© Borgis - New Medicine 2/2001, s. 2-3
Mieczysław Chmielik, Anna Bielicka
Assessment of reasons for nasal obstruction in children visiting the laryngologist
Department of Paediatric Otorhinolaryngology, The Medical University of Warsaw
Head of Department: Prof. Mieczysław Chmielik, MD.
Summary
Difficulty in nasal breathing may be a reason for reduced physical and intellectual development of the child. Especially, it may cause chronic sinusitis, hearing loss from the Eustachian tube, or can lead to distorted growth of the facial skeleton, resulting in a so – called adenoid facies. These disorders may cause poor results in school or in sport. To decrease the number of complications in this area, a correct diagnosis is necessary. A total of 942 children coming to the emergency laryngology service because of nasal obstruction from 01.01.2000 to 30.04.2001 were examined. The percentage of patients coming with difficulty in nasal breathing was calculated. Complications were also analysed, where conservative or/and operative treatment was applied. The results of treatment were appraised. Conclusions for family doctors, paediatricians and laryngologists were established.
INTRODUCTION
Breathing is one of the essential human functions. In the child the normal functioning of the respiratory system is the basis of normal physical and intellectual development. Upper respiratory tract illnesses can have an influence on the function of the whole respiratory tract. This means that protracted illnesses of the nose and sinuses in our climatic circumstances are the most frequent cause of visits to the doctor by children. They therefore constitute a social problem.
The study of the pathophysiology of these illnesses can contribute to more effective prevention and treatment. In contemporary literature we did not find any details relating to the proportion between the mechanical causes of nasal obstruction and immunological causes leading to swelling of the nasal mucous membrane. In our study we decided to estimate this proportion using patients coming to the laryngology emergency service.
THE PURPOSE OF THE STUDY
The purpose of this study was the estimation of the most frequent causes of nasal breathing difficulty in children coming to the laryngologist. We have also tried to evaluate the effectiveness of applied treatment.
MATERIALS AND METHODS
Patients coming to the paediatric laryngology emergency services in Warsaw live mainly in the city and its immediate area. Patients approach the laryngologist mainly because of an emergency or acute disease. Some patients, who come to the laryngologist, have planned admission to the hospital. Therefore, the selection of patients had to a great extent a random character, which should ensure that their cross – section mirrors the proportions in other laryngology wards working in similar circumstances.
Among 7,012 children coming to the laryngology admission room in the period between 01.01.2000 and 30.04.2001, we analysed 942 (13.4%), aged from 8 months to 15 years, who approached the laryngologist because of difficulty with nasal breathing. There were 422 (44.8%) girls and 520 (55.2%) boys. The average age of the group was 7 years and 4 months.
RESULTS
Children with nasal obstruction constituted 13.4% of all children coming to the laryngologist.
Adenoid hypertrophy was diagnosed in 191 children (20%), and palatine tonsillar hypertrophy in 158 children (16.8%).
Adenoid hypertrophy and otitis media with effusion were recognised in 110 children (11.6%), and palatine tonsillar hypertrophy and otitis media with effusion in 79 children (8%).
Septal deviation was found in 71 patients (7.5%), and septal deviation with adenoid hypertrophy in 18 children (2%).
Altogether, adenoid hypertrophy was diagnosed in 556 patients. This represents 59% of children with nasal breathing difficulty, and 7.9% of all examined children.
In 43 children (4.6%), chronic swelling of the nasal mucosa and/or dissimilarities of the anatomic structure of the lateral nasal wall, leading to recurrent rhinosinusitis, were recognised.
Nasal and sinus polyps were the cause of nasal breathing difficulty in 17 children (1.8%) – in 4 children they were polyps were associated with mucoviscidosis, and in 2 children it was choanal polyp.
In 9 children (0.9%) unilateral choanal atresia was recognised.
Adhesions in the nasal cavities (post – intubation, post – battery, post – operation) – in all cases unilateral – were found in 5 children (0.5%).
Others reasons for nasal obstruction among the analysed children were: hamartoma of the nasal cavity (4 cases), cyst of the dorsum of the nose (2 cases), angiofibroma juvenile (1 case), encephalomeningocele (1 case), and a genetic defect of the nose (1 case).
The causes of nasal obstruction lasting from several hours to several days were estimated separately. Swelling of the nasal mucous membrane related to acute infection was found in 128 children (13.6%) – in these in 55 patients it was an acute bacterial rhinosinusitis. In 11 children intraorbital complications were associated with acute sinusitis.
In 77 children (8.2%) a foreign body was found in the nasal cavity, while in another 21 patients (2.2%) a fracture of the nasal bones was the cause of nasal obstruction. Post – traumatic nasal septum abscesses was recognised in 2 cases.
Surgical treatment was applied to 623 children (66%).
In 177 children (18.7) an adenoidectomy was performed, in 135 (14%) adenotonsillotomy, in 89 (9.4%) cases applied adenoidectomy and tympanotomy, and in 54 (5.7%) adenotonsillotomy and tympanotomy, and in 4 cases adenoidectomy and ventilatory drainage of the middle ear were performed.
Septorhinoplasty was carried out in 69 patients (7.3%), in 2 children reconstruction of the nasal skeleton with preserved cartilage, and in 1 child with post – operation nasal cavity atresia a reconstruction of the nasal cavity was performed.
Functional endoscopic sinus surgery was applied in 29 children (3%).
Polipectomy was necessary in 14 cases (1.5%).
In 21 children (2.2%) was made a closed reduction fractured nasal bones under general anaesthesia. In 2 cases drainage of the subperichondrial abscess was necessary. In 6 children with intraorbital complications of acute sinusitis, an ethmoidectomy was performed. A maxillary sinus puncture was made in 3 cases, and a frontal sinus puncture in 2 cases.
Surgical treatment was performed in all cases of choanal atresia (8), nasal tumours (4), cysts of the dorsum of the nose (2), and in a case of juvenile angiofibroma.
CONCLUSIONS
Comparing our results with details from the past few dozen years, we have noticed a decrease in the number of children coming to a laryngologist because of deviation of the nasal septum. At the same time the number of children with adenoid hypertrophy as the main reason for impairment of nasal patency has increased. Among the group of children with a blockage in nasal patency caused by swelling of the nasal mucosa, we isolated patients with dissimilarities in the anatomical structure of the lateral nasal wall. This group was not isolated in preceding research because computerised tomography is necessary to establish this diagnosis.
Piśmiennictwo
1.Brodsky L.: Nasal Obstruction in Children. In: G.B. Healy (Ed.) Common Problems in Pediatric Otolaryngology. Year Book Medical Publishers Inc., Chicago. 1990, pp. 157-164. 2.Danielewicz J. et al.: Analiza przyczyn niewydolności oddechowej nosa u dzieci kierowanych do adenotomii. Pamiętnik Konferencji Naukowej IV Dni Otolaryngologii Dziecięcej Zakopane 18-10.09.1969, PZWL W-wa 1970, 117-121. 3.Haapaniemi J.J.: Adenoids in school – aged children. J. Laryngol. Otol. 1995 Mar; 109 (3): 196-202. 4.McCaffrey T.V., Kern E.B.: Clinical evaluation of nasal obstruction: a study of 1000 patients. Arch. Otolaryngol. 1979; 105:542-545. 5.Paradise J.l. et al.: Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings. Paediatrics 1998 Jun; 101 (6): 979-86. 6.Triglia J.M., Nocollas R.: Nasal and sinus polyposis in children. Laryngoscope 1997 Jul; 107 (7): 963-6. 7.Wang D.Y. et al.: Chronic nasal obstruction in children. A fiberoscopic study. Rhinology 1995 Mar; 33 (1): 4-6.
