Back to School—Part 2: ENT Health

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Okay, counting down. Claire has meet and greet this Friday, and first day of school is Aug 15! I am always conflicted this time of the year, happy that she will start school and that we’ll get back into a routine, but also anxious because we have to get back into a routine.

Let’s talk about other Back to School Health—ENT related topics so that your child is set up to have as healthy and academically successful school year as possible. Dave pointed out to me that perhaps my blogs are too long and boring the readers. I will listen to him and try to write shorter, more frequent, blogs that get straight to the point. Last week I focused on quality and duration of sleep and making sure that your children are not snoring or having poor sleep because of enlarged tonsils and/or adenoid as the cause for less than perfect nighttime breathing. Now, let’s focus on vision and hearing.

If an otherwise healthy kid happens to have some fluid trapped in the middle ear space, and enough to cause mild conductive hearing loss, then that’s not a good way to start the school year. While a little bit of middle ear fluid behind the ear drum certainly does not make anyone deaf or have significant hearing loss, enough fluid behind the eardrum with some negative pressure can negatively impact your child’s listening especially in settings where there is much background noise (that would pretty much be the classroom, playground, soccer field, or anywhere you find many preschool and school aged children). Chronic fluid in the middle ear is called Otitis Media with Effusion. 

How did the fluid get there? Any preschooler who gets a viral upper respiratory track illness (a cold) is at risk of having an acute ear infection at the same time, when virus and bacterial go from the nasal passage up the eustachian tube into the middle ear space. Even after the acute infection is over, the fluid may stick around for several weeks. If the fluid does not clear, it is a “plumbing” that medications can’t fix, and either it goes away with time or this is when ENTs may recommend ear tubes, especially if there is measurable conductive hearing loss and fluid has been around for more than 3 months. If you’re interested read the most recently published clinical practice guidelines from consensus by the American Academy of Otolaryngology-Head Neck Surgery, American Academy of Pediatric, and American Academy of Family Physicians on when tubes should be recommended.

So, bottom line, if your child has been speaking very loud, and always says “huh” and you are tired of repeating yourself many many times, instead of believing it’s just “selective hearing”, please have your primary care provider take a good look at his/her ears/eardrum, and even do a office hearing screen (tympanometry) to make sure that they don’t “fail” the screen. If the child fails, you definitely should take your kid to see an ENT and get a formal audiogram (hearing test done by an Audiologist in a sound booth or with other specialized equipments). Along those lines, TV turned up loud, history of not “listening” according to the teacher, and less than stellar school performance or attention span, making sure that the child has normal hearing is absolutely critical to ensure a great school year.

Even though I am not an ophthalmologist (eye doctor, a medical doctor/MD to be distinguished from an optometrist, who is an O.D., Doctor of Optometry), making sure a child has normal vision, or has correction for his/her vision if necessary, is certainly important to ensure a great school year. For your child’s annual well visit or check-up, or back to school history and physical, ask your primary care providers about vision checks. If you think your child may have problems with his/her vision, or if he/she has expressed that they can’t see very well, absolutely make sure your child gets a formal and complete vision exam. As a Pediatric Sub-Specialist, I am certainly biased in that you should make sure whether you take your child to an optometrist or ophthalmologist, you want to make sure that the person doing the vision check has lots of experience working and testing children. If there are additional problems it is very beneficial to o have a formal evaluation by a pediatric ophthalmologist if you have access to one. Children may have near or far-sighted vision, like adults, and if a formal vision test is not done then correction will not occur and then it’s hard to expect a child to see what is on the “smart board” or traditional chalk board/instruction board at the front of the classroom.

Okay, vision, hearing, and breathing have been assessed. Now what? I will write a separate blog about the next and big hurdle…nutrition and lunches!


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