Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My 5-year-old son has been complaining of severe ear pain (just the right ear) and occasionally says that he hears a sound in the same ear. When he is abroad he has a nonstop cold, phlegm, and chest congestion. But when he travels here he is absolutely fine. He also suffers from nose blockage and struggles to breathe through his nose. He breathes through this mouth only most of the time. The doctors abroad suggested surgery to remove his adenoids. However, when he is here he is absolutely fine and the doctors are against surgery. Could you please suggest what is the solution for his suffering?
Hi,
Welcome to icliniq.com.
Have you taken an adenoid x-ray? Can you upload the x-ray if you have taken it? Do you think there could be some allergen in his place abroad which could be causing allergy and nose block in your son? Does he take food properly? Is there any dust inside the house abroad? Any chance of pollens or house dust mites? Does he have any sneezing or running nose? Does he show any rashes over his body?
The ear pain is there only in the right ear and when only he stays abroad? Does your son have an ear problem here? Do you feel he has hearing loss from that ear? Have you covered his normal ear and checked the hearing from his affected ear, let me know. Can you upload the relevant X-ray and blood tests?
What we are worried if the adenoids are causing ear block this can lead to compromised development as your son will have some hearing loss. Removal of adenoids will take care of this problem. You may have to get some ear tests done. Meanwhile, the allergy may aggregate the problem when he is abroad and here it may not be aggravated. But adenoids will not lessen in size even while in India.
Patient's Query
Thank you doctor,
Answers to your questions are:
Yes, I have taken an adenoid x-ray about a year ago. I have attached the x-ray.
Possibly, there could be some allergen in the abroad which could be causing allergy and nose block in my son. He is a picky eater. But he definitely eats well. There won't be any dust inside the house as far as I know.
Yes, he has sneezing, running nose and does not show any rashes over his body. He has pain only in his right ear and he does not complain of it when in India.
We tested his hearing by closing one of his ears and he hears normally. We do not see any difference. But he does not favor loud noises. He hates them. Loud such as vacuum cleaner, crakers, speakers, etc, makes him feel irritated. The doctors here would not refer to these reports. All we were told was that the adenoids will decrease when he is 7 years old and not to worry. But when he is abroad, almost every day he has a cough, cold and every month down with fever at least for a couple of days.
Hello,
Welcome back to cliniq.com.
I have seen the attached reports. (attachment removed to protect patient identity).
Your son has an extremely big adenoids. Fluid in the right ear and hearing loss as well. This is a clear indication for surgery. He needs adenoidectomy with myringotomy with or without grommet insertion.
I think you have not consulted the right doctors for this. May be you were consulting a pediatrician for this purpose.
If you want to know how I am sure of this, in the x-ray there is absolutely no space behind the nose for air to pass. There is a complete block in the nasopharynx area. Most possibly it is grade 4 adenoids. The adenoids have blocked the eustachian tube opening inside the nose (not just in the right but in left also). Blocked tube causes reduced ventilation and drainage of that particular ear causing fluid accumulation, reduced pressures and pain. This is what is bothering your son from that ear.
The fluid is indicated by the B type curve in the right ear shown by your report of tympanometry (impedance audiogram) and the PTA (pure tone audiogram) uploaded by you shows 30 dB hearing loss. In the PTA the 30 dB hearing loss is shown in the left ear. In the left ear, the curve is C which also shows impaired ventilation of middle ear most probably due to adenoids. If you wait till adenoids to resolve on their own say by another three to five years, your child would have had a serious compromise with his hearing and there will be adenoid facies and reduced mental development. We have seen conservative approaches fail in many cases and the kids end up dull and with reduced school performance. They are inattentive because they are unable to hear well due to this problem. Your son already has a 30 dB hearing loss in one ear and fluid in the other.
I hope I am making it clear to you. If you want to discuss this I am keen to help you. Adenoids may or may not regress normally by three or four years. Sometimes, we find adenoids in kids of 15 years also. But you son already is having damages due to it. His ear problem is serious.
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Otolaryngology (E.N.T)
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