Top 3 Ent Problems in Children: Ear Infections, Blocked Nose and Snoring

Updated on May 22, 2024

Did you know that we see many children with Ear Nose Throat conditions at our busy ENT specialist clinics in Singapore? Many different paediatric ENT problems exist, affecting your child’s ability to grow and function to the best of their potential but what are the top 3 most common ENT problems in children? Is it ear infections and hearing loss? Is it loud snoring with persistent difficulties breathing and a disturbed sleep pattern? Is it recurrent sore throats? Or is it a chronic cough that doesn’t go away? Or recurrent sniffing with strange mucus noises coming from your child’s nose? Or maybe it’s the constant mouth-breathing due to a persistently blocked nose? Let’s look at the Top Three ENT problems in Children which we see in huge volumes at our Paediatric ENT clinic in Singapore:

  1. Blocked ears with/without ear pain
  2. Persistent snoring with mouth-breathing and difficulties breathing
  3. Persistent blocked nose with/without sneezing and runny nose

Let’s talk about the ear problems first which commonly occur in children:

Blocked ears with/without ear pain

These common ear symptoms in children are very often associated with the state of their nasal airways and overall general health status. Some children go about their daily routine with mild hearing loss due to fluid buildup behind their eardrums and their parents are totally unaware of their child’s hearing and ear issues until this is detected at school with a screening hearing test. As the fluid behind their eardrum is not yet infected with bacteria, the child may not suffer any earache until they fly, especially during the flight landing phase. This may lead to severe excruciating earache and even the risk of eardrum rupture during the flight because their poor child cannot equalize the air pressures behind their eardrums, in turn linked to abnormal sluggish Eustachian pressure tube function.

Blocked Ear and Blocked Nose | ENT Specialist Singapore

The Eustachian pressure tube are important structures deeply located right at the back of the nose and they are the linking passage between the eardrums and the space behind the nasal passages. Most of the time, their resting state is to stay in the “closed” position but they do need to open up at the right time for short periods, in order to equalize the pressures between the eardrum and the nose, e.g. during flight landing, traveling in lifts in tall skyscraper buildings, sitting on a train going through a tunnel. If these important Eustachian pressure tubes don’t open properly, then the short term complications are severe ear pain, increased risk of ear infections and hearing loss, with a persistently blocked ear feeling. In the longer term, more serious ear problems may arise, namely the formation of retraction pockets, which are abnormal “sucked in” areas of the eardrum, in turn leading to the eventual appearance of cholesteatoma, a benign but extremely destructive skin cyst growing in some people’s ears which needs proper ear and mastoid surgery to remove completely.

If your child has these blocked ear, ear pain and hearing loss symptoms, then your child needs to be seen by your friendly Children’s ENT specialist in Singapore. This will usually include a quick and safe endoscopy or camera check of the ears and nose, and also a hearing test with ear pressure checks (tympanometry). Management of these Children’s ENT issues will then be tailored according to the clinical findings in your child but usually, a trial of medications will be started first for a mutually agreed length of time between you and your Paediatric ENT specialist. If the ear problems do not improve with medications, then other options including ventilation tube insertion in the eardrums (grommets) may be advised.

Persistent snoring with mouth-breathing and difficulty breathing

Definitely another extremely common ENT presentation in children at our ENT clinics in Singapore! 

Some children have been suffering loud snoring (often louder than their Dad’s own snoring!), restless sleep pattern with waking episodes at night, associated with difficulty breathing through their nose, for quite some time. Some parents mistakenly assume this is “normal” but let me assure you, it is NOT normal to have your child noisily breathing with disrupted sleep (your own sleep may be disrupted sometimes as a result!). 

Some children may sleep in funny body positions, such as sleeping on their tummy with their head twisted to one side, sleeping with their bottom stuck in the air, repeat tossing and turning movements and even rotating round the entire bed like a scene from the horror movie “The Exorcist”! Watch if their mouths are often open to breathe during the daytime and worse at night when asleep. Gasping and choking noises when asleep or suddenly going very quiet after they have been snoring for a while, are not good signs as they are likely caused by airway obstruction due to obstructive sleep apnea. 

The common causes for an abnormal blocked airway leading to snoring and disrupted sleep with difficulty breathing through the nose, are enlarged swollen tonsils and adenoids blocking your child’s airway at 2 different levels. This causes sleep apnea, a serious health condition which leads to recurrent dips in the blood oxygen levels, in turn affecting the good blood supply to the brain and heart. If left untreated, longer term problems with sleep apnea in children may cause daytime fatigue, attention deficit and behavioural problems at school, mood swings and temper issues, bed-wetting, poor appetite “picky eater’ and low energy levels. Your child’s brain secretes healthy levels of growth hormone when he or she sleeps well, hence the eventual negative effects on their overall health and growth status.

Adeno-tonsillectomy (child) | healthdirect

Remember: Children need lots of good quality sleep to grow and function well to maximise their potential, so recurrent sleep-disordered breathing problems is really unhealthy for your growing child, especially if it continues in the longer term and if simple nasal meds like Zyrtec, don’t seem to help at all. 

Persistent blocked nose with/without sneezing and runny nose

Another very common ENT problem in children, allergic rhinitis (nasal allergies or “morning sinus”), often presents with persistent blocked nose with watery nasal discharge, a runny nose, and may cause the child to constantly sniff, rub or even dig their nose because allergic rhinitis in children also causes itching of the nose. Allergic rhinitis, or nasal allergies, if left untreated, may lead to chronic severe inflammation and irritation of the nasal lining, so that the risk of nosebleeds is much higher. The constant nose-rubbing, nose-digging and sniffing with blowing of the nose are all also risk factors for recurrent nosebleeds in children (and also adults).

When we see patients with such troublesome blocked runny nose symptoms, many of them may already be using nasal steroid sprays like Nasonex and Zyrtec but guess what? Few have had allergy testing done! Allergy testing, whether in the form of a skin prick test or blood test, is the most important investigation needed here to find out what allergens may be driving the recurrent nasal symptoms, including sneezing bouts, runny nose, watery itchy eyes, itchy nose, snoring, mouth-breathing and blocked nose. 

In Singapore, the Number One trigger for allergic rhinitis, as well as other atopic conditions such as eczema and allergic asthma, are the 3 species of House Dust Mite. They are microscopic organisms which leave their saliva and droppings all over your house and workplace, and you are breathing in these irritant substances all the time. Atopic allergic conditions also commonly run in families, so we see the same group of conditions popping up in parents and then their children.

House Dust Mite | Pest Information & Prevention Tips

I would say that the whole point of having allergy testing is to find out if you are allergic to House Dust Mites because desensitization treatment in the form of sublingual immunotherapy (SLIT) may be suitable for you. This is a safe pain-free needle free way to train your body not to react so badly to stuff like House Dust Mites, with a very high success rate using just a simple spray under your tongue every morning. SLIT does not contain any steroids and it technically isn’t a vaccine, though many of my patients understand it better that way. It is definitely NOT “experimental” as SLIT has been in clinical use for many years with proven evidence-based outcomes for House Dust Mite (and Grass). We have many patients who have already completed their three year course with good results, with many kiddie and adult patients feeling better with less nasal irritation, and yet also not needing to depend on their nasal steroid sprays. Many parents are concerned about the long term use of nasal steroids (Nasonex, Avamys, Flixonase, Dymista, Exnise) due to the slight systemic absorption into their child’s body. Indeed, it is worth noting that some studies have suggested a temporary slowdown of children’s growth when using the nasal steroids on a daily basis for a prolonged period of time.

In conclusion, dear parents of children with ENT problems, please look out for these worrying symptoms and signs in your child, both awake and when asleep, because there may be more worrying ENT conditions lurking. If in doubt, it is always worth bringing your child for a checkup at your friendly ENT specialist in Singapore!

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The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.