Pediatric Rhinology - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Nasal and sinus problems, including allergies, nasal obstruction, and sinusitis occurring especially in children, are difficult to deal with. They impair breathing, speech, and swallowing. These problems affect a child’s quality of life, learning, and development. Understanding sinonasal structures and pathology, along with advancements in imaging and surgery, has made it easy and safe for surgeons to deal with complex procedures.

What Is Rhinology?

The study of the nose and sinuses is called rhinology. It deals with diseases of nasal passages and paranasal sinuses (hollow spaces present in bones around the nose). A rhinologist is a specialist otolaryngologist (ENT [ear, nose, throat]) who is specialized in treating the nose.

What Are the Problems Related to the Nose and Paranasal Sinuses?

Some of the problems related to the nose and sinuses are

• Chronic Sinusitis: When sinuses get inflamed and blocked for more than 12 weeks or longer, the condition is known as chronic sinusitis. Breathing becomes difficult, disturbed sleep and affected thinking may be seen in this condition.

• Endoscopic Sinus Surgery: This procedure improves the drainage of sinuses and prevents the building up of mucus in the chambers of sinuses, thereby reducing infections.

• Nasal Congestion: Characterised by the narrowing of nasal passages and nearby tissues causing restricted airflow due to structural narrowing and swelling of tissues and blood vessels or both.

• Nasal Polyps: Soft, painless, noncancerous growths on the lining of the nose or sinuses that cause blockages are known as nasal polyps.

• Nasal Tumors: Abnormal growth that is noncancerous, nasal tumor occurring rarely among 40 years old or more than 40 years old.

• Deviated Nasal Septum: Septum divides the nasal cavity into two parts. A septum often deviates, causing difficulty in breathing.

• Skull Base Surgery: Surgeries are done to remove anterior skull base tumors and lateral skull base tumors.

• Thyroid Eye Disease: Surgery done to treat thyroid eye disease is complex. It involves orbit, bony spaces around the eye. Diseases of the nasal and sinuses among children include problems related to inflammatory nature, congenital diseases like malformations and structural deviations of the nasal septum, and systemic metabolic pathologies affecting the nose and sinuses.

What Are the Symptoms of Nasal and Sinus Problems in Children?

Symptoms of nasal and sinus problems include

• Noisy breathing.

• Bleeding in the nose.

• Disturbed sleep.

• Increased mucus production.

• Sneezing.

• Difficulty in speech.

• Difficulty in breathing.

• Difficulty in swallowing.

• Headaches in the sinus areas.

• Numbness on the face and tingling sensations

• Sore or lump present inside the nose.

What Are the Causes of Nasal and Paranasal Sinuses Issues Among Children?

Causes of nasal and paranasal sinuses include

• Genetic factors.

• Immunological function of the mucosa.

These factors contribute to the development of disease in the upper airway tract in children. This happens due to changing anatomy in the growth phase. Inflammatory diseases among children include

• Acute Rhinosinusitis: Due to viral infection of the upper airway resulting in the common cold.

• Chronic Rhinosinusitis: Changes due to inflammation of sinus mucosa persisting for 12 weeks leading to chronic rhinosinusitis. According to studies, bronchial asthma and gastroesophageal reflux syndrome (which occurs when acid in the stomach comes back to a tube connecting the mouth and stomach) are associated with chronic rhinosinusitis.

• Allergic Rhinitis: Sinusitis causing due to allergens like dust.

• Adenoid Disease: Adenoids are always filled with bacteria. Because of this reason, infections of the nose and nasal sinus occur.

What Are Congenital Disorders of Nasal and Paranasal Sinuses?

Deformities in shape occur, resulting in a bifid nose, double nose, etc. Other deformities include

• Atresia (Absence) of Nostrils and Nasal Atresia: Due to congenital defect or due to severe infection or trauma.

• Nasal Fistula: These are non-closed fissures and may lead to abscess.

• Nasal Meningoencephaloceles: They appear as nasal polyps.

• Choanal Atresia: Narrowing or blockage of nasal airway by tissue. It may be single-sided or double-sided.

• Deformities of the Nasal Septum: This causes obstruction in breathing.

What Are Systemic Inflammatory Diseases of Nose and Paranasal Sinuses?

• Primary Ciliary Dyskinesia (PCD): Also called immotile cilia syndrome, which is a rare inherited disorder linked to autosomal recessive trait. PCD is associated with cilia of the lung, nasal mucosa, and middle ear.

• Cystic Fibrosis: Studies have shown that bilateral nasal polyps are common in children who have cystic fibrosis.

How Are Issues Related to Nasal and Paranasal Sinuses Diagnosed?

• Nasal Endoscopy: Nose and sinus passages are viewed with a thin tube fitted with a camera and light.

• Anterior Rhinoscopy: A shining light is used to view the inside of the nose.

• Allergy Test: The test is done to identify the agent from which the allergy is caused.

• MRI (Magnetic Resonance Imaging): Imaging test to diagnose polyps and tumors.

• CT (Computed Tomography): To get a better view of sinuses, polyps, and tumors.

• Biopsies: Small tissue from growth is taken and sent to a lab for further evaluation.

What Are the Treatment Options?

Treatment options are

1. Medicines:

• Oral antibiotics.

• Antihistamines for allergy.

• Decongestant medications if necessary.

• Rinsing of sinuses with saline solution.

• Using nasal spray that contains corticosteroid medication.

• Oral corticosteroids can be given.

• Resting is also essential.

2. Lifestyle Changes:

• Avoiding irritants, eating healthy to boost the immunity.

3. Surgery:

Endoscopic sinus surgery:

• Minimally invasive surgery that does not need excision.

• It helps remove polyps causing blockages.

• Open sinuses and create space for medication and better drainage.

• Surgeries are done to correct structural deformities like deviated nasal septum, enlarged turbinates, etc. Even after surgery, individuals may have to use a nasal spray or anti-inflammatory medications as prescribed by the doctor and according to the cause of the congestion.

• Open surgery (craniotomy, where part of the skull is opened temporarily) is done in case of large tumors.

• Small tumors can be removed by endoscopic surgeries.

• In the case of skull base surgeries, both endoscopic and open surgery procedures are combined for the treatment.

• Septoplasty: To correct the septal deviation, this procedure is performed. This procedure is done through the nose.

Conclusion

The nose is a very important part of the human body. Any slight obstruction may cause inconvenience and affects the quality of life. This is especially true for children, as they often experience various nose and sinus-related issues that can greatly affect their well-being. Therefore, it is crucial to have a thorough understanding of these conditions, as it enables early identification and diagnosis. Early detection allows for effective treatment, which can ultimately resolve the problem and restore a high quality of life for individuals of all ages.