ENT Problems in Children: When to See an ENT Specialist
Earache, reduced hearing, snoring, mouth breathing and frequent throat infections are the most common ear, nose and throat (ENT) problems in childhood. Most settle on their own or with simple measures, but some can affect hearing, speech development, sleep and school progress and need an ENT assessment.1,4
This guide summarises the situations parents ask about most, which symptoms can be watched, and which ones need an examination or urgent care.
Key points
- Ear infections: most get better on their own within 3 days; earache that has not improved after 3 days, repeated infections or suspected infection in a baby under 12 months need a doctor.2
- Glue ear (fluid in the middle ear): causes temporary hearing loss and usually clears within 3 months; if it lasts longer, hearing tests are considered.1
- Snoring and pauses in breathing: the most common cause in children is enlarged tonsils or adenoids.4
- Tonsillitis: usually lasts 3 to 4 days; surgery is considered only for frequent, severe episodes that meet set criteria.3,5
- Any concern about hearing should be checked; long-lasting hearing loss can affect speech and schooling.1
Earache and middle ear infections
In children an ear infection causes earache, a high temperature, reduced hearing, discharge from the ear and a feeling of pressure or fullness. Babies and young children who cannot describe pain may rub or pull at the ear, not react to some sounds, be irritable or restless, eat less or lose their balance.2
Ear infections often get better on their own within 3 days, although symptoms can sometimes last up to a week. Paracetamol or ibuprofen ease the pain; children under 16 should not be given aspirin. Do not put cotton buds or fingers in the ear, and keep water out of it. There is no evidence that decongestants or antihistamines help ear infections.2
Glue ear: fluid and hearing
Glue ear is fluid filling the middle ear and is much more common in children. The main symptom is temporary hearing loss, often in both ears; earache, ringing in the ears and balance problems can also occur. If it lasts a long time it may affect a child’s speech development and progress at school.1
Signs that a child may not be hearing well include speaking loudly, being hard to understand, often asking people to repeat themselves, turning the TV up loud, struggling to hear people far away, being easily distracted and finding listening tiring.1
| Option | When and for whom |
|---|---|
| Watchful waiting | There is no effective medicine and most cases clear within 3 months, so monitoring comes first1 |
| Autoinflation (blowing up a balloon through the nose) | May help fluid drain while waiting; not usually recommended under 3 because it must be done several times a day1 |
| Hearing tests | When glue ear lasts more than 3 months1 |
| Temporary hearing aids | One of the two main hospital options1 |
| Grommets | Small tubes placed in the eardrum drain the fluid; they usually fall out naturally within 6 to 12 months1 |
| Adenoid removal | Occasionally recommended1 |
Children with Down’s syndrome or a cleft lip and palate are less likely to recover on their own and are assessed earlier.1 Antibiotics are used only if glue ear leads to an ear infection.1
Snoring, mouth breathing and adenoids
Regular snoring, pauses in breathing, unusual sleeping positions or frequent waking at night can be signs of obstructive sleep apnoea. During the day there may be sleepiness, poor concentration and school problems, morning tiredness, refusing breakfast, poor growth and weight gain, and in younger children hyperactivity or aggression.4
The most common cause in children is enlarged tonsils or adenoids. An overnight sleep study is the main investigation, and removing the adenoids and/or tonsils is the most common treatment; nasal sprays, orthodontic treatment and weight management are among the other options.4 Read more in enlarged adenoids in children.
Frequent sore throats and tonsils
Tonsillitis is common in children, and symptoms usually go within 3 to 4 days.3 Tonsillectomy is not offered simply because of a few episodes: it is considered when episodes are disabling and there have been 7 or more documented episodes in one year, 5 or more a year for two years, or 3 or more a year for three years.5 Keeping a record of episodes and missed school days makes the decision much clearer. See when is tonsillectomy needed for details.
When to see an ENT
An ENT assessment is sensible if your child has:
- earache that has not improved after 3 days, or repeated ear infections;2
- suspected hearing loss, or glue ear lasting more than 3 months;1
- delayed speech or difficulty listening at school;1
- regular snoring, pauses in breathing during sleep or constant mouth breathing;4
- frequent, severe episodes of tonsillitis;5
- a long-lasting blocked nostril on one side or smelly discharge from one side (see one-sided nasal obstruction).
Parents also often ask about prominent ears; for timing, see the best age for otoplasty.
When it is urgent
Get same-day medical advice or call emergency services if:2,3
- your child seems generally unwell, has a very high temperature or is shivery;
- there is swelling around the ear or fluid coming out of it;
- there is new hearing loss, vomiting, dizziness or a severe sore throat;
- a baby under 12 months has pain in both ears;
- your child cannot swallow, is drooling, cannot open the mouth or is struggling to breathe.
What happens at the appointment
The eardrum is examined with a small lighted instrument; fluid in the middle ear can usually be seen this way, and the examination should not be painful.1 Hearing tests can show how severe any hearing loss is and what is causing it.1 The nose, adenoids, tonsil size and sleep history are assessed together; for snoring, a short video of your child sleeping is very helpful.
Frequently asked questions
Does my child need antibiotics for an ear infection straight away?
Not always. Ear infections often get better on their own within 3 days; the doctor decides on treatment depending on the cause and which part of the ear is affected.2
Does glue ear cause permanent hearing loss?
The hearing loss from glue ear is temporary and most cases clear within 3 months. When it lasts longer, treatment options are considered because of its effect on speech and school.1
How long do grommets stay in?
Grommets usually fall out naturally within 6 to 12 months.1
My child snores every night. Is that normal?
Regular snoring should be assessed for sleep apnoea, especially with pauses in breathing, daytime sleepiness or concentration problems. Enlarged tonsils and adenoids are the most common cause.4
How many episodes of tonsillitis before surgery?
When episodes are disabling, the usual criteria are 7 documented episodes in a year, 5 a year for two years, or 3 a year for three years.5
Should I clean my child’s earwax?
Do not put cotton buds or fingers in the ear.2 If wax is causing a blockage, it can be checked at an examination.
An ENT assessment for your child
Note the dates of ear infections or tonsillitis episodes, the medicines used and any comments from teachers about hearing. For snoring, a short video of your child sleeping is very helpful.
Sources
This article is general information, not a personal diagnosis or treatment recommendation. Seek prompt medical care for urgent symptoms.