Introduction
Rehabilitation of children with disorders of speech and language, voice disorders, communication and hearing, swallowing, and breathing is inadequate even in the present day. A multidisciplinary team approach is required in both hospital and long-term care facilities to improve the results of treatment in such patients.
What Are the Common ENT Disorders in Children?
The common ENT (ear, nose, and throat) disorders in children in which new trends in rehabilitation have been included are:
1. Chronic Rhinosinusitis:
Rhinosinusitis is a condition that is common in both adults and children. The symptoms last for more than three months. Acute rhinosinusitis is treated with antibiotics, mostly Amoxicillin; other options are Clavulanate and Cephalosporin. In case of allergy, Azithromycin is given. In cases where medical therapy is not successful, and the patient has a chronic or recurrent condition, the underlying medical condition is evaluated.
Functional Endoscopic Sinus Surgery (FESS) is used for removing polys and polypoid mucosa. After surgery, follow-ups are initiated, which may last for a year, and are performed with nasal endoscopy and by assessment of breathing spaces, nasal secretion, and sinusotomy patency. All children with the condition are subject to allergy tests, and in chronic recurrent cases, immunodeficiency tests are done.
2. Choanal Atresia:
Choanal Atresia is one of the most frequent congenital nasal defects that causes obstruction of the posterior nasal choanae, and in half of the cases, it occurs bilaterally. The condition is mostly associated with genetic syndromes.
The main treatment option for the condition is surgical intervention. But an endonasal endoscopic approach is less invasive and safest in terms of compliance. The most common complication of choanal atresia surgery is restenosis. The adjuvant measures used to reduce restenosis risk are nasal stenting, balloon dilatation, and mitomycin C. Stentless endoscopic repair is also available in recent times.
3. Obstructive Sleep Apnoea:
Obstructive sleep apnoea is characterized by partial or complete airway obstruction. Adenotonsillectomy is the first therapeutic option in the treatment of the condition. In addition to surgery and medical therapy, rehabilitation is also required in such patients. Neuromuscular and myofunctional therapy are required in such cases.
4. Juvenile Laryngeal Papillomatosis:
Juvenile Laryngeal Papillomatosis is a rare viral infection. These occur as single and multiple lesions in the glottic region, which extends to the tracheobronchial tree and lungs. The aim of treatment is the maintenance of adequate airway patency to avoid tracheostomy.
How Is Breathing Rehabilitation Done in Children With Laryngotracheal Axis Stenosis?
Laryngotracheal axis stenosis (obstruction of the upper airway between the trachea and larynx) is caused in children mainly due to the following conditions:
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Vocal cord paralysis.
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Tracheal stenosis (abnormal narrowing or constriction of the airway).
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Tracheomalacia (a genetic central airway anomaly).
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Laryngomalacia (a congenital defect that results in the collapse of supraglottic structures during inspiration).
Nowadays, breathing rehabilitation is used in children for mucus removal from the airway and for improving pulmonary function.
The different techniques used are:
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Forced expiratory technique.
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Compressions.
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Cough.
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Positive expiratory pressure.
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Physical exercise.
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Aerosol and nasal unblocking.
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Autogenic drainage.
The main goal of breathing rehabilitation is to remove airway secretion in cases where the physiological mechanisms (like a cough) are ineffective.
What Are the New Trends in the Pediatric Tracheostomy and Laryngotracheal Reconstruction?
Tracheostomy is a surgical procedure by which an opening is made in the trachea, which aids in breathing. In children, tracheostomy is mainly indicated in cases of airway obstruction rather than in infective cases. After tracheostomy, each child is assessed for deglutition and phonation.
A multidisciplinary approach involving the medical, surgical, and rehabilitative teams is required for the management of breathing and swallowing difficulties in children after the laryngotracheal reconstruction procedure. The rehabilitation program, in such cases, takes into consideration both swallowing function and respiratory function, including weaning from the tracheal cannula.
How Is Voice Rehabilitation in Pediatrics Done?
The voice craft method is characterized by vocal maneuvers that help develop control over the individual muscle group with the vocal mechanism. The training consists of thirteen training exercises. Each exercise is used to gain control of a specific structure of the vocal mechanism. Six voice qualities which include twang, opera, sob, speech, falsetto, and belting, are used for voice production control. Proprioceptive-Elastic Voice Rehabilitation Program (PROEL) is used for obtaining muscle relaxation and elasticity through unstable balance, body movement, and facilitating postures.
What Is Music Rehabilitation in Children With Cochlear Implants?
Music involvement helps children in improving their social interaction and self-expression. It helps in relieving stress that some children encounter during language training. The three cardinal elements of music are melody, rhythm, and timbre. Of these, the rhythm sensation is found to be similar in ones with normal hearing and ones with a hearing disorder.
Cochlear-implanted kids can usually recognize familiar songs from memory but show poorer performance when compared to children with normal hearing. In most cases, music acts as a motivational tool for positive behavior. Music helps in breaking social barriers and help in removing fear due to hearing loss.
Music therapy, in combination with speech therapy, has the following benefits:
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Development of auditory skills.
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Development of good listening habits.
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Development of sequential memory.
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Improves voice quality.
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Improves speech rhythm.
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Development of suprasegmental language elements.
What Is Aural Atresia Rehabilitation?
Aural atresia is a condition in which a patent ear canal is absent. Patients with atresia on both sides are provided with BAHI (Bone Anchored Hearing Implant) or a bone conduction hearing aid. After age eight, canalplasty is the treatment of choice. Hearing rehabilitation aids patients with atresia. The choices include softband BAHI, percutaneous BAHI, canalplasty, bone conduction hearing aid, and bonebridge. Early identification and management are important for long-term success.
Conclusion
Rehabilitation of pediatric patients with disorders of speech and language, hearing and communication, voice disorders, swallowing difficulties, and breathing difficulties is not widely available in both hospitals and long-term care centers. Even the technicians and physicians needed for such programs are inadequate in most countries. A multidisciplinary team for the rehabilitation of pediatric patients with ENT disorders in specialized third-level centers is very much needed.
