Pediatric ENT Program

Pediatric ENT Program: "Comprehensive and Personalised Care for Children with Ear, Nose, Throat and Airway disorders "
To provide unparalleled care for the little ones, we have a team of Pediatric trained ENT surgeon, Pediatric Intensivists, Anesthetists,Pulmonologists, Pediatricians ,Psychiatrists and various other specialities like Audiologists, Speech and Language therapists, Occupational therapists, Physiotherapists,Psychologists and Special Educators to name some.

Our program of pediatric ENT is unique as our team specialises in managing all Pediatric ENT conditions from Adenoid and tonsil surgery to Cochlear implantation to Airway surgeries.

Common Conditions we manage are

• Tonsil and Adenoid Hypertrophy
• Ear infections and hearing loss
• Chronic ear infections and cholesteatoma
• Allergies and Sinusitis in children
• Noisy breathing and snoring in children
• Sensorineural hearing loss and Cochlear Implantation program
• Congenital Airway Problems and Airway surgeries
• Hoarseness and Voice disorders
• Head and Neck masses and Swellings
• Foreign bodies in the aerodigestive tract
• Swallowing Assessments in babies and swallowing therapy

I am an ENT surgeon who has established my pediatric ENT practice in Bangalore for over a decade working with pediatricians, various interdisciplinary specialists, therapists and parents. 

​Virtual Visit to the Center and maps at:

https://plus.google.com/u/0/+DrSheelusENTandCochlearImplantCenterBengaluru/about

https://childrenentdoc.com/

I am based in the private sector as Consultant ENT surgeon since 2006  and running my own ENT Center with Deafness habilitation services. Since 2006, I have also  worked with various pediatric units like Indira Gandhi Institute of Child Health, Spastics society of Karnataka and National Rural Health Mission updating and upgrading pediatric ENT services.

​https://www.linkedin.com/in/sheeluchildrenentdoc/

 

I am pleased to say that approach of improving opd diagnosis is very popular among the pediatricians. We regularly perform opd based airway assessments in children and have popularised flexible nasoendoscopy in children.

Our pilot of Universal pediatric hearing screening was the first universal hearing screening pilot under NRHM and was presented to secretary to health, Government of Karnataka. I introduced Swallowing assessments in children at spastics society and regularly assesses babies who had long NICU stay and are tube fed. Our team has weaned many babies off the feeding tubes.

I have worked relentlessly with NGO’s, Anganwaadi’s and Rotary for pediatric ENT assessment. I believe in providing end to end care. All children are followed up and help for treatment and habilitation.

Dr Sheelu’s ENT Center has been one of the finalists for BMJ Asia Healthcare Awards in 2015.

My mentors in India and abroad include the doyens in cochlear implantations and pediatric airway surgery. With their support and training, we want to make difference in the lives of many more children....

I also volunteer as “Shikshika” for Balbharathi of my local community and make use of  opportunity to spend time with children eg. Volunteer at Bannerghetta Biological Park. I regularly participates in charity events to raise awareness for Pediatric ENT cause.

And finally, I thank God for giving me this wonderful opportunity to work with the kids.

  

Importance of the nasal breathing in children

Babies are nasal breathers and do not know how to breath through the mouth when they are born.
At birth, human babies are obligate nasal breathers.

Breathing through the nose enables adequate facial growth and proper positioning of the teeth. It also leads to calm and restoring sleep.

Noisy breathing or snoring is not normal in children. The commonest cause of nose block is allergic rhinitis. A child with blocked nose leads may have bad breath and suffer with sinusitis more frequently. Also these children are less interested in eating as they cannot smell food and hence enjoy it.
Another common cause of mouth breathing in children is Adenoid hypertrophy or Adenoid enlargement. These are lymphoid tissues like tonsils in the space at the back of the nose. The size of adenoids is usually confirmed with a nasoendoscopy.

Breathing through the mouth can cause the following

• Unexpressive face; 
• Changes in positioning of the teeth; 
• Dental caries; 
• Aesthetic facial alterations (elongated face, hypotonic lips);
• Gritting or grinding of teeth (bruxism); 
• Sleep disorders (superficial or restless sleep); 
• Attention deficit or learning disorder; 
• Mood swings.

Read more on allergies,sinusitis and adenoids in the following links:

http://sheelusrinivas-entpractice.blogspot.in/2013/01/allergen-avoidance-is-it-worthwhile.html

http://sheelusrinivas-entpractice.blogspot.in/2017/01/sinusitis-in-children.html

http://sheelusrinivas-entpractice.blogspot.in/2015/05/removal-of-adenoids-and-tonsilswhich.html

When to consult an ENT Doctor for my child?

"Your child's Pediatrician is the primary care provider and incharge of your child's health."

Parents should consult a Pediatric ENT only if the child's Pediatrician has suggested them to do so.

Pediatric otolaryngologists are concerned with treatment of medical and surgical ENT disorders in children. They have been trained to take care of children from newborn period to teenage years.

Children are not just small adults.The disease presentations and management can differ from adults.Right from the clinical approach for diagnosis differs in children.It needs specialised training and experience in working with children to keep them comfortable while examining them.

A child will not always be cooperative and will not be able to answer medical questions or express their problems. Sometimes they have their own ways of expressing concerns. I cannot forget a 3 year old telling me her ears are "singing" and we did go ahead and found a cause.

If we learn to interact with kids, they are also capable of giving information.They may not answer direct questions or get overwhelmed with questioning.

Interaction with the child is a must for a pediatric otolaryngologists as child is the one who needs attention.This is especially useful in diagnosing social and communication disabilities.Many times parents are in denial or do not know age appropriate behaviours,in these situations direct interaction with the child is a must.

All of the above requires experience,skill and judgement with the team including the primary treating pediatrician.

Finally be a child with the child....and the doctor for the family.

Preschool Health Screening: Is it necessary and what does it involve?

Schools have started and I have started getting visits of little ones whose parents are advised to see ENT doctor following the childs health screenings in school.

 Preschooler

There are a few points about school/pre school health screenings,I would like to discuss here.

Before we start, lets talk about "Neural Plasticity" and 'Critical Period" 

During early period of life, neurons in brains are moldable (plastic) and it is easy to teach any skill to a child. Once the child is above 5 years,it is difficult to do rehabilitaton and bring them age appropriate. Hence we say that the critical period is the early infant or toddler years.

Let me take you through some common questions asked by parents:

1. Preschool screening: Is it mandatory? Should it be made mandatory by law?
My toddler has been visiting pediatrician regularly,why another screening?

The pediatrician is definitely your child's primary physician.When you visit a pediatrician in well baby clinics/immunization clinic, usually they record the growth and development of the child.
However, there are other aspects of development like speech,language,cognition,social and emotional behaviour.
In many parts of the world,it is mandatory by law.

2. Parent permission is compulsory for any screening.

3. Child's birth records and health records should be available during screenings.This is for the screening practioner to understand the child's growth (age appropriate) or to make provisions for any insults at birth and need extra time required to achieve age appropriate milestones.

4. Who should do it?
A health practitioner or a registered nurse trained in screening.

5. What does it involve?
Apart from physical examination and interacting with the child, they may also plan some activities (like blocks/scribbling etc age appropriate)

6. What are the components in a standard screening?

Eye contact, motor control and body language in a typical kindergardener

Any screening should involve hearing and vision tests.Apart from this: motor development,language development (mother tongue or a language which is spoken at home around the baby),social emotional development and cognition is informally checked.

7. Will they "label" or diagnose my child?
No! its only a screening.If there is any concern, child will be sent to appropriate specialists for confirmatory diagnosis or sometimes only a re screening is advised.

8. Should I be rest assured if my child passes screening for any future health or disability issues?
No.If at any time parents have concerns about the child's growth or development, tey should bring it to the notice of pediatrician who can advise you further.

9. Finally and most important, screening should be done as early as possible,We have better chance of correction and treatment early, best being a child below 3 years of age.
This will give us enough time for intervention and make the child school ready.

10. My child is shy and will not allow screening?
The health practitioners are trained to handle kids and very well trained that each child is different.

Vertigo in Children

Vertigo in children is uncommon.The attacks of vertigo in children may be less dramatic than adults,however they cause severe anxiety if a diagnosis is not reached and appropriately explained.

The clinical diagnosis involves accurate history which many adults are not capable of giving.The reason I say so is that the terms "Vertigo" "Dizziness""Giddiness" and "Imbalance" are very commonly used without proper understanding by adult patients,let alone poor child!
When a child presents with vertigo, we also need to keep in mind their distractibility,coordination capabilities and behavioral problems.Also the compliance in pediatric population to perform otoneurological examinations is limited

Let us go through various terms commonly used by patients or parents.
Dizziness can be used to explain different sensations like lightheadedness, Fainting or Syncope, Giddiness (when engaging in activities like spinning) or Vertigo.

Vertigo is a sensation of spinning (either we feel spinning or the surrounding is spinning).It can be associated with nausea,jerky eye movements,headache,sweating and ringing in the ears or hearing loss.

Vertigo is an uncommon complaint in children and adolescents.Despite the most significant technological achievements in the development of diagnostic tools like scans and audiology, diagnosis is still based mainly upon the patient’s history and physical examination.There could be history of migraine or vertigo in the family.

The child's pediatrician may refer to Pediatric ENT for further otologic and audiologic evaluation.If required, the child may be seen by neurologist for evaluation.

There have been various scientific studies about the etiologies or causes of vertigo in children.The common causes of vertigo or the differential diagnosis includes Migraine associated vertigo or variants,Benign Paroxysmal Vertigo, Otitis Media and rarely other inner ear pathologies.

It is worth mentioning about "Motion Sickness" here.
It is a clinical phenomenon provoked by passive locomotion or movement of the visual environment only.It consists of pallor,tiredness,weakness,hypersalivation,nausea and emesis.

Diagnosis should be followed by adequate symptomatic treatment and management of underlying etiologies.The success of treatment of vertigo lies in regular follow up.