The child with the drippy nose


In this autumn season, with school well underway, we are having more and more patients with runny noses. Most of the time, this is a seasonal problem. Primary providers may reassure parents that it is likely due to allergies. These days, nearly all of the medicine used to treat allergies are "over the counter" and don't need a prescription.

However, there are some children whose noses run through the year. There are several possible diagnoses, of course, and many of them tend to be of a surgical nature. For most parents, the idea of bringing a child to the operating room is usually daunting, so we try conservative management. Another term used for this approach is "medical therapy".

Some studies show that the same medicine that would treat nasal allergies will also treat enlarged mucous membranes and adenoids. For many reasons, and despite the literature suggesting otherwise, medicines are not always successful.

On inspection, sometimes the diagnosis can be seen easily (such as deviated septum). Often, a small scope is used to examine beyond the very front of the nasal cavity to make the diagnosis. There are some very rare anatomical abnormalities that can cause mucus to flow out of the nostrils instead of the usual route down the throat, but the most common diagnosis by far is enlarged adenoid. The team may then consider the procedure known as adenoidectomy.

One of the more interesting topics is what comprises chronic sinusitis in a child. The proverbial "snotty-nosed kid" actually, in all likelihood, might have more than "just allergies". If those discharge elements are cultured, they tend to be infectious - my approach to such children is more careful. Also, to prove allergies in a child can also be difficult due to the use of percutaneous investigation.

This procedure is done in an operating room under general anesthesia. There are no scars or incisions, and the adenoid tissue is removed through the mouth. (Please see social media posts for anatomy images as well). For the most part, this is a very well tolerated procedure and other than the day of surgery, there are actually very limited post-operative recommendations. An example might include no "PE" (aka gym class, or physical education) or extracurricular sports. We actually tend to give no dietary restrictions, although most parents give cool and soft food and drinks, since the anesthesia might cause a sore throat.

After the procedure we have a 3-month follow-up appointment and the overwhelming majority of patients / parents report that their child can breathe much better, sleeps better and has had less severe nasal discharge.

If someone you know has such issues, consider a thorough investigation: give Hudson ENT a call and schedule an appointment.

#adenoidectomy #allergies #deviatedseptum

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