Feb 22, 2017, 15:33 PM
by
R.A. Braganza, MD, Ear, Nose & Throat
Chronic stuffy nose often accompanied by mouth-breathing is a common occurrence in children. This results in a decrease in normal nasal function which is to warm, humidify and filter the air going to the lungs. In the cold and flu season it may be just be secondary to a child getting one viral upper respiratory infection after another. This is more likely to occur in younger children especially if in daycare. A seasonal variation in nasal congestion could suggest allergic rhinitis although certain allergies may be year-round. Sneezing or congestion which is triggered by changes in weather or strong odors may indicate nonallergic rhinitis. Chronic sinusitis is caused by bacterial infection in the sinuses and may result in discolored mucus coming out of the child’s nose. It can also result in postnasal drip and a chronic cough. The adenoids are lymphoid tissue located in the back of the nose and are there to help fight infections but sometimes they are unable to completely eradicate the germs and remain chronically infected and or enlarged and cause chronic symptoms similar to those caused by chronic sinusitis. After taking a detailed history which can often help narrow down the causes of the chronic nasal congestion, physical examination is done. The septum is the wall in the middle of the nose and it can be deviated or crooked especially if there has been any history of trauma. Nasal endoscopy is a procedure done in the clinic and is usually tolerated in older children. After topical anesthetic is applied, a small scope is used to evaluate the nasal cavity to provide more detailed information of the nasal structures. The size of the adenoids can also be evaluated. X-rays of the sinuses and or the adenoids may be necessary in some children. Laboratory testing may include cultures of the nose and blood tests for allergies or the immune system.
Once the diagnosis is made, avoidance of known triggers of nasal congestion would be the first step. Nasal steroid sprays are beneficial in the treatment for many causes of nasal congestion. Antihistamines would be recommended for allergic rhinitis and certain types of non-allergic rhinitis. A prolonged course of antibiotics would be indicated for chronic sinusitis and adenoiditis. Surgical removal of the adenoids can help open the airway and even help chronic sinusitis by improving drainage. Unless a deviated septum is causing a very severe obstruction, surgery for it is usually undertaken when the child is in the late teens and nasal development is nearly complete. Endoscopic sinus surgery can be considered after other measures have been tried but it is usually reserved as a last resort in children.
Dr. Braganza is board certified by the American Academy of Otolaryngology Head and Neck Surgery (AAOHNS) and received his medical degree from UCLA. He performed his residency in Otolaryngology Head and Neck Surgery at UCSD and is a member of the American College of Surgeons. He has also served on the Board of Governors of the AAOHNS and as Chairman of the Cottage hospital ENT department. Dr. Braganza has been recognized by Castle Connolly as one of nation’s Top Doctors in 2012 and 2013.