Nasal Obstruction In Children: Why You Might Worry?

Nasal obstruction in children is a common cause for an ENT consultation. While older children can communicate how they feel, in the case of infants, families need to keep a close eye for symptoms such as snoring, obstruction and rhinorrhea. Nasal obstruction in infants could be visible right after birth when the mother notices issues while feeding the baby. Older children would experience noisy breathing and mouth breathing. It is important that parents have their children with such symptoms consulted by an ENT doctor.

What Is Nasal Obstruction?

The nasal passage starts from the nostril to the back of the throat. Nasal obstruction is referred to as a complete or partial blockage in either of the air passages. Nasal obstruction isn’t a disease but directs towards an underlying disorder.

What Are The Symptoms Of Nasal Obstruction In Children?

Infants who have nasal obstruction show signs right after birth. Any blockage in the nasal passage demonstrates difficulty in breathing and noisy breathing. While feeding too, there is difficulty when there is a nasal obstruction. In addition, infants cry more as this helps with breathing as crying facilitates movement of air in and out.

Some of the common symptoms include:

• A nasal voice
• Poor sense of smell
• Noisy breathing
• Snoring at night
• Difficulty breathing
• A runny nose

Less common symptoms include nose bleeds, headaches, bad breath and pain. It is important to understand the root cause of the nasal blockage. Older children may show chronic mouth breathing and snoring at night. Photos of children who always have their mouth open may be a sign of nasal obstruction.

What Are The Causes Of Nasal Obstruction?

The causes behind a nasal obstruction could be many. Some of the conditions occur due to congenital conditions, while others are acquired later in life. The age when noisy breathing starts too could help to specify the cause. Some causes can include:

• Rhinitis: This condition can cause the lining of the nose to be inflamed or swollen due to allergens, infection and irritants like pollen and smoke. Infants experiencing rhinitis can feel distressed and it would be hard on the parents too. An ENT doctor would do a careful evaluation with additional testing if necessary to give a diagnosis.
• Nasal Polyps: A nasal polyp is the growth of excess tissue which protrudes from the lining of the sinus into the nasal passage. Nasal polyps result from chronic infection or nasal irritation. ENT doctors generally do a physical examination and have an X-ray for a diagnosis to evaluate the extent of the problem.
• Adenoid Hypertrophy: The adenoids are part of the lymphoepithelial tissue. This condition of adenoid hypertrophy is caused by the increased size of the adenoids. It can occur as an acute or chronic infection of the adenoids. It is a common nasal obstruction in children. While most are asymptomatic, symptomatic cases would be treated with specific antibiotics depending on the causative agents. Allergic conditions are treated with intranasal corticosteroids and antihistamines. Ear infections may be common too. Evaluation by an ENT doctor is essential.
• Deviated Nasal Septum: The nasal septum is what separates the two nasal passages in the nasal cavity. It’s made of cartilage in the front and with bone at the back. A child may be born with a deviated or crooked septum. It could happen after an injury too. If the nasal tissue is twisted it can block the nasal passage. Surgery may be needed for a correction and it is termed as septoplasty.
• Hematoma: Collection of blood following an injury to the nose can lead to nasal obstruction. It generally occurs following a trauma to the nose and needs to be treated immediately.
• Choanal atresia: This is when the back opening of the nose is blocked with either tissue or bone. It can occur either unilaterally or bilaterally. If it occurs in infants, it is noticed right after birth and immediate surgical repair is needed to help the child to breathe normally. The diagnosis could be made much later if it is only one sided. The symptoms of one sided choanal atresia is nasal stuffiness, discharge and one-sided sinusitis. This condition can be treated using telescopes through the nose.
• Tumors: Benign or malignant tumors are another cause of nasal obstruction in children. Although rare, it may be present. This is presented as persistent stuffiness of one side of the nose and may also be associated with bleeding, swelling or drainage. A thorough physical examination and X-ray can help make the diagnosis.
• Foreign Body: Children when at play may insert foreign objects into their nose. This is a common cause of nasal obstruction in children. The usual things placed in the nose include beads, cotton, peanuts or toys. Usually, foul smelling drainage from the nose may be experienced. Removal of these objects could happen at an ENT clinic. If the foreign body has been present for a long time, then general anesthesia may be needed for painless removal.

How Is Nasal Obstruction Diagnosed?

The ENT specialists use a combination of tests based on the child’s symptoms and medical history. Common tactics for diagnosis include:

Physical examination of the nostrils: The otolaryngologist would do this as the first step.

• Flexible or rigid nasal endoscopy: This procedure allows the doctor to see the inner cavity of the nose from front to back.
• X-rays: This helps to evaluate the size of the adenoids and the extent of obstruction at the back of the nose.
• Maxillofacial CT scan: This is a face scan with a two dimensional X-ray which helps to evaluate the structure of the bone to find if there is any narrowing or incomplete development of the nasal cavity. It helps to evaluate the nasal polyps and the sinuses.
• Maxillofacial MRI: It is two dimensional imaging which is used to evaluate the soft tissues causing nasal obstruction. It is used to evaluate vascular malformation or tumors.

When Is A Child Referred To an ENT Specialist?

The pediatrician may manage certain cases of the nasal obstruction for ENT conditions, however an ENT specialist is needed to evaluate complex cases. If treatment from the general physician does not help, it is important to seek the help of a specialist.