Friday, April 2, 2021

FUNCTIONAL DISORDERS MANIFESTING AS ENT SYMPTOMS AMONG KIDS

ENT Consultants sometimes have paediatric patients, who come with certain  symptoms but detailed examination and investigation reveals no pathology. So in such cases we have to look upon the possibility of functional disorders. 
WHAT ARE THE SYMPTOMS ? 
Children may have various complaints, of which ear complaints are, pain in the ear , ringing sensation, hearing loss, balance problems. After ear examination , audiological and radiological evaluation, everything  may be normal. 
Neck and throat complaints are difficulty in swallowing, neck pain, difficulty or pain during talking. Sometimes they will complain about breathing difficulty or stomach pain. 
HOW TO DEAL WITH SUCH PATIENTS ? 
Great deal of patience and  time is needed as for the kid their symptoms will be real. Detailed  history  to be taken, in order to find out any issues or problems kid is facing .it could be at school, or any fight between siblings, parents ,family members or friends. Sometimes it could be  because of  arrival of a new baby and constant attention given to the newborn or bullying by school mates . The changes that occur during puberty or adolescence also have an impact on kids health and wellbeing. 
WHAT HAS TO BE DONE  ? 
Have a nice rapport with the kid. Detailed history, thorough examination, audiological and  radiological investigation and sometimes endoscopy may be needed,  before arriving at a diagnosis of functional disorder. Explain the condition to the parents  and reassure them. Sometimes these kids may need psychological evaluation as there will be anxiety and depression problems too. 
MANAGEMENT depends upon individual kids. Some of them require only reassurance, emotional support and counselling. Few may require further follow up. 
 Once in our emergency department an adolescent kid came  with sudden loss of voice and vocal cords (sound box) were normal on examination and after talking to the kid  further,  she told me about the teasing she had to face from her neighbors for getting low marks in a subject. Her way of response was to stop talking altogether. Other instances they complaint about stomach ache and refuse to go to school for the fear of bullying or scolding from the teachers. 
This topic was chosen to create awareness about this  problem. We  should  give time for these kids to open up and should show compassion towards the kid and  his or her parents also. 

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