Parents are constantly looking for that one pill or supplement that will help boost their child's immunity.
Now, consultant ear, nose and throat (ENT) specialist Dr Lim Wye Keat says it's better to expose your children to germs to help them build up a natural immunity to bacteria and viruses.
He thinks it's counterproductive to protect your children from the common cold by using face masks and preventing them from going to school.
“In my opinion, it will be a disadvantage as infection with the otherwise harmless common cold virus only serves to boost the child’s immunity,” he says.
“How does one expect to have a strong immunity? Vaccines? That’s artificial. Vitamins? Waste of money. Nothing truly replaces real-life training!” he emphasises.
It has been observed by epidemiologists that allergic rhinitis and other allergic diseases have increased in incidence over the last few decades. One theory, he says, is the hygiene hypothesis that has been put forth to explain the dramatic rise in incidences. In fact, this theory is a favourite of Dr Lim's.
“Basically, its premise is that a child’s immune system needs real-life germs to fight, meaning viruses and bacteria. Our society is now cleanliness-obsessed, with a million cleaning agents to kill 99.99% of germs. This overzealous approach has then denied the child’s immune system of the real-life encounters it needs. I stress once again, nothing beats real-life training. The child’s immune system consequently turns on otherwise harmless antigens like dust mite and animal hair. In other words, we are making an enemy of something that would not have harmed us in the first place,” he says.
Dr Lim says parents who want to prevent allergy should let their children run around barefoot and use a little less cleaning agents!
Glue Ear
Among the ENT problems common in Malaysian children is glue ear (or otitis media with effusion) or middle ear effusion. Parents should also look out for allergic rhinitis and obstructive sleep apnoea.
Dr Lim, who specialises in children's ENT problems, did his fellowship at Melbourne's Royal Children's Hospital from 2001 to 2002.
“For the ear, a common problem with children is glue ear, or middle ear effusion. This is mucus accumulation in the space behind the eardrum that is the consequence of a middle ear infection. This condition is common in both Malaysian and Australian children,” says Dr Lim.
Glue ear is generally asymptomatic, as it is the expected phase following acute middle ear infection. Common symptoms include partial hearing loss, mild pain, and rarely, mild imbalance. Glue ear is a product of middle ear infection, which in turn, is a product of the common cold.
“The most common cause of hearing loss (partial and temporary) in a child would be glue ear. If there is mild hearing loss only, the child may not say anything, and the parents would be none the wiser,” he explains.
Parents may suspect hearing loss when the television is turned on too loud. A child may not respond when called or only responds when the child can see the caller’s face. One will also notice that the child’s performance at school drops.
However, Dr Lim is quick to point out that if a toddler is slow to speak, it is mandatory to exclude hearing loss.
“If a child can’t hear language, naturally he wouldn’t be able to reproduce language. Historically, severe hearing loss of both ears due to infectious and congenital disease has led to deaf mute children. Fortunately, this is something that is seen less frequently nowadays,” says Dr Lim.
Treatment for Glue Ear
“Glue ear is a natural consequence of middle ear infection. If left alone, it resolves spontaneously within a few weeks. Giving antihistamines, antibiotics and corticosteroids may be useful, but it may not make much difference compared to natural resolution,” he explains.
If the glue ear causes all sorts of problems at home such as poor hearing, pain, behavioural problems or if it persists beyond a few months, then surgery, he says, is justified.
Surgery involves making a hole in the eardrum with or without insertion of a plastic tube. This is called myringotomy and grommet insertion. This is to drain the fluid and to allow air to get through to the middle ear.
“There are drawbacks and risks to surgery, but when benefits outweigh risks, by all means, go for surgery,” he says.
Allergic rhinitis
For those with nasal problems, allergic rhinitis is one of the most common disorders. This is an allergy of the nose, which is related to asthma and skin allergy. In Malaysia, allergic rhinitis is extremely common and is basically allergy to dust mite.
Allergic rhinitis hardly needs any introduction. A child would have blocked nose, often at night in bed or first thing in the morning, sneezing, runny nose and itch. The eyes are often red and itchy.
“There may also be nose bleeds originating from the front part of the septum of the nose. Snoring and disturbed sleep are also associated with allergic rhinitis,” explains Dr Lim.
It is mostly a non-life threatening problem. If symptoms are mild and tolerable, no active treatment is necessary.
“However, if symptoms become a nuisance, or contribute to sleep and breathing disturbances, then one should start on medication. Antihistamines and corticosteroid nasal sprays may be taken separately, in combination or serially. These serve to dampen the immune system’s response, as allergy is basically hyper-responsiveness of the immune system,” he explains.
Although there are fears about nasal corticosteroid sprays, Dr Lim assures they are very safe without any genuine risk to the body. The effect is directly to the nose, and minimal amounts of the steroid actually get absorbed into the body.
“Allergy testing is an area that is, in my opinion, superfluous for allergic rhinitis. I do not see any significance to knowing what a child is allergic to as the treatment is the same, regardless of the allergen,” he emphasises.
The medications for dust mite allergy, animal hair, pollen, fungus and other allergens are exactly the same: Antihistamine orally and nasal steroid sprays.
However, Dr Lim says allergy testing may be useful in the case of asthma and skin allergy.
“Avoidance and allergen load reduction strategies are great in theory, but not so great in practise. It’s pretty difficult to avoid allergens that can only be seen with a microscope. Washing mattress sheets in hot water every week is often advised, but that often takes too much time. Vacuum cleaners and air-filters are way too expensive to be cost-effective,” he says.
Surgery for allergic rhinitis only serves to relieve nasal obstruction. At no time does surgery “cure” allergy, explains Dr Lim. The runny nose, sneezing and itch will persist, despite surgery.
Adenotonsillar Hypertrophy and Obstructive Sleep Apnoea (OSA)
This is in relation to children with throat problems. When the tonsils and adenoids, which are located at the back of the tongue and back of the nose respectively, are enlarged, the upper airway is narrowed and predisposes the child to snoring and breathing difficulties during sleep.
“Adenotonsillar hypertrophy is a major factor leading to obstructive sleep apnoea. Big tonsils can often be seen by the child’s parents. Snoring, difficulty and struggling to breathe, long pauses in breathing, and daytime sleepiness or hyperactivity are symptoms of OSA,” he says.
Obstructive sleep apnoea is largely due to big tonsils and adenoids. These two are collections of lymphoid which enlarge when there is an infection.
“Obesity in children does make OSA worse. Preventing obesity in children is a mammoth task for the community at large. So, to prevent OSA, prevent obesity as well,” says Dr Lim.
Unfortunately, obstruction of the upper airway is often made worse by allergic rhinitis and sinus infections. If parents are concerned about their child’s snoring and disturbed sleep, Dr Lim often recommends treatment directed at the nose first, as explained for the treatment of allergic rhinitis.
“From my experience, steroid sprays when applied daily shrinks any swollen obstructive tissues within the nose, and improves the airway well enough to avoid surgery,” he says.
Surgery for OSA in children is often the removal of the adenoids and tonsils, or adenotonsillectomy.
When to see a doctor
Glue ear, allergic rhinitis and obstructive sleep apnoea are not immediately life-threatening conditions. At worse, each of these conditions affects the quality of life. If parents are concerned that their children are sleeping badly and are cranky during the day, then they should take them to a general practitioner, paediatrician or ENT specialist.
“No one ever died from a blocked and runny nose. At worse, OSA for many years in adults may lead to high blood pressure, heart attacks and strokes. In children, OSA mainly affects wakefulness during the day,” says Dr Lim.
How to care for the ear, nose, throat
The ear, nose and throat have natural cleaning processes. The wax of the ear canals are carried out by a natural conveyor belt system. The nose and sinuses have the cilia of the mucosal cells, fine hairs that carry mucus and germs out. The throat’s phlegm is often washed out by the water and food we consume, going into the stomach.
Dr Lim recommends using seawater sprays for the nose as it has no side effects.
“Seawater is basically saline. It is natural and helps to make mucus and crusting in the nose more fluid, and therefore easier to be carried out. Basically, it acts as a flushing agent,” he says.
“For the ears, do not use cotton buds to clean the ear canals. Malaysians, by and large, love to clean the ear canals, because of the obsession with cleanliness and the perception that ear wax is dirty. Wax is just a natural product of the skin of the ear canal, no dirtier than the hair that sprouts from our scalps,” he says.
In fact, cotton buds, he says, often push the wax deeper inside, resulting in wax impaction, hearing loss and occasionally pain. The general rule is, don’t disturb your kids' ears!
Using headphones and earphones
In the last 30 years, people have had access to music at almost any time thanks to earphones. However, in the last 10 years, we are seeing the younger population listening to music almost constantly.
“The pathology here is noise-induced hearing loss due to excessive noise damage to the nerve receptor cells of the cochlea. This was previously associated with industrial loud noise exposure over many years, for example military personnel and factory workers. But the amount of noise delivered to the sensitive ears of the young has also increased tremendously,” he says.
“I am aware of some studies that have strongly suggested that noise-induced hearing loss does occur too in the young. I believe that deafness will be more prevalent among young adults, not necessarily to the degree of needing hearing aids, but still bad enough to be symptomatic or problematic,” he says.
The bottom line is to use earphones sparingly and to watch your child closely for recurring ear, nose and throat infections.
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