Pediatric Allergies: A Mother's Struggle with Nasal Issues

Nasal allergies: A helpless mother?

Hello, my son is 4 years and 6 months old.
Ever since he started kindergarten three months ago, he has been constantly catching colds.
We have visited various hospitals, and initially, he was diagnosed with cold symptoms.
However, his general cold symptoms (without fever) have not improved.
Later, I asked the doctor if it could be nasal allergies.
After the examination, she noted that he had slight dark circles under his eyes, but it wasn't severe.
She prescribed medication for nasal allergies, but the problem still did not improve.
I am considering visiting an otolaryngologist to determine the underlying issue.
The situation has become more serious.
My child's symptoms include clear nasal discharge, non-yellow nasal congestion, and occasional eye watering, with coughing being less frequent.
However, the nasal congestion is the most severe problem.
At night, he snores loudly and even experiences brief episodes of apnea.
The doctor used an endoscope and observed what appeared to be a mass in the nasal cavity.
I forgot the medical term for it, but he mentioned that if it swells, it could obstruct the airway, and surgery is recommended.
He advised me to consider this, stating that such surgeries are often performed on children.
I would like to inquire about the necessity of this surgery and whether there are alternative treatment options available.
Thank you for your assistance.

Hsin-Yi, 40~49 year old female. Ask Date: 2011/12/08

Dr. Xiao Kaiwen reply Pediatrics

What you might be referring to is the adenoid tissue, which is located in the nasopharynx and is unique to children.
This tissue is present at birth and serves as a type of immune tissue that protects us during early childhood.
However, as we grow older, it gradually shrinks.
In some cases, if it does not shrink adequately during childhood, it can become overly enlarged, leading to a sensation of nasal obstruction and severe snoring during sleep.
Typically, this condition improves as the individual matures and the adenoids shrink.
However, if the obstruction is severe enough to significantly impact sleep and quality of life, potentially leading to obstructive sleep apnea, surgical removal may be considered.
Therefore, it would be advisable to discuss with an otolaryngologist whether the condition is severe enough to warrant surgery (and if surgery is necessary, it should be performed).

Reply Date: 2011/12/08

More Info

It sounds like you are facing a challenging situation with your child's ongoing nasal issues. From your description, it seems your son has been experiencing persistent nasal congestion, runny nose, and possibly sleep disturbances due to snoring and apnea. These symptoms can be quite distressing for both the child and the parents, and it’s understandable that you are seeking clarity and options for treatment.

Based on the symptoms you've described, it appears that your child may be suffering from allergic rhinitis, which is common in children, especially those who have recently started school and are exposed to new allergens. The presence of dark circles under the eyes can also be indicative of allergies. However, the fact that your child has a significant nasal obstruction, especially if it is causing snoring and potential sleep apnea, raises additional concerns.

The "meat-like" growth you mentioned could refer to nasal polyps or enlarged adenoids. Nasal polyps are non-cancerous growths that can develop in the nasal passages or sinuses, often associated with chronic inflammation or allergies. Enlarged adenoids, which are lymphatic tissue located at the back of the nasal cavity, can also obstruct airflow and contribute to breathing difficulties, especially during sleep.

In terms of treatment options, surgery is often considered when conservative measures fail to provide relief, particularly if the obstruction is severe enough to cause sleep apnea or significant breathing difficulties. Adenoidectomy (removal of the adenoids) is a common procedure in children and is generally safe. It can lead to significant improvements in breathing, sleep quality, and overall quality of life.

Before proceeding with surgery, it is essential to explore all options. Here are some steps you might consider:
1. Consultation with an ENT Specialist: Since you have already seen an ear, nose, and throat (ENT) specialist, it would be beneficial to have a thorough discussion about the findings from the endoscopy. Ask about the size of the obstruction, the likelihood of it resolving with medical management, and the potential risks and benefits of surgery.

2. Allergy Testing: If allergies are suspected, consider having your child undergo allergy testing. Identifying specific allergens can help tailor treatment, which may include antihistamines, nasal corticosteroids, or allergy shots (immunotherapy) if appropriate.

3. Nasal Corticosteroids: These can help reduce inflammation in the nasal passages and may alleviate symptoms without the need for surgery. Discuss with your doctor whether a nasal spray might be appropriate for your child.

4. Environmental Modifications: Reducing exposure to allergens in your child's environment can also be beneficial. This may include using air purifiers, keeping windows closed during high pollen seasons, and regularly cleaning bedding and toys to minimize dust mites.

5. Follow-Up: If you choose to pursue surgery, ensure you have a follow-up plan in place to monitor your child's recovery and any changes in symptoms.

Ultimately, the decision to proceed with surgery should be made collaboratively with your child's healthcare team, considering the severity of symptoms, the impact on your child's quality of life, and the potential benefits of the procedure. It’s important to feel comfortable and informed about the choices you make for your child's health.

In summary, while surgery can be a necessary and effective option for treating significant nasal obstruction in children, exploring all available treatments and ensuring a thorough understanding of your child's condition is crucial. Don't hesitate to seek a second opinion if you feel uncertain about the recommended course of action. Your child's health and well-being are paramount, and you are taking the right steps by seeking help and asking questions.

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