I believe that many otolaryngologists and ophthalmologists often have the encounter that many children often come to the clinic with involuntary dry cough, wrinkled nose, squeezed eyes, sighing and other symptoms, but often with rhinitis, pharyngitis, conjunctivitis or as allergic diseases after repeated treatment but never cured, or often recurring. Long-term use of a large number of medications and drug changes have brought about a considerable impact on the growth and development of children. What is this all about?
In fact, this is transient tic disorder in children – often first seen in otorhinolaryngology or ophthalmology because of early muscle twitching or voice twitching of the face – which is essentially a neurological disorder.
The disorder has the following characteristics.
1, hyperactivity, but not ADHD, just high energy.
2. Twitching, predominantly facial, often with eye squeezing, nose wrinkling and dry cough.
3, Later there will be obscene syndrome. So early and correct diagnosis is very critical.
The following characteristics are often found in clinical practice.
1. Parents are often very nervous and attached to the child, often over-interrogating the child, or stopping the child, which we call “behavior reinforcement”, and have the experience of multiple visits.
2. The tics are regular, often disappearing during play, interactive activities, sleep, dry cough, blinking, etc., and reappearing when the child is idle or does not like to do something.
3. Facial symptoms can appear at the same time or one by one, often as a bad habit.
4. All examinations are generally normal, there is no organic lesion, and the children are generally in good physical condition.
5, often in a short period of time, multiple visits, doctors often misdiagnosed, ophthalmologist said “conjunctivitis”; ear, nose and throat doctor said “rhinitis”, “pharyngitis”; internal medicine doctor said “bronchitis”. “Bronchitis”. However, the treatment and repeated use of medication by multiple departments were ineffective.
So what kind of disease is transient tic disorder in children? Transient tic disorder is a psychological (psychiatric) disorder that is caused by a sudden contraction of a group of muscles that causes purposeless twitching, fast and involuntary movements, and frequent repetition. It has three causes.
① original movements with protective significance (e.g., blinking caused by conjunctivitis, foreign bodies in the eyes, pharyngitis-induced phlegm-causing sounds) that later become habitual.
(ii) Acquired movements due to imitation of others.
③ due to mental stimulation, psychological stress, in order to the exhale of tension and caused.
Transient tic disorder is most common in children between the ages of 4 and 10, and is more common in boys. There are various types of twitching, such as eyelid muscle twitching leading to eye squeezing, teeth baring, laryngeal muscle twitching leading to phlegm sound, neck and limb muscle twitching leading to head shaking, head nodding, neck twisting, arm shaking, leg shaking, etc. Therefore, it is often first seen in ophthalmology and otorhinolaryngology.
So how should we as ENT ophthalmologists, and parents of children, treat this disease? We should do the following.
1. To ease the parents’ tension, do not pay too much attention to and repeatedly remind the child’s tics, and adopt “behavioral weakness” treatment for the tics, i.e., do not ask too much about the concern or simply let them restrain, as studies have shown that loose interactive communication helps to weaken the tics.
2, for the first doctor should have knowledge of the disease, or at least can do to guide the parents of the child to the neurology department for proper consultation. Otherwise, simple treatment with “conjunctivitis”, “pharyngitis” and “rhinitis” will not be effective, and over time, the tic symptoms will remain in a habitual manner and must be controlled with It is necessary to use psychotropic drugs to control it.
3. In the early stage, the main treatment is “behavioral weakness”, supplemented by short and medium-term oral treatment with glutamate + vitamin B1, and in the middle and late stage, once the twitching has a tendency to long-term habits, you should promptly visit a neurologist to interrupt the “vicious circle” with drugs. Haloperidol, Tebretol, Benadryl, etc.
In short, the disease requires communication, communication and awareness among doctors, parents and children in order to effectively diagnose and treat a psychiatric disease, and the symptoms of the child should be treated in a three-dimensional biological-psychological-social medical model. Only by treating the “patient” can the doctor effectively treat and cure the “disease”.