Welcome to Children’s Ear Nose and Throat Care in London

I have been a Children’s Ear Nose and Throat Consultant Surgeon in London for 10 years. It’s a privilege and joy to do this work helping children with such problems as blockage in breathing when asleep, tonsillitis and glue ear. I have been a doctor for 24 years, and have specialised in treating Ear Nose and Throat problems for 20 years, with the last 11 being purely dedicated to those that children can have. I have done over 4000 tonsillectomy operations, over 3000 adenoidectomy operations, and over 1000 grommet surgeries. I work closely with paediatricians, and am very enthusiastic about the progress children can make. I see private patients at 61 Wimpole St, The Portland and The Cromwell Hospitals. My aim is to give a gentle, rounded approach, carefully taking into consideration the needs of each individual child and the concerns of each child’s parents.

  • Glue Ear and Grommets

    Grommets are extremely effective in the treatment of persistent symptomatic glue ear with improvement in hearing happening straight away after the surgery.I describe the condition and grommets in the video linked below.

    How long does the operation take?

    The actual operating time taken is usually 20 to 30 minutes.
    Children are gone from their parents eyes for about an hour and a quarter as parents are there in the anaesthetic room until the anaesthetic begins, but then the anaesthetic is done properly, monitoring equipment is put on, and then the child is taken into the operating room. We then check that everyone in theatre is the correct person to be there and that we have the correct child i.e. safety checks are carried out. Then we get the equipment in including the microscope to carry out the surgery. The surgery is an carried out.

    Note/Disclaimer : The above is general information, and a general guide. Each child is actually unique and so limitations, risks and benefits for each child are different. Treatment is carried out in a was specific to the individual child’s needs and situation.

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  • Tonsils and Tonsillectomy

    Tonsils are glands at the back of the throat. There is one on either side, inside the muscles. They can be seen by looking into the mouth, one on either side of the uvula (which people, sometimes refer to as the “dangly bit” in the middle of the mouth) at the back. They are the same as the glands in the neck which become swollen when one has a throat infection.

    They tend to grow in size until about the age of six years old. From the age of six the throat grows quicker than the tonsils so effectively they, very slowly, get smaller. They particularly reduce in relative size during the teenage years as the face starts to grow more.

    They can cause two problems, blockage of breathing when asleep and tonsillitis.

    Blockage of breathing when asleep, i.e. Snoring, Disturbed Restless Sleep, and Sleep Aponea (a word used to describe breathing which blocks completely).

    This happens because the throat is made of muscles. Normally when we are awake there is a resting tone in those muscles. When we fall asleep however the muscles go slightly floppy i.e. with reduced tone. The walls of the throat therefore start to fall then towards the middle. If the tonsils are enlarged then they start to fall in as well such that there is less room for air to flow for breathing. Initially this can cause snoring, but as the tonsils grow further they can block the breathing completely. This situation is made worse if the adenoids which is another gland sitting at the back of the nose is also enlarged.

    Once the tonsils fall in to obstruct the breathing then the carbon dioxide in the child’s blood rises, and this is detected by the child’s brain stem, which then leads to the child waking up to some extent. As the child moves from being in deep sleep, to be more awake the muscles in their throat becomes stronger and the airway becomes held open again. The tonsils move back into their original position and the breathing improves. The problem is that the child has missed out on the really good part of sleep i.e. the deep part of sleep. Effectively it’s the same as someone waking the child every few minutes the result is the child has had disturbed restless sleep and in the morning is over tired resulting in them being very sleepy or over active.

    Parents often bring videos of their children asleep to demonstrate the problem and this is very helpful.

    Tonsillitis

    Tonsils themselves can be prone to recurrent infections with sore throat and fever, often needing antibiotics with time off school. They often appear bright red with white spots on when looking in the mouth.

    Tonsillectomy, Coblation and Traditional Dissection Technique

    This refers to removal of tonsils with “ectomy” meaning out. It is a very common operation. It takes about half an hour, although children are gone from parent’s eyes for just over an hour, as time is taken preparing and doing safety checks in theatre. Going through the mouth they can either be shaved back to the muscle (coblation technique), or separated from the muscle (traditional dissection technique). As most of the nerve fibres are in the muscle, the coblation technique which disturbs the muscle least is least painful. This technique is excellent where the reason for surgery is blockage of the airway when asleep. A very small amount (estimated less than 5%) of the tonsil is left behind though on the muscle. There is a theoretical chance of infection of this residual tonsil tissue in the future, so if tonsillitis it the main reason for surgery, we may decide together to use the more traditional dissection technique that removes all of the tonsil. Each child is treated as an individual with treatment especially for their needs.

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  • Blocked Breathing, Sleep Aponea

    Blockage of breathing when asleep, i.e. Snoring, Disturbed Restless Sleep, and Sleep Aponea (a word used to describe breathing which blocks completely).

    This happens because the throat is made of muscles. Normally when we are awake there is a resting tone in those muscles. When we fall asleep however the muscles go slightly floppy i.e. with reduced tone. The walls of the throat therefore start to fall then towards the middle. If the tonsils are enlarged then they start to fall in as well such that there is less room for air to flow for breathing. Initially this can cause snoring, but as the tonsils grow further they can block the breathing completely. This situation is made worse if the adenoids which is another gland sitting at the back of the nose is also enlarged.

    Once the tonsils fall in to obstruct the breathing then the carbon dioxide in the child’s blood rises, and this is detected by the child’s brain stem, which then leads to the child waking up to some extent. As the child moves from being in deep sleep, to be more awake the muscles in their throat becomes stronger and the airway becomes held open again. The tonsils move back into their original position and the breathing improves. The problem is that the child has missed out on the really good part of sleep i.e. the deep part of sleep. Effectively it’s the same as someone waking the child every few minutes the result is the child has had disturbed restless sleep and in the morning is over tired resulting in them being very sleepy or over active.

    Parents often bring videos of their children asleep to demonstrate the problem and this is very helpful.

    Read More >
  • Nasal Block

    The nose can be thought of as a pipe going on either side from the front nostril to a back nostril further back. The sinuses open into the side wall of this pipe, and the adenoids sit behind the back nostril.

    Nasal blockage and discharge can be very troublesome indeed in children.

    Nasal blockage can due to a problem with this pipe i.e. the lining of the pipe becoming swollen so that the hole for breathing is smaller than normal. “Rhin” is a word used to mean nose, and “itis” is a word used for swelling & inflammation. Such children are said to have “Rhinitis”. This can be
    1. Infective, as happens to all of us we have a cold (infective rhinitis), or
    2. Allergy (allergic rhinitis) or
    3. No unidentifiable cause (intrinsic rhinitis). Treatments vary from salt water drops to allergen avoidance, to active medicines.

    Nasal blockage may also be due to enlarged adenoids blocking the back nostril. Removal of adenoids (adenoidectomy) can be considered for children with this problem.

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  • Adenoids and Adenoidectomy

    Adenoids are glands, just like tonsils in the throat, or the glands in the neck. They sit just behind the back of the nose, and can contribute to nasal blockage. If large they can also contribute to upper airway obstruction when asleep with snoring, disturbed sleep and even sleep apnoea.

    It is not possible to see the adenoids looking at the front of the nose as they actually sit right at the back, behind the nose itself. The nose on each side has a front nostril, then there is the nasal cavity, which can be thought of as a pipe on each side, and then there is a back nostril, with the adenoids sitting just behind the back nostril. If the adenoids are large then they can block this back nostril.

    It is also not possible to see the adenoids by looking in the mouth as they are on the back wall above the uvula (often called “the dangly bit) which sits in the middle at the back of the mouth.

    In some children it is possible to assess the size of the adenoids by looking at them directly with a thin telescope passed through the nose.

    If nasal blockage with nasal discharge (i.e. infection coming constantly out of the nose), is present, and thought to be due to enlarged adenoids then they can be removed by adenoidectomy surgery. (“ectomy” means “out”, so the word adenoidectomy just means removal of them). Removal is done going via the mouth, using electricity to effectively vaporise them. It takes about 20 minutes surgical time, although children are gone from the parents eyes for about an hour as safety checks and preparation in theatre add to the total time.

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  • Tongue Tie

    Tongue tie is where the connection between the underside of the tongue and the floor of the mouth is very short. This can interfere with feeding in newborn babies.

    My approach is to work closely with lactation consultants, and where needed to divide the tongue tie surgically. This is a very simple procedure which consists of dividing the short membrane connecting the tongue and the floor of the mouth.

    If the membrane is thin then dividing it can be done just in clinic using local anaesthetic, with the help of a nurse, and myself taking just a few minutes.

    If the membrane is thicker it may be necessary to carry out the procedure under general anaesthetic, although again the anaesthetic and the procedure itself would take just a few minutes.

    Recovery from the procedure is quick, with children they encouraged to feed within straight away. Even if the procedure is done under general anaesthetic children go home the same day.

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Updates

Videos by Ian Hore

Video describing Glue Ear and Grommets :

https://youtu.be/Un3EVzBNWNE

and

Video describing Tonsils, Tonsillitis, Sleep Aponea and Tonsillectomy :

https://www.youtube.com/watch?v=WFERBX6fMxs

Read More >

About Me

Children's ENT Consultant Surgeon at The Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Trust in London for 10 years
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Professional bodies:

  • Fellow of the Royal College of Surgeons of England.
  • Member of the Royal Society of Medicine.
  • Member of ENTUK,
  • Member of The British Medical Association
  • Member of the European Society of Paediatric Otolaryngology.