CHILD WITH HIS NOSE ALWAYS CLOSED

What are the causes

Some children may have, even for very long periods, a persistent nasal obstruction that results in snoring during the night, forced breathing through the mouth, nasal voice. Sometimes these symptoms plus the cough. Difficulty in breathing through the nose can lead to irregular sleep with frequent awakenings, daytime sleepiness, decreased attention and academic performance. Sometimes these kids have some real crisis of apnea, with periods shorter or longer stop breathing and subsequent recovery of it with a loud deep breath. It 'a very distressing for both the child and parents.

The causes of persistent nasal obstruction may be congenital malformations is the main cause of obstruction in the first months of life ("choanal atresia," congenital deviation of nasal septum, etc..), Which acquired through traumatic events, such as bone fractures nasal frequent cause of obstruction in older children and adolescents.
Regardless of the causes of nasal obstruction malformations that continues over time in children are mainly these four:
1. The "adenoid", namely the enlargement of the lymph tissue of that area of the pharynx which is behind the nose and which can result in blocking of the flow of air through the nose same;
2. Allergic rhinitis, in which the blocking of the passage of air through the nose is due to the thickening of the mucous membrane that lines the walls of the nasal cavities because of allergic inflammation;
3. Rhinosinusitis, not only infrequent complication of the common cold, but also of the same allergic rhinitis and adenoid hypertrophy, in which the airway obstruction of the nose is determined by purulent secretions coming from the sinuses, air-filled cavity usually placed around the nasal passages;
4. The dental malocclusion. Abnormalities of your teeth and palate, such as a highly arched palate upwards ("arched palate") can lead to a narrowing of the nasal passages and therefore a difficult passage through them of the inhaled air.

How to recognize the causes

Usually the recognition of the cause responsible for the nose always closed even if it is not difficult, it should be stressed, sometimes the factors responsible are more than one. For example, a rhinosinusitis can implant a nose in a child allergic or adenoid, as often coexist hay fever and enlarged adenoids. The history of the most common rhinosinusitis, that in young children does not give almost never headaches not yet developed the frontal sinuses, is that of a "cold" that does not pass after 10-15 days. The child who has had an initial acute cough, runny and stuffy nose, fever often continues after the disappearance of fever, to have a stuffy nose and you can often see the nasal discharge becoming gradually more and more dense until it took aspects frankly purulent, with a thick yellowish or greenish color, bad breath, cough that does not go (the "brat" for once). It can be said that a cold that does not go after 10 days is very likely to become a rhinosinusitis. The confirmation will be given by the physician examining the nasal passages with a simple otoscope can observe the presence of these secretions (maxillary rhinosinusitis). Sometimes the purulent discharge is visible in the form of wedges of pus from the nose down when the doctor examines the throat with bulb and abbassalingue (ethmoid sinusitis). It is absolutely true that the diagnosis of sinusitis is necessary x-rays, or rather should not do it ever. X-rays of the sinuses, in fact, for technical reasons, easily gives false positives, ie, the X-ray tends to iperdiagnosticare sinusitis even when it is not there.
Diagnosis is out of the history of the cold that does not pass, the presence of purulent nasal secretions, direct examination of the nose by the pediatrician.
history of the child with "adenoids" (adenoid hypertrophy) is that of a child who snores at night, breathing with his mouth open even during the day, speaks in a nasal voice : The appearance is that of a child spent "just wake up" are children who sleep badly, wake up frequently, are often sleepy during the day. Have sometimes, at night, the crisis of apnea which we have previously spoken. If the adenoids are very large it may happen that your pediatrician will be able to see them when looking at the throat with the spatula. Other times, more often, can not see them. For diagnostic confirmation, which in practice is often superfluous, it may be useful X-ray examination of the neck or dell'otorino with fibroendoscopio. When your child has seizures apnea night, the problem is not only large but also the adenoid tonsil great: they are enlarged tonsils that during sleep, during inspiration, fall back and block the airway.
The allergic rhinitis that gives stuffy nose persistent rhinitis is called "perennial" that allergy to dust mites home or to cat dander or mold. The pollen rhinitis, known as seasonal rhinitis, as well as having a clear seasonality, appearing in spring, are not responsible for much of the nose to nose "leaking", with intense itching and sneezing often prejudice. Children with persistent rhinitis allergy to dust mites are children who typically sneeze when you wake up, when you put their slippers or when they go to the bathroom. Usually do not have excessive nasal secretion but if there is clear, aqueous, unless that does not overlap with rhinitis sinusitis. This is often close family members of children with allergies, sometimes with previous personal food allergy in the earliest stages of life, sometimes with prior or current atopic dermatitis, sometimes with a history of asthma episodes. The examination of the nasal cavity by the pediatrician, made, as mentioned by the simple otoscope with which usually you look at the ears, you can view the mucosa dl swollen nose, but a pale-purple swelling.
Finally it happens sometimes that in children with nose always closed after it is detected and treated the underlying problem, for example, have been removed adenoids, snoring breath and difficulty in breathing through the nose persist. In these cases, often, these children have the palate deformed, very high, or other deformities maybe induced by the same adenoids. These abnormalities of the palate and dental occlusion may be responsible for persistent snoring breath and need to be addressed specifically.

What to do?

It should first be stated with confidence that the problem of the child with his nose always closed is a problem that must be managed by the pediatrician. Parents should not, in other words, direct access all'otorinolaringoiatra. In fact, as the experiences of everyday life seem to prove otherwise, conducted exclusively pediatric allergic rhinitis and rhinosinusitis that, finally, the same adenoid hypertrophy. Compete all'otorino, in fact, obstructions malformation, the presence of severe crisis of nocturnal apnea, cases of rhinosinusitis or adenoidal hypertrophy that can not be resolved with proper treatment, to assess the need for studies on diagnosis by fibroendoscopio or a surgery. The ENT specialist, in other words, is the "surgeon" should intervene only at a later time, and only for specific indications recognized by the pediatrician. Regarding dental malocclusions obviously it is a specific field for which the intervention is indispensable orthodontist.
Usually, as mentioned, the search of the grounds of persistent nasal obstruction, does not appear very difficult and, usually, the physician is able, without examination or instrumental tests to make the diagnosis.
treatment of sinusitis antibiotic treatment must be continued over time (10-15 days or more) to eradicate the infection permanently. It 's always useful to associate a nasal spray cortisone completely harmless to facilitate the decongestion of tissues and drainage of the sinuses. If the sinusitis tends to recur despite adequate treatment must consider the possibility of the coexistence of allergic rhinitis and adenoids, and in rare cases selected, the possibility of local defects favoring the infection that will be up dell'otorino ascertain endoscopy. We reiterate that it is totally unnecessary X-ray examination of the paranasal sinuses, which therefore should never be executed. May be useful to limit the CT or MRI, but these tests should be reserved for special cases such as in the presence of major complications or in anticipation of surgery.
For adenoid hypertrophy surgery is not the only option. You can also groped medical treatment based on the use, for two months, nasal spray steroids. This treatment, in a significant percentage of cases, if done well, is able to put the problem under control. Utility very uncertain and entirely devoid of any scientific evidence are the treatments with antihistamines (perhaps they can be of some use the newer antihistamines, where it is associated with allergic rhinitis), various vaccines, immunostimulants.
If you do not appreciate satisfactory results it is necessary surgery which should cover, if there are crises of apnea, for the reasons previously said, even the tonsils.

When do allergy tests

The allergy tests are, as always in pediatric allergy, to confirm a suspicion of solids. Serve to confirm and should not be a routine for all "children with his nose always closed." The suspicion emerges from a set of elements that have already hatched and by the simultaneous observation of the absence of one of the other factors, however, as mentioned, often more factors can coexist. The treatment with drugs of the child with "perennial rhinitis" will be the same whatever the responsible allergen; the definition of which is, however, it is essential to put into practice the rules of prophylaxis which allow to reduce the contact with the factors responsible. It then will follow the rules of prophylaxis for dust mites, for cat dander, for the mold, depending on the specific allergy. For the nose always closed the main treatment is cortisone spray. The sprays of the latest generation are basically harmless and can be used even for very long times. It has great effect on symptoms stuffy nose treatment with oral antihistamines, however very effective treatment for the nose "leaking" of the pollen rhinitis. The reason for this lies in the fact that histamine, a substance that is precisely opposed by antihistamines, is unimportant in generating the symptom "blocked nose". The antihistamine may also be involved, but only as a drug of association, non-exclusive, because these allergic children tend to contract more easily than other children and recurrent viral infections in this antihistamine has a protective effect found.