Pediatric Nasal Obstruction

What is nasal obstruction?

Nasal refers to the nose. The nasal cavity is the air passage starting at the nostril (opening of the nose) and ending at the back of the throat. Nasal Obstruction is a partial or complete blockage of one or both of these air passages.

What are some of the symptoms of nasal obstruction?

Nasal obstruction in an infant is usually noted very soon after birth. Infants primarily breathe through the nose, so any blockage of this passage will be seen early on as difficult and noisy breathing. When these children cry, their breathing improves, as air can move in and out of the mouth without problems. Breathing problems will be especially noticeable during feeding.

In older children, nasal obstruction usually results in noisy breathing (Darth Vader sounds), snoring, and/or mouth breathing. Your child may or may not have a runny nose as well. Mouth breathing can go unnoticed by many parents. One trick to noticing this is to look back at previous pictures of your child to see if the mouth is always open. (many times this condition is noted during summer vacation when the family sleeps closer together)

When may my child be referred to an ear nose and throat specialist for evaluation of nasal obstruction?

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. If treatment started by your primary care physician does not help your child’s condition, then a referral may be made to a specialist.

What are some of the causes of nasal obstruction?

There are many different causes of nasal obstruction. Some causes are present at birth (congenital). Other causes are acquired later in life. The age at which the noisy breathing started also helps to determine the specific cause. Some of the causes are listed below:

  1. Rhinitis – Swelling or inflammation of the lining of the nose can be caused by allergies, irritants like smoke and pollution, and infection to name a few. In infants, this swelling can lead to considerable distress on the part of the child and parents. Careful evaluation of the nose will lead to a likely diagnosis. Sometimes, additional testing is necessary to confirm the cause.
  2. ADENOID HYPERTROPHY is another common cause of nasal obstruction in children. See this topic under common diagnoses.
  3. Foreign Body – A common cause of nasal obstruction in the younger child is
    an object (foreign body) placed in the nose (such as a bead, peanut, cotton, etc) during experimentation or play. These patients usually develop foul-smelling drainage from the nose on the side containing the object. Removal can many times be accomplished in the office. Occasionally, if the foreign body has been present a long time, a brief general anesthetic will be necessary to remove it painlessly.
  4. Deviated Nasal Septum – The nasal septum separates the two nasal passages in the nose. It is made up of bone in the back and cartilage (softer tissue like the top of the ear) in the front. A child may be born with a crooked (deviated) septum or may acquire a crooked septum through injury to the nose. If this tissue is severely twisted, it can block a nasal passage. This is commonly corrected with a surgery called a SEPTOPLASTY.
  5. Nasal Polyps are another cause of nasal obstruction. A nasal polyp is a growth of tissue that protrudes from the sinus lining into the nasal passage.
    Because polyps are usually the result of chronic irritation or infection, a complete evaluation, including X-rays, is necessary to diagnose the cause and determine the extent of the problem.
  6. Hematoma: Injury to the nose can also result in a hematoma (collection of blood) that may obstruct the nasal passage. This commonly occurs after a trauma to the nose and must be treated immediately or loss of support to the nose will result.
  7. Choanal atresia can be one-sided (unilateral) or affect both sides (bilateral). It means that the back opening of the nose is blocked with either tissue or bone. If both sides are involved, it is usually noted shortly after birth. In this case, surgical repair is needed immediately to allow the child to breathe normally. If only one side is involved, the diagnosis may be made much later in life. Symptoms include nasal discharge, stuffiness only on one side, and sometimes, one-sided sinusitis. In many cases, unilateral or one-sided atresia can be repaired using telescopes through the nose.
  8. Tumors: Among the other less common causes of nasal obstruction in children are benign or malignant tumors, which may be noted initially by persistent stuffiness on one side of the nose. This may also be associated with bleeding, drainage, or swelling. After a complete physical exam, the ear, nose, and throat specialists may order X-rays or other studies to aid in the diagnosis.

What is involved with an evaluation for nasal obstruction by an ear nose and throat specialist?

Again, the age of the patient and the specific symptoms will help determine the best way to evaluate the obstruction. All patients receive a careful and thorough physical exam. This may include a small flexible camera used to look into the nose by a Pediatric ENT.

In addition, X-rays can help look at the nose, sinuses, and surrounding tissues that cannot be seen directly. X-rays may include plain X-rays (which takes 20 minutes – like a picture), CT scans (also take 20 minutes and are taken by the child placing their head in a large white “donut”), or magnetic pictures (MRI).