COMMON EYE AND EAR DISORDERS

INTRODUCTION: Approximately 11 million Americans aged 12 years and older could improve their vision through proper refractive correction. More than 3.3 million Americans aged 40 years and older are either legally blind (having best-corrected visual acuity of 6/60 or worse (=20/200) in the better-seeing eye) or are with low vision (having best-corrected visual acuity less than 6/12 (<20/40) in the better-seeing eye, excluding those who were categorized as being blind). The leading causes of blindness and low vision in the United States are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Other common eye disorders include amblyopia and strabismus.

REFRACTIVE ERRORS Refractive errors are the most frequent eye problems in the United States. Refractive errors include myopia (near-sightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances), and presbyopia that occurs between age 4050 years (loss of the ability to focus up close, inability to read letters of the phone book, need to hold newspaper farther away to see clearly) can be corrected by eyeglasses, contact lenses, or in some cases surgery. Recent studies conducted by the National Eye Institute showed that proper refractive correction could improve vision among 11 million Americans aged 12 years and older

AGE-RELATED MACULAR DEGENERATION Macular degeneration, often called age-related macular degeneration (AMD), is an eye disorder associated with aging and results in damaging sharp

and central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the central part the retina that allows the eye to see fine details. There are two forms of AMDwet and dry. Wet AMD is when abnormal blood vessel behind the retina start to grow under the macula, ultimately leading to blood and fluid leakage. Bleeding, leaking, and scarring from these blood vessels cause damage and lead to rapid central vision loss. An early symptom of wet AMD is that straight lines appear wavy. Dry AMD is when the macula thins overtime as part of aging process, gradually blurring central vision. The dry form is more common and accounts for 7090% of cases of AMD and it progresses more slowly than the wet form. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. Dry AMD generally affects both eyes. One of the most common early signs of dry AMD is drusen. Drusen are tiny yellow or white deposits under the retina. They often are found in people aged 60 years and older. The presence of small drusen is normal and does not cause vision loss. However, the presence of large and more numerous drusen raises the risk of developing advanced dry AMD or wet AMD. It is estimated that 1.8 million Americans aged 40 years and older are affected by AMD and an additional 7.3 million with large drusen are at substantial risk of developing AMD. The number of people with AMD is estimated to reach 2.95 million in 2020. AMD is the leading cause of permanent impairment of reading and fine or close-up vision among people aged 65 years and older.

CATARACT Cataract is a clouding of the eyes lens and is the leading cause of blindness worldwide, and the leading cause of vision loss in the United States. Cataracts can occur at any age because of a variety of causes, and can be present at birth. Although treatment for the removal of cataract is widely available, access barriers such as insurance coverage, treatment costs, patient choice, or lack of awareness prevent many people from receiving the proper treatment. An estimated 20.5 million (17.2%) Americans aged 40 years and older have cataract in one or both eyes, and 6.1 million (5.1%) have had their lens removed operatively. The total number of people who have cataracts is estimated to increase to 30.1 million by 2020.

DIABETIC RETINOPATHY Diabetic retinopathy (DR) is a common complication of diabetes. It is the leading cause of blindness in American adults. It is characterized by progressive damage to the blood vessels of the retina, the light-sensitive tissue at the back of the eye that is necessary for good vision. DR progresses through four stages, mild nonproliferative retinopathy (micro aneurysms), moderate nonproliferative retinopathy (blockage in some retinal vessels), severe nonproliferative retinopathy (more vessels are blocked leading to deprived retina from blood supply leading to growing new blood vessels), and proliferative retinopathy (most advanced stage). Diabetic retinopathy usually affects both eyes. The risks of DR are reduced through disease management that includes good control of blood sugar, blood pressure, and lipid abnormalities. Early diagnosis of DR and timely treatment reduce the risk of vision loss; however, as many as 50% of patients are not getting their eyes examined or are diagnosed too late for treatment to be effective.

It is the leading cause of blindness among U.S. working-aged adults aged 2074 years. An estimated 4.1 million and 899,000 Americans are affected by retinopathy and vision-threatening retinopathy, respectively.

GLAUCOMA Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, recent findings now show that glaucoma can occur with normal eye pressure. With early treatment, you can often protect your eyes against serious vision loss. There are two major categories open angle and closed angle glaucoma. Open angle, is a chronic condition that progress slowly over long period of time without the person noticing vision loss until the disease is very advanced, that is why it is called sneak thief of sight." Angle closure can appear suddenly and is painful. Visual loss can progress quickly; however, the pain and discomfort lead patients to seek medical attention before permanent damage occurs.

AMBLYOPIA Amblyopia, also referred to as lazy eye, is the most common cause of vision impairment in children. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. Conditions leading to amblyopia include strabismus, an imbalance in the positioning of the two eyes; more nearsighted, farsighted, or astigmatic in one eye than the other eye, and rarely other eye conditions such as cataract. Unless it is successfully treated in early childhood amblyopia usually persists into adulthood, and is the most common cause of permanent one-eye

vision impairment among children and young and middle-aged adults. An estimated 2%3% of the population suffer from amblyopia.

STRABISMUS Strabismus involves an imbalance in the positioning of the two eyes. Strabismus can cause the eyes to cross in (esotropia) or turn out (exotropia). Strabismus is caused by a lack of coordination between the eyes. As a result, the eyes look in different directions and do not focus simultaneously on a single point. In most cases of strabismus in children, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth (congenital strabismus). When the two eyes fail to focus on the same image, there is reduced or absent depth perception and the brain may learn to ignore the input from one eye, causing permanent vision loss in that eye (one type of amblyopia).

COMMON EAR, NOSE & THROAT PROBLEMS IN CHILDREN

INTRODUCTION: Children often have a significant level of Ear, Nose, Throat and Upper Respiratory problems. Because of their inability to vocalise , often the symptoms are neglected till they flare up into a severe infections. While these are treated at the time, failure to address the underlying conditions may, leads to persistent or frequent recurrences of the problems. My child is having a flu all the time; My child needs to visit the doctor every other week may be common comments made by parents in the playgroup and kindergarten age. Hearing difficulty may be undiagnosed leading to learning impairment in this age group. Asthma cases are also higher when the recurring allergies and infections are not controlled.

BLOCKED NOSE AND MOUTH BREATHING These are relatively common symptom. Often, the cause may be obvious such as the common cold or flu. However if this happens regularly or remains persistent beyond two weeks, an ENT evaluation may be necessary. Long-term mouth breathing in a child can lead to delayed mid face development which is permanent.

POSSIBLE CAUSES:

Allergy Sinusitis Swollen Turbinates Enlarged Adenoids or Tonsils

RUNNY NOSE The most common cause for a runny nose is the common cold or flu. This typically increase in severity over 2 to 3 days often associated with a cough or fever. It runs its course and recovery is expected within a week. If symptoms persist beyond a week, sinusitis will need to be excluded especially if the discharge is thick and discolored. If the discharge is clear and there are morning symptoms of sneezing and congested nose, the most likely cause is allergy. Allergy can be triggered by the environment or diet. There is an increase risk of asthma if the allergy is not well controlled. With proper diagnosis and treatment, cure is possible for allergy.

CHRONIC COUGH Chronic cough may be caused by allergy or sinusitis resulting from a post nasal drip. Chest infection and asthma are the other causes. A persistent cough is not normal and needs to be evaluated by a doctor. In the event where all the routine tests were not helpful allergy workup in particular food allergy may review reveal the cause.

SINUSITIS This is the infection of the sinuses. The predisposing cause is a common cold, which has affected the sinuses. Often one would require antibiotics. Failure to eradicate sinusitis will lead to a chronic condition in which surgery may be necessary. Individual with allergies will tend to have more persistent symptoms. Again accurate diagnosis is the key.

SORE THROAT Pharyngitis and Tonsillitis are common causes. Usually this starts as a viral infection in which antibiotics is not necessary. If the sorethroat worsens, and phlegm develops, a course of antibiotics is helpful. Tonsillitis is often

associated with high fever in a child. If this is happening regularly, then a visit to the ENT doctor would be helpful. The best time to bring your child to the ENT doctor is when your child is having the acute infection, as this would allow a more accurate assessment. Tonsillectomy and adenoidectomy, which is the removal of the tonsils and adenoids, can now be accomplished as a day procedure with quick recovery.

SNORING Adult snores but some children snores like adults. Regularly loud snoring and noisy breathing should be assessed to exclude blocked nose, allergies, enlarge adenoids and tonsils. Sleep Apnoea can occur in which the child can become lethargic, with lack of energy and disinterest in his environment. Correction of the underlying condition will reverse this and return the child to his normal self. If the cause is enlarged adenoids and tonsils, their removal will solve the problem.

EAR ACHE This is caused by either an external or middle ear infection and is also a frequent cause of hearing loss. The symptoms are varied depending on the age. In infants and toddlers look for ear pulling, scratching at the ear, hearing problems, crying, irritability, fever, vomiting and ear drainage. In the older children and adults, earache, pressure sensation, hearing loss, dizziness, ear drainage and fever may present. Treatment will involve ear cleaning, eardrops, antibiotics and occasionally drainage of the fluid in the middle ear. If left untreated, the infection may cause serious problems if spread to the surrounding areas.

HEARING LOSS A child that has delay or inaccurate speech needs to have their hearing assessed. Similarly for the child that does not respond to the environment, parents, teachers or misinterpret commands will need to a hearing check. Diminished hearing affects learning ability, which is critrical in our highly competitive environment. The cause is usually in the outer or middle ear. In rare situation, the hearing loss is a result of a nerve condition. As one can see, many of the childs problems are inter-related. By just tackling the symptoms without searching out and managing the underlying cause, the problem will recur and persist. The take home message is if your child is having recurring symptoms in the same areas, do consult your physician for an evaluation. Most of the problems can solved if there accurate assessment and treatment.

BIBLIOGRAPHY
BOOK REFERENCE: O.P.Ghai essential pediatrics, 7th edition, CBS publishers and distributors Parths fundamentals of pediatrics, 1st edition, jaypee publications Hockenberry Wilson Wongs Nursing care of infants and children, 8 th edition Manoj Yadav, a textbook of child health nursing, peeve publications Smeltzer, S, et al Medical-Surgical Nursing. 10th Edition Lippincott Williams andWilkins (2004) Luckman and Sorensen, Medical-Surgical Nursing. 3rd .Edition W.B. Saunders Company (1987) Jacob, S, et al Structure ad Function in Man. 5 th Edition W.B. Saunders Company (1982) JOURNAL REFERENCE

http://www.ncbi.nlm.nih.gov/pubmed/23911046
WEB REFERENCE: http://www.webmd.com/eye-health/features/child-eye-and-visionproblems http://www.scribd.com/search?query=eye+and+ear+disorder+of+children http://kidshealth.org/parent/general/eyes/vision.html

http://www.geteyesmart.org/eyesmart/living/children-diseasesconditions.cfm

ROLE OF ADENOTONSILLECTOMY IN OSAS CHILDREN AND BEHAVIOURAL DISTURBANCE

Passali D, Passali FM, Cambi J, Bellussi L. Otolaryngol Pol. 2013 Source ENT Department, University of Siena, Siena, Italy. Electronic address: d.passali@virgilio.it.

Abstract AIM: The main aim of this study was to assess the presence of behavioural disturbances in child with OSAS before and after adenotonsillectomy (AT).

BACKGROUND: In children adenotonsillar hypertrophy is associated with increased probability of OSAS. Children with OSAS present

neurobehavioral disorders like attention deficit and hyperactivity, learning disabilities and daily attitudes due to excessive sleepiness.

MATERIALS AND METHODS: 195 consecutive young patients suffering from OSAS and recurrent throat infections (control group) underwent AT. All underwent clinical evaluation, polysomnography, Behaviour Assessment System for Children questionnaire (BASC-2), for parents evaluation of behavioural disturbances and nasal functionality tests (before and 6 months after surgery).

RESULTS: Snoring and nocturnal apnoea were no more present in almost all. In OSAS group before AT 12 children were normal, 4 children were borderline

and 2 were clinically significant at the BASC-2. After AT 16 children were normal, 2 children were borderline and none was clinically significant according to the same questionnaire. In the control group 9 children were normal and 1 was borderline both before and after AT.

CONCLUSION: Adenoids/tonsils hypertrophy and nasal hypoventilation are frequent causes of snoring and OSAS. AT improves significantly both snoring/apnoeas and OSAS children's behavioural disturbances. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. Nasal functionality tests can be useful for the differential diagnosis between sleep apnoea syndrome and other noises.