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Hot Topic Blog - Oral/Pharyngeal Sensory-Motor, Orofacial Myofunctional, & Airway Information


By David McIntosh; MBBS, FRACS, PhD; Paediatric ENT Specialist; Associate Professor, James Cook University in Australia

April 2017


Contemplate this child's story. It is so easy for children to fall through the cracks, whether it is due to medical complacency, ignorance, or arrogance. Please make sure every parent knows that snoring and mouth breathing are signs of potential low oxygen levels, which is not good for children’s brains and general wellbeing. 

Master D is an 11 year old child who has had long standing learning and behavioural problems. He is currently under the care of a paediatrician. His parents have been worried about poor sleep, mouth breathing, and concentration problems. A plan had been suggested to start Ritalin to see if this would help his behaviour. 

Shortly after this visit to the paediatrician, Master D and his parents saw the dentist for a routine visit. There was a new dentist working at the clinic that day, and she took a very active interest in Master D's story. The family discussed their concerns, highlighting his snoring and chronic mouth breathing. The dentist indicated she could see changes in his teeth and jaws that may be a result of chronic mouth breathing. She offered to refer him to an ENT (Ear, Nose, and Throat Physician) but advised they would need to travel to see one who had an interest in airway problems and was pro-active in fixing these problems. 

His parents were very relieved that someone had taken their concerns seriously and were more than prepared to drive 500km one-way to do so. Two days prior to departing to see the ENT, the family had a follow up with the paediatrician. They informed him they were going to defer the trial of medication until after the ENT consultation. The family were then quite taken aback when the paediatrician said to parents they were wasting their time seeing an ENT, there was nothing wrong, and the ENT would say to just let him outgrow it. 

Determined to follow through and see for themselves, the parents and child followed through with the ENT visit. After a 6-hour drive, they saw the ENT that afternoon. A careful history was taken, and within a few minutes of a simple examination, Master D was diagnosed with large adenoids, a deviated septum, and large inferior nasal turbinates. He was scheduled for Category 1 surgery by the ENT. 

After the surgery, the parents and school noticed dramatic changes. He slept better, had better focus and attention, and interacted better with those around him. His paediatrician was impressed by the changes and made contact with the treating ENT to learn what he had done that resulted in such changes. More patients then started to follow the same pathway as Master D, driving 6 hours to see the doctor that just wanted to help. 

About the Author

Associate Professor Dr. David McIntosh of ENT Specialists Australia was kind enough to write this month’s blog. David also contributes to Facebook groups collaborating with other specialists who manage breathing problems in kids. They talk about mouth breathing, and David contributes amazing knowledge about how mouth breathing can lead to serious heart problems. David has kindly contributed this blog in the hope that parents will take a more proactive role in finding breathing problems in their own children and insist doctors take their concerns seriously.

David is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development and its relationship to ENT airway problems, and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. He is passionate about Indigenous Health. And, he has undertaken advanced surgical training in ENT and Head and Neck Surgery and Paediatric training at Starship Children's Hospital in Auckland, New Zealand. He is the author of Snored to Death: Are you dying in your sleep?

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