Allergic Rhinitis In Children
Overview
Rhinitis is a reaction that can occur in the nose, eyes, and throat. Generally, this is caused when the person or child inhales an allergen through the mouth, nose or if the allergen comes in contact with the eyes. These allergens increase the release of histamine inside the body. As a result, there is a set of allergic reactions like itching, sneezing, swelling, and the building of fluids inside the fragile linings of the nose and eyelids. However, this is unusual, but children under the age of 2 years can get sensitized to the available indoor allergens (a substance that can cause allergy). Some of the most common indoor allergens are mites and pet danders. Sensitization to the outdoor allergens is more commonly seen in children older than five years.

So, What Is Allergic Rhinitis?
Allergic rhinitis is the reaction that can occur in the eyes, throat and nose. It is caused by an allergy-causing agent known as allergens. Normally these allergens are harmless, but when children or people have an allergy to a particular allergen, the body thinks that this is a foreign particle and attacks them to kill them. For this body releases histamine. This histamine causes several reactions like itching and swelling of the affected part.

Causes Of Allergic Rhinitis
Generally, allergic rhinitis occurs when the child inhales something they are allergic to. It starts a set of chain reactions in the local part, particularly the nasal passage (nostrils). Some of the most common reasons for allergic rhinitis are:-

Pollens. Either they are from trees, grass or weeds.
Dust particles.
Waste of cockroaches.
Animal dander (a material that is shed from the body of humans and animals containing furs or hair)
House dust mites.
Mould (fungi).
What Are The Symptoms Of Allergic Rhinitis?
Each child may experience differentsymptoms. However, the most common symptoms of allergic rhinitis are listed below.

Clear drainage from the nose
Sneezing.
You may observe the presence of a bump at the back of your neck.
Itchy nose, throat, eyes, and ears
Nosebleeds
Stuffy nose
Runny nose
Snoring
If the problem persists for longer than one year, the children might also experience some of the following symptoms.

Breathing through the mouth makes it difficult to breathe through the nose due to rhinitis.
Ear infections that come back again after treatment.
There will be a markedly decrease in the school performance of the child.

What Are At The Risk Of Having Allergic Rhinitis?
Children who are already suffering from other allergic diseases like asthma, food allergy, and eczema are more likely to get affected by allergic rhinitis. For example, among the children having asthma, about 8 out of every ten children also have allergic rhinitis. In addition, children whose parents have a history of allergic rhinitis are also at a higher risk of having allergic rhinitis.

What Are Cochlear Implants?
While the majority of people who suffer from hearing loss may be helped with hearing aids, for some, hearing aids do not provide the benefits they need. Why is this?

Simply stated, hearing aids only amplify sounds. For people with a moderate - to - profound hearing loss, even the most advanced hearing aids may not work because making sounds louder does not make them clearer.

You may be able to hear sound with hearing aids, but understanding speech and other sounds may still be very difficult. Using a hearing aid with a moderate - to - profound hearing loss can be likened to listening to a loud, badly tuned radio program. And in some cases hearing aids may not provide audibility. In such cases, a cochlear implant may be the best option.

What is a cochlear implant ?
A cochlear implant is an electronic device that can restore useful hearing and provide improved communication abilities for persons who have severe to profound sensorineural hearing loss (nerve deafness) and who cannot benefit from hearing aids.

How is an implant different from a hearing aid?
Cochlear implants differ from hearing aids in two important ways:

Hearing aids simply amplify sounds. A cochlear implant, on the other hand, transforms speech and other sounds into electrical energy that is used to stimulate the hearing nerve in the inner ear
Unlike most hearing aids, cochlear implants have both internal and external components. The implant system consists of an external speech processor and headset (worn behind the ear) and an internal, surgically implanted receiver/stimulator package with an electrode array.
A cochlear implant does the job of the hair cells in the inner ear. As a result it restores your ability to perceive and understand sound. Unlike a hearing aid, a cochlear implant doesn't make sounds louder. Rather, it bypasses the damaged part of the ear and stimulates the auditory (hearing) nerve directly. This provides a clearer understanding of sound and speech.

Working of a cochlear implant:
Sound is picked up by a microphone placed on the ear.
The microphone converts the sound into electrical energy. This electrical signal is transmitted through a cable to the speech processor.
The speech processor is an ear level device. It analyses and digitises the sound into coded signals. This coding is done by the processor depending on how it is programmed.
The coded signal from the speech processor is sent to the transmitting coil worn on the head. This coil is held in place with a magnet. The transmitting coil sends the coded signal across the skin via radio frequency link, to the receiver stimulator package.
The receiver- stimulator package is surgically fitted in the mastoid bone of the skull just behind the ear. The receiver stimulator package contains a magnet so that the transmitting coil and receiver are aligned with each other without any direct contact through the skin.
The signal from the receiver stimulator package is sent to the electrode array which has been surgically put into the scala tympani of the cochlea.
Stimulation of the electrode array leads to stimulation of the nerve endings in the cochlea. This results in a sensation of sound.

What Are The Benefits Of A Cochlear Implant System?
Hearing is the basis on which we learn to speak and communicate with our friends and families in schools and communities. Cochlear implant systems can offer a wide range of benefits including hearing speech, environmental sounds and music.

Nearly all cochlear implant users hear environmental sounds, keeping them in touch with their surroundings - including traffic, sirens, alarms etc.

Virtually all recipients hear speech sounds through their cochlear implant. It usually takes some time to begin to understand these sounds especially for children.

Learning to understand speech and speech in difficult situations allows many adults to return to work or to continue a career which was interrupted by hearing loss.

Hearing the speech of others as well as their own voice helps CI recipients to tune their speaking abilities. Recipient s report that improved speech skills can open up new social, educational and career opportunities.

Many people are able to use the CI system so effectively that they can understand speech without lip - reading and can have interactive conversations over standard and mobile phones.

Infants and children
Children born with a profound hearing loss who received a cochlear implant at a young age may learn to listen and speak, going on to obtain age appropriate language skills. Your child may be able to attend a mainstream school and enjoy success in further education, employment and community life.

Studies have shown that children implanted before the age of two achieved spoken language skills equal to, or closely ranked with their hearing peers.

Adults
For many adults, suffering a hearing loss is just part of getting older. While hearing aids can be effective, there may come a time when a hearing aid just isn't enough.

Talking on the phone, reading to your grandchildren and taking part in community activities or social events may once again be possible with a cochlear implant.

Best ENT Doctor in India - Dr. Ameet Kishore
Dr (Prof) Ameet Kishore is a graduate of the AFMC (Pune) and was awarded the medal for ENT. He obtained his higher surgical training in ENT Surgery in the UK and attained Fellowships of the Royal College of Surgeons of Edinburgh as well as the Royal College of Physicians and Surgeons of Glasgow.

He has received special training and experience in Microscopic Ear surgery, Neuro-Otology, Cochlear Implants, Endoscopic Sinus Surgery and in Paediatric ENT at various centres in UK, Europe and USA.

He was trained at the National Centre for Cochlear Implantation (UK) since 1995 and thus has extensive experience in management of deafness and in cochlear implantation. He set up and is the lead surgeon for the cochlear and hearing implant programme (for children and adults) at Apollo Hospitals. He has over 1800 cochlear implant recipients in this programme.

His team is particularly experienced in management of complex cochlear situations and is the only active programme in North India for Auditory Brainstem Implantation.

This programme also provides Bone Anchored Hearing Aids (BAHA), Bonebridge and Vibrant Soundbridge middle ear implants as options for patients with hearing loss.

Dr Kishore has large experience in endoscopic nasal and sinus surgical procedures like Functional Endoscopic Sinus Surgery (FESS) and Balloon Sinuplasty. Also performs advanced endoscopic procedures such as orbital decompression, optic nerve decompression, dacryocystorhinostomy (DCR), endoscopic closure of CSF leaks and endoscopic pituitary tumour surgery.

He was trained at the Royal Hospital for Sick Children, Glasgow in the Paediatric ENT, and is competent in the management of the child with common ENT problems as well as complex conditions that affect the paediatric ear, nose, throat and airway.

Is experienced in the management of conditions and lumps of the head and neck, salivary and thyroid gland. Well versed in microlaryngeal surgery and phonosurgical techniques for hoarseness.

He held the post of Consultant and Sr Lecturer at the Glasgow Royal Infirmary University Hospital for a number of years before returning to India, having spent over 15 years overseas.

His academic profile includes 6 book chapters, over 30 articles in peer reviewed journals and numerous presentations at National and International Conferences.

With over 25 years of ENT experience, he is Sr Consultant in ENT & Neurotology at Indraprastha Apollo Hospital, New Delhi and the Founder Director & Lead Consultant of Adventis ENT, Head Neck & Cochlear Implant Clincs.