a formal audiogram with an audiologist. Ultimately, issues of conductive or sensorineural hearing loss or central auditory processing disorder and a variety of medical and surgical managements can help to address the spectrum of diagnosed hearing disorders.
Speech Delay
The ability to communicate effectively is vital to scholastic and occupational success.3 Children with delayed speech development are at a severe disadvantage in school. If parents are concerned about the child’s language development or articulation, they should ask their doctor if the child might benefit from a formal evaluation with a speech-language pathologist and subsequent speech therapy. An otolaryngologist can also help assess medical causes of speech impairment, including ankyloglossia, palatal anomalies, or tonsil hypertrophy.
Sleep Disordered Breathing
Children who snore or have witnessed apneic pauses, gasping, or choking can be paradoxically hyperactive during the day with impaired behavioral and neurocognitive function.4 The poor quality sleep experienced by children with obstructive sleep-disordered breathing can lead to short-term consequences, such as diminished attention spans, headaches, hypersomnolence or hyperactivity, and enuresis, and longer-term health effects on the heart, lungs, brain, and other body systems. Parents who notice their child snoring or not getting restful sleep should discuss this with their physician, as the child may require a sleep study or other evaluation. Children with suspected attention deficit hyperactivity disorder and concomitant symptoms of sleep-disordered breathing might be evaluated by an otolaryngologist to rule out sleep apnea before commencing prescription medication for the ADHD. Often medical or surgical management of sleep apnea can significantly improve the child’s quality of life.
Facial Trauma/Sports
Facial fractures are fairly common in active children, and care should be taken during higher risk activities to minimize the risk of trauma to the craniofacial skeleton. Protective sports gear (helmets, facial visors, mouth guards) should be worn when appropriate. Children with suspected nasal or facial fractures, auricular hematomas, or concussions should be evaluated expeditiously after an injury, as some of these conditions are best addressed in an immediate fashion.
Recurrent Upper Respiratory Infections
During the cooler months at school, children are more likely to be indoors and in fairly close quarters. This leads to increased risk of acquiring upper respiratory infections like the common cold, and other subsequent infections of the upper aerodigestive tract, including otitis media, sinusitis, and tonsillitis. Parents should be reminded that the average child suffers with 20 viral upper respiratory infections by the age of 12,5 the vast majority of which do not benefit from the administration of antibiotics or treatment other than conservative care. Children should be taught to wash their hands frequently, to cough into their sleeve, and how to use nasal saline irrigations. If the child has repeated episodes of acute otitis media, tonsillitis, or sinusitis that are affecting quality of life, or has chronic symptoms of these infections, it is reasonable for the parents to request evaluation with an otolaryngologist–head and neck surgeon.
References:
- Lü J, Huang Z, Yang T, Li Y, et al. Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening. Int J Pediatr Otorhinolaryngol 2011; 75(8):1045-9.
- Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics 2010; 125(6):e1348-55.
- Muir C, O’Callaghan MJ, Bor W, Najman JM et al. Speech concerns at 5 years and adult educational and mental health outcomes. J Paediatr Child Health 2011; 47(7):423-8.
- Landau YE, Bar-Yishay O, Greenberg-Dotan S, Goldbart AD, et al. Impaired behavioral and neurocognitive function in preschool children with obstructive sleep apnea. Pediatr Pulmonol 2012; 47(2):180-8.
- Grüber C, Keil T, Kulig M, Rolls S, et al. History of respiratory infections in the first 12 years among children from a birth cohort. Pediatr Allergy Immunol 2008; 19(6):505-12.