Dr Dennis Chua is currently a Visiting Consultant to KK Women’s and Children’s Hospital. He sees paediatric ENT conditions such as snoring and sleep disordered breathing in children, airway problems, sinus conditions, allergies, hearing problems and salivary gland diseases in kids. As one of Singapore’s leading ENT specialists, Dr Chua offers a complete range of specialised ENT treatments.
Dr Dennis Chua is a Kids' ENT Doctor manages allergies in children, a very common condition in Singapore.
Nasal allergies and nasal obstruction are common in children. They present with blocked nose, runny nose and can have disturbed sleep at night. A child may be rubbing his nose and eyes, and have sustained bouts of sneezing. This affects their performance in school and also reduces their quality of life. Allergic rhinitis in children and precipitate sleep apnea which can have serious health consequences. (See Pediatric Sleep Apnoea link)
Prevention is often better than cure. Skin prick testing can be performed in suitable cases to look for possible allergens. This is a simple, painless test and the results will be ready within 30 minutes. Most patients who test positive on skin prick test tend to be allergic to house dust mites. Singapore being a very humid country has a high prevalence of house dust mites and measures to decrease the house dust mites load around the sleeping environment can help. This includes using dust mite-proof covers, washing bed sheets in hot water and sunning them regularly. (Click here for allergen avoidance advice)
Sublingual immunotherapy (SLIT) is an effective treatment for allergies in selected patients and stops the ‘atopic march’ in which allergic rhinitis (nasal allergy) which can lead to childhood asthma. This is a possible treatment in a select group of patients who is committed to receiving the treatment for many months.
Dr Dennis Chua is an experienced pediatric ENT doctor in Singapore that manages little children with snoring.
Tonsils and adenoids are part of the immune system and are considered the “gatekeepers” to the mouth and nose below the age of 2. However, after the age of 2, they have a little useful function. When the tonsils and adenoids are enlarged, they can cause obstruction to breathing. When severe a child has snoring and sleep-disordered breathing from the adenotonsillar hypertrophy, they may appear to snore, choke or gasp when they sleep. This raises the possibility of Obstructive Sleep Apnoea (OSA) which can cause general health problems.
OSA in children has been recognised since the 1970s and since then the effects of paediatric OSA has been well-studied.
Consequences of untreated obstructive sleep apnoea include failure to thrive, enuresis (bed-wetting), attention-deficit disorder, behaviour problems, poor academic performance, and cardiopulmonary disease. Sleep apnoea in children can result in poorer memory and concentration. This can affect the learning ability significantly and can result in poorer academic grades in children. The most common etiology of obstructive sleep apnoea in children is adenotonsillar hypertrophy.
Clinical diagnosis of obstructive sleep apnoea in the clinic is reliable and may not warrant a sleep study if the cause of OSA is obviously from the adenotonsillar hypertrophy. According to the American Academy of Otolaryngology 2011 Clinical Practice Guideline, a sleep study will be necessary in children who have comorbidities such as obesity, Down’s Syndrome, neuromuscular diseases, sickle cell disease or mucopolysaccharidoses. Overall, less than 10 per cent of children who suffer from OSA will need a sleep study before surgery.
In these cases, adenoidectomy and tonsillectomy effectively cures OSA and restores the child’s breathing pattern.
As one of the best Kids' ENT Doctor, Dr Dennis Chua manages patients with tonsilltis or tonsillar enlargement. Most of these patients do not require surgery and can be managed conservatively.
Tonsillitis (infection of the tonsils) is a common infection during childhood. It can result in missed school and if it is recurrent, a significant decrease in the quality of life. A child with tonsillitis frequently presents with fever, sore throat and a loss of appetite. Sometimes there can be associated enlargement of the cervical lymph nodes where there can be tenderness of the neck.
Tonsillectomy (tonsil operation) can be considered when a patient has frequent attacks of tonsillitis resulting in missed school and affecting quality of life. Sometimes, the big tonsils can result in obstructive sleep apnoea and snoring and may need removal as well. Occasionally, asymmetrical tonsils where it is bigger on one side may need a biopsy to ascertain the diagnosis. Lymphoma can rarely present with an asymmetrical tonsil that is bigger on one side. Surgery can be performed safely in a day surgery setting with minimal pain.
Dr Dennis Chua is an experienced Pediatric ENT specialist that sees many patients with fluid in the middle ear.
Glue ears or Otitis media with effusion is a relatively common condition in the paediatric population. This is a condition associated with fluid collection in the middle ear. This is because their eustachian tube (connects the middle ear to the back of the nose) is still immature and is unable to drain out the fluid from the middle ear. Frequently they may have large adenoids that can obstruct the opening of the eustachian tube thereby worsening the problem. Otitis media with effusion can result in hearing loss which can affect speech and language development in a growing child. As this condition is relatively painless, it can often be missed. It is imperative to seek early treatment to avoid any developmental delay sequelae in children with hearing loss.
This is an infection caused by Epstein Barr Virus, occurring usually in teenagers. It is spread by saliva and therefore sometimes known as the “Kissing Disease”. Patients can present with sore throat, fever and fatigue. There are usually associated small neck lumps (lymph nodal enlargements) and the liver can have mild inflammation with raised liver enzymes. Physical examination will reveal white exudates on the tonsils and sometimes on the adenoids as well.
Treatment is symptomatic and in severe infection affecting the appetite, the patient may need to be admitted to the hospital for an intravenous drip for rehydration and steroids. Antibiotics may be given as prophylaxis to prevent a bacterial infection. Even after recovery, patient may experience chronic fatigue for a few weeks after. It is important to ensure the liver inflammation subsides after the infection clears.