33 Nasal Obstruction in Children This chapter covers nasal obstruction in children. Other presenting symptoms of sinonasal disease include rhinorrhea, epistaxis, mass, and anosmia, and those are covered in detail—including pediatric diagnosis—in Chapters 28 through 32. By far, these are the most common causes of nasal airway obstruction in the pediatric population.
Background
Nasal obstruction is an extremely common complaint in the pediatric population, which can significantly impact the child’s quality of life.
Significant confusion and misuse surrounding pediatric “sinusitis” versus nasal issues exists in the lay press and among medical colleagues.
Neonates are obligate nasal breathers for the first several months of life, and nasal obstruction in this instance can be life threatening.
The etiology of pediatric nasal obstruction can be categorized into the classifications of infectious/inflammatory, congenital, iatrogenic/traumatic, immunologic/other, and neoplastic.
The evaluation and management of pediatric sinonasal complaints are approached differently than in adults for several reasons including the following:
Decreased ability to provide a reliable history
Different underlying disease processes, often related to growth, development, and exposure to infectious organisms
Less cooperative with diagnostic procedures
Possible decreased compliance with treatments (such as nasal saline irrigations)
Infectious/Inflammatory Etiologies
Rhinitis, rhinosinusitis, adenoiditis: Viral infection (much more commonly than bacterial infection) resulting in inflammation of one or more areas of the uppermost aspect of the respiratory tract. Children develop six to eight upper respiratory infections (URIs) per year, and 0.5 to 5.0% of these URIs will be complicated with acute sinusitis.
Adenoid hypertrophy: Extremely common, often with associated mouth breathing and snoring, with characteristic facies (open mouth, long and narrow face, short upper lip)
Nasal polyposis: In children usually associated with asthma, cystic fibrosis, or allergic rhinitis.
Antrochoanal polyp: Originates in the maxillary sinus and can grow to very large sizes, even extending into the nasopharynx or oropharynx.
Neonatal rhinitis: Can be related to nasal trauma in the neonatal period (vigorous suctioning), viral URIs, milk/soy allergies, extraesophageal reflux, or an idiopathic etiology.
Chronic rhinitis of childhood, or “daycare nose”: Typically, occurs in children less than 6 years of age, with ongoing mucopurulent rhinorrhea and nasal airway obstruction.
Gastroesophageal reflux or extraesophageal reflux: Commonly identified in children and may be “silent” apart from nasal complaints.
Vasomotor rhinitis: Excessive cholinergic response related to head position, food intake, temperature changes, or environmental irritants, leading to turbinate hypertrophy and nasal congestion; rare in children.
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