Nasal congestion

Pediatric Nasal obstruction

What is nasal obstruction? 

Nasal obstruction is when one or both of the nasal passages are blocked, or there is difficulty breathing from the nose. 

What are symptoms of nasal obstruction?

Nasal obstruction can cause noisy breathing, snoring, mouth breathing, and/or runny nose.

What causes it? 

Pediatric nasal obstruction can be due to a variety of causes.  Some are present at birth (called congenital), others are acquired later in life.  Some of the causes include:

  • Colds and flus: Mucus and swelling of the lining in the nose from illnesses can cause temporary nasal obstruction.
  • Enlarged adenoids: The adenoids are tissue similar to the tonsils that is located at the very back of the nose above the roof of the mouth.  Infections can temporarily make the adenoids enlarged, but adenoids can remain enlarged in children with allergies or other longstanding inflammation of the nose. 
  • Allergies:  Allergies can cause mucus to accumulate in the nose, it can also cause the lining in the nose to swell and the adenoids to enlarge.  
  • Non-allergic rhinitis: Irritant such as smoke or pollution can cause mucus to accumulate in the nose and the lining in the nose to swell.
  • Large/swollen turbinates:  Inside the nose there are several small bones covered with nasal lining called turbinates.  The job of the turbinates are to direct airflow through the nose and to humidify.  Allergies, infections, and other irritants can cause the turbiantes to swell. 
  • Deviated nasal septum: The right and left sides of the nose are separated by a wall made of bone and cartilage called the nasal septum. At times, the septum can lean more to one side, causing obstruction on that side. This deformity can be present at birth or a result of trauma to the nose later in life.
  • Nasal polyps: Nasal polyps grow out of the lining of the nose and sinuses into grape-like growths.  While uncommon in children this can block the nasal passages.
  • Foreign bodies: A common cause of nasal obstruction in younger children is an object placed in the nose, such as a peanut or a bead.  These patients typically develop foul smelling drainage from the nose
  • Choanal atresia or pyriform aperture stenosis: These rare conditions are a result of abnormal growth of the nose as a fetus.  These are called congenital abnormalities.  Choanal atresia describes when the back of the nose (nasopharynx) is closed off with bone and/or tissue at birth. Pyriform aperture stenosis describes when the bony nasal opening is narrow, obstructing the nose.
  • Nasal cysts or tumors: These are among the lest common causes of nasal obstruction in children.  These can be benign (non-cancerous) or malignant (cancerous).  They can cause bleeding and drainage as well.  They are seen more commonly when the symptoms affect only one side of the nose.

What are the long-term effects of nasal obstruction?

Newborn infants must breath from the nose to coordinate breathing with nursing and feeding.  An obstructed nasal passageway can affect sleep quality in all children. Breathing from the nose is also important for facial development in childhood. Long term nasal obstruction can impact the health of the ears increase the risk of ear infections.

How do we evaluate it? 

 Although your primary care physician and other specialists may be able to manage some causes of nasal obstruction, an ear, nose and throat specialist is usually the best qualified specialist to evaluate most of these cases. We will get a complete history and examine the front of the nose and the inside.  In some cases, a flexible fiberoptic camera may be used to evaluate the entire nasal cavity to the very back of the nose (nasopharynx). This can be done in clinic without the need for general anesthesia.  Sometimes your doctor may order an Xray of the neck to evaluate the size of the adenoids.  CT scans and MRIs are uncommonly ordered but may be needed in the setting of nasal polyps or congenital abnormalities (meaning a child is born with the problem) .

How is it treated? 

 Treatment decisions are based upon the cause of the obstruction.  This could include watchful waiting, washing the nose with saline rinses, medications, or surgery.

Does my child need surgery?

Providers typically recommend surgery when other medical therapy isn't effective.  Surgery is also the best option for congenital abnormalities.

Surgical treatments include:

  • Removing foreign objects
  • Surgically shrinking the turbinates, called a turbinate reduction
  • Adenoidectomy to remove enlarged adenoids
  • Polypectomy to remove nasal polyps
  • Sinus surgery to treat chronic sinusitis
  • Treatment for choanal atresia or pyriform aperture stenosis

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