Paediatric Ear Nose Throat (ENT) – Head & Neck Surgery Section
The section of Paediatric ENT within the Department of ENT-Head Neck Surgery at NUH works closely with the University Children's Medical Institute at NUH (made of up the Departments of Paediatric Medicine, Neonatology and Paediatric Surgery) to see both emergency and elective cases. Our patients come through self-referrals and referrals from private general and specialist practitioners, school health clinics, outpatient clinics and from the University Children's Medical Institute at NUH. In additional to local patients, we also treat many international patients from Malaysia, Indonesia, Vietnam, Cambodia, Myanmar, Brunei, Bangladesh, Middle East, China, Russia, India and Sri Lanka.
Paediatric ENT Clinics
- ENT – Head & Neck Surgery Clinic (Non-subsidised clinic) is located at Kent Ridge Wing 2, Level 3.
- CLF (Subsidised clinic) is located at Main Building 1, level 1.
Both clinics see paediatric patients everyday of the week (except Sat and Sun), from 9am to 1pm and 2pm to 5pm.
Non-subsidised patients may choose to see other ENT consultants not within the Section of Paediatric ENT of ENT Department.
Some common Paediatric ENT concerns
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Kids Hearing
Hearing loss is one of the most common congenital disorders. Early detection and management of hearing loss is crucial for the best speech, learning, and social development outcomes.
Our friendly team of audiologists, auditory-verbal therapist and ENT surgeons provide a one-stop service to our patients. At NUH, children as young as a few hours old are screened for hearing loss using specialised tests, such as the Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR). Genetic testing for hearing loss is available.
A complete range of conventional, digital and bone conduction hearing aids is available. Surgery may be needed to insert grommet tubes, remove tumors, widen external ear canals, repair ear drums and abnormal or diseased ear bones, or reconstruct abnormally shaped or absent ears. Bone anchored hearing aids and bone anchored prosthetic ears are also possible. Middle ear implants can be used for middle ear problems and also sensorineural hearing loss when hearing aids fail. Nowadays, a cochlear implant device surgically placed into the inner ear allows profoundly deaf children and adults to hear. Auditory-verbal therapy and language therapy post- implant is available here.
Some children with normal hearing tests may still complain of hearing loss. They may be mistakenly diagnosed as lying, badly behaved or autistic. In fact, they may have disorders of processing sounds like Central Auditory Processing Disorder (CAPD), or hearing dys-synchronization (Auditory Neuropathy). Special tests are performed to exclude these.
Kids Airway
Noisy breathing, feeding and voice problems often co-exist. A flexible nasoendoscopy and airway X-rays can diagnose the site of obstruction in the clinic. Our speech and swallow therapist assesses for related voice and feeding problems. A rigid bronchoscopy under general anaesthesia may be needed. Where possible, we attempt decannulation of tracheostomy so that the child can breathe, speak and socialise normally. Complex airway reconstruction surgery with rib grafts, stents, and resection-anastomosis surgery is available.
Kids Nose, Allergy and Sinusitis
Nose block, discharge and itch, sneezing and epistaxis are common complaints in children. Various kinds of food and environment allergies can be excluded by skin, food elimination and blood tests by our allergy nurses. Comprehensive counselling on allergen identification and avoidance is given. If necessary, flexible and rigid scope by the ENT is done to exclude tumors, infections and congenital nasal problems.
Besides medications, oral sublingual immunotherapy is also available for de-sensitisation. Minimally invasive functional endoscopic sinus surgery (FESS) is done for severe persistent sinusitis failing medication, with image guided systems for increased safety.
Kids Snoring and Sleep Apnoea
Snoring is not just a social problem, some snorers stop breathing during sleep. Increasingly, snoring has been linked to poor concentration, learning and IQ; problems related to behaviour, heart, blood pressure, weight and growth; nightmares, asthma, and even sudden death. In children, the most common cause is adenoid and tonsil enlargement. However, a nose, throat or craniofacial growth cause is possible too.
To determine the severity of the condition and to exclude a central brain cause, a children sleep study will be performed by our Paediatric Respiratory Medicine Service.
Treatment may involve weight and diet control at the Obesity Clinic, night-time masks delivering pressurised air, obturators or surgery. Surgery may involve removal of enlarged tonsils and adenoids, radiofrequency reduction of nose turbinate swellings, laser or conventional soft palate surgery, and tongue base advancements. Craniofacial disproportions may require facial advancements by our Plastic & Neurosurgeon colleagues.
Unintelligible Speech Service for Resonance Disorders
Unintelligible speech may be due to an undetected hearing loss or disorders of language, articulation, voice and resonance. A resonance problem, in particular, is easily missed and there is a lack of awareness among the public that this can be helped. Resonance disorders include hypernasal speech, hyponasal speech or a combination of both.
Hypernasality is commonly associated with children who have a cleft palate. However, many children and adults with poor oro-facial muscle tone, craniofacial disproportions and short, scarred or undetected hard palate defects may have velopharyngeal insufficiency or incompetence (VPI) that results in hypernasality and reduced speech intelligibility. VPI is also sometimes due to very large tonsils, or may be revealed after adenoid surgery.
After a general ENT examination to exclude hearing loss, mouth, tongue and voice problems, a small flexible scope is passed through the nose to visualise the movement of the soft palate during speech. Many patients benefit from speech therapy and may never need surgery. However some may need surgery to correct the problem.
For appointment, click here.
Click here to read more about Department of ENT, Paediatric ENT Section.
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