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Nose block in children
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
One of the most common and under estimated problems in children is nose block, which might range from simple occasional nose block that happens intermittently as mild snoring, to sever cases of chronic sleep apnea.
Causes of nose block in children:
1/ acute rhinitis: which is a viral or bacterial infection that causes generalized congestion and edema in the nasal and sinus mucosa that tightens the air passages of the nose.
2/ allergic rhinitis: which is an allergic reaction of the nasal and sinus mucosa to an allergen that might be anything like dust, smoke, perfumes, pollens or food.
3/ large turbinates: turbinates are part of the nasal structures that are present normally in all people. Inflammation may cause enlargement of these turbinates making the nasal cavity narrower, a problem that might be temporary or prolonged. (See polyps Vs adenoids Vs turbinates)
4/ large adenoids: the Adenoid is a lymphoid tissue that are present normally in the back part of every child’s nose that helps in defending infections of the nose and throat similar to what tonsils do, it usually shrinks with time and becomes very small by the age of 10 years. If this adenoid got infected or inflamed it will increase in size and will obstruct the back passage of the nose, a problem that might be temporary or chronic (see polyps Vs adenoids Vs turbinates)
5/ large tonsils: which might be due to several causes
6/ other rare cases like choanal atresia, tumors, and foreign bodies
Assessment of a child with nose block should include detailed history of the symptoms that gives a clear idea about the severity, length and burden of the symptoms on patient’s life, association with ear or throat problems which might be a relation or a complication of the primary problem.
Examination of the child is most likely simple, using light to look at mouth, throat, nose and ears.
X-rays are sometimes needed to evaluate the size of the adenoid and to rule out other complications.
Complications of nose block in children depends mainly on the severity and length of the problems, which might include recurrent ear infections and decrease hearing due to accumulation of fluid in the middle ear due to obstruction of the post nasal opening of the Eustachian tubes that ventilates and drains the middle ear through the nose, Recurrent infection of the sinuses due to abnormal aeration of the nasal and paranasal sinus cavities, different lung and heart complications that might be related to chronic airway obstruction and post nasal secretions.
Treatment of nose block in children depends on the cause of this obstruction; most of the causes could be treated with anti allergic medications and nasal sprays, but in cases of no improvement on the medical therapy, surgery to remove the obstructing factor could be needed, although parents should be clearly informed that the medical treatment is a slowly acting therapy that should be given enough time to be proved as active or failure before proceeding to the surgical option.
Written By: Dr Ibrahim Issa MD. Otolaryngology Consultant , Laryngologist & Phonosurgeon.
Edited By: Dr Mohammad Murad MD. Otolaryngology Specialist.
