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The chief complaints with which we are now concerned are abnormal and diseased affections of the
nose and nasal spaces, sinuses, etc, and early symptoms of impaired hearing, the latter in a large number
of instances have been a result (secondary) of the former (primary) nasal affections. It is as well to
stress here that the first and essential thing to do is to correct the primary exciting cause in the nose in
order to relieve the secondary effect in the ear. The chief thing to bear in mind in examining children
is a careful look-out for any positive signs or symptoms of nasal obstruction or nasal respiratory
insufficiency and any attendant ill-effects present, such as mouth breathing, the most frequent sign, and
also any of the potential disabilities which could follow in unrelieved cases.
It is very important also to observe and note a certain group of symptoms resulting from nasal
obstruction which are more marked and fairly common in young children; they are grouped together and
called by the general term, aprosexia, namely, mental depression; disinclination to work; and loss of
energy, etc; the children are considered dull and stupid and may be one or more classes below the
average child of their age. The urgency of the detection and correction of the underlying cause cannot
be too strongly emphasised. A careful examination of the nose and naso-pharynx should always be made
before any treatment is advised. It is only by accurately diagnosing the cause of the abnormality that
one can expect to remedy the condition.
A smalI number of children complained of recurring attacks of 'sore throat', with moderate hypertrophy
of the tonsils; these were in most instances secondary to diseased nasal-sinus conditions through the
lymphatic drainage of the nasal accessory sinuses, and 'descending infection' which connect directly
with the tonsil lymphatic gland. Again we must emphasise here that the correct procedure is, first to
relieve the diseased condition in the nasal area and when this is effected, usually the unhealthy state of
the tonsils will soon recover. In a small number of instances, however, where the diseased condition
has been neglected and allowed to become chronic and the tonsil tissue itself through continuous
'overloading' is now diseased and destroyed and beyond repair or function, removal of the tonsils is
indicated, but in any case the nasal defects must always be treated. Hence the importance of the early
detection and correction of nasal abnormalities.
A smalI number of other 'complaints' included in the E.N.T. group such as 'foreign bodies' viz, pea,
beads, bits of toys, impacted pieces of cotton wool, etc, in the ear or nose; epistaxis (nose bleeding);
'external otitis' were seen and treated during the year. In the case of the latter, 'external otitis' fairly
common in children, as in adults, a special note is advisable. This condition involves the auditory
meatus, the entry passage to the middle ear, not the inner ear itself; it may extend around the meatus to
the outer ear, lobe, etc. This can be most intractable and chronic if not correctly treated; it also impairs
the hearing owing to the mass of 'debris' being constantly formed in the meatus. It must not be confused
with wax in the ear. It is really a form of eczema and is commonly allied to allergic symptoms, which
is important to remember in treatment. There have been several of these cases during the year. They all
responded satisfactorily in a short time to treatment.
The audiometric scheme established by the Local Authorities for some years has been exceedingly
helpful in the detection of many cases of impaired hearing which might otherwise be missed".
Audiology Unit
The Audiology Unit is held within the precincts of Blanche Nevile School for the Deaf, and there
is close co-operation between the medical and teaching staff. Four sessions are held each week, and
the Unit continues to serve the whole of the London Borough of Haringey, and also the London Boroughs
of Enfield and (part of) Barnet.
Dr. L. Fisch, Consultant Otologist, reports:-
"ln order to keep the list of children waiting for examination as short as possible, additional
clinical sessions were introduced. Dr. Douglas, the Principal Medical Officer for School Health is now
conducting this additional clinical session, and this helps greatly to reduce the waiting list. She is
also assisting Dr. Fisch with his regular clinics and is responsible for the general organisation and
administration of the work. Dr. Udall, Senior Lecturer in Paediatrics at St. Bartholomew's Hospital
attends a clinical session, and assists Dr. Fisch. This is also a most valuable help. Both Dr. Douglas
and Dr. Udall are now fully trained in all aspects of child audiology and are able to conduct clinics
independently.
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