Endoscopy of the airway in children
It may be necessary to examine your childs airway with a fibreoptic endoscope (camera).
Whilst this sounds like a difficult thing to do in a child, they in fact cope remarkably well.
The procedure involves placing some local anaesthetic on some cotton wool in the nose which remains for about 20 minutes. This does not hurt but can make the nose feel blocked and leave a slightly bitter taste
The procedure is carried out with a nurse holding your child with an arm around their arms and one across the forehead. The endoscope is very small (2.4 mm in diameter) but can feel a little strange and uncomfortable. However the procedure only lasts a few minutes. If you are happy to hold your child yourself and not have a nurse that is fine – please inform your doctor of your wishes.
The findings of the examination are captured on video and played back to you after the procedure.
There are no real side effects of having this done other than the taste from the anaesthetic, the distress of being held and the potential gag reflex.
Rigid endoscopy through the mouth is a similar procedure but without the anaesthetic in the nose. This examination is particularly useful for examination of the vocal folds but is more suited to older children.
The patient is asked to stick their tongue out and this is held by the examiner. A rigid scope which has an angled lens is passed over the tongue and a view of the back of the throat and voice box is displayed on a screen.
For patients with throat or voice issues this is the preferred examination to flexible endoscopy.
Please not that we take infection control very seriously and our endoscopes are cleaned after each procedure with the Tristel wipe system that is recognised by our professional association ENT UK.
Microscopic examination and procedures of the ear
The microscope provides magnification which allows a detailed examination of the ear. This is sometimes necessary to check the tympanic membrane and middle ear structures.
Sometimes a suction device is used to clear the ear of wax or infection. This is not a painful procedure but can be noisy and unsettling for children. It may be necessary to restrain a child whilst performing the examination.
When trying to remove a foreign body from the ear it is essential that child remains still during the procedure to avoid the risk of damage to delicate ear structures. Usually the first attempt is the one most likely to achieve success and a quick procedure with restraint is preferable to a general anaesthetic.
Nasal cautery is a procedure undertaken to seal a blood vessel in the nose that is causing recurrent nosebleeds.
A topical local anaesthetic is applied on cotton wool and placed in the nasal cavity for about 15 minutes. After removing the cotton wool the vessel to be cauterised is identified. A silver nitrate stick is applied around the vessel until it has sealed.
The procedure is not usually painful but may "sting" a little.
The silver nitrate reaction produces a dark grey fluid reaction which can stain the skin temporarily. It is best to apply some cotton wool in the front of the nose to reduce the risk of this happening.
Bleeding can occur when the ":scab" comes away and it is important not to itch or pick at the area.
Antibiotic cream is prescribed after the procedure to be used for 5 days. The patient is advised to avoid contact sports, hot baths and not to fly for the following 10 days.
Taking oral steroids - what can you expect?
Although the dose of steroids that you have been prescribed seems like a lot as it is a reducing course over 8 days there are unlikely to be significant side effects. However the steroids do make patients feel quite "hyper" and "edgy" s well as hungry. Sleeping may be difficult and it is best to take the steroids in the mornings if possible.
For those patients with reflux disease, diabetes or hypertension, these may be made worse by the steroids.
Steroids can have an effect on emotion and mood and you may wish to let your family know this. Whilst often patients have a sense of euphoria they may also become emotionally labile.
Weight gain with a short course is unusual.
Very rarely one can develop a reaction to the steroids where the blood supply to the hip can go into spasm and if there is any hip discomfort the steroids should be discontinued immediately.