Other Nose & Sinus Treatments

On this page we cover:

• Nasal Endoscopy
• Epistaxis
• Inferior Turbinate Reduction
• Septoplasty
• Nasal Fracture
• Choanal Atresia Repair

 

Nasal Endoscopy

Nasal endoscopy is a common procedure that is done by ENT physicians. This procedure can be done in the office or under anesthesia. Nasal endoscopy may be recommended by your pediatric ENT surgeon to better examine and evaluate the inside of your child’s nose. Common problems that involve a nasal endoscopy include:

• Nasal obstruction/mouth breathing (blocked breathing through the nose)
• Chronic sinus infections or nasal drainage
• Concern for nasal polyps or other lesions
• Evaluate for snoring or enlarged adenoids
• Septal deviation
• Evaluate healing after septum, sinus or choanal atresia surgery

The endoscopy can be performed with a small, fine, flexible camera or with a thin, rigid camera. Here at ENT for Children, we take all steps possible to keep your child informed and as comfortable as possible during the endoscopy. We will spray a grape flavored medication inside your child’s nose to help decongest and numb the inside of the nose. The procedure is very interactive and is displayed live for the child and parents to see. Most endoscopies are very short and take less than a couple minutes. The information gained from the short endoscopy can be very helpful in diagnosing and treating your child’s problem.

Epistaxis

Nosebleeds are a very common problem in children. These can occur sparingly or can occur very frequently causing significant disruptions. Nosebleeds most often start from the blood vessels along the front of the septum. This area is prone to bleeding due to frequent irritation from nose blowing, dry air, allergies, rubbing the nose, sneezing, and picking out crusts. Nosebleeds can be worse if your child has a bleeding disorder or uses nasal steroid sprays or during the winter months.

Symptoms
Bleeding from the nose can occur anytime. The bleeding can be from one or both sides and can last only a minute or two or can be more severe with blood clots.

Diagnosis
Investigating the cause of your child’s nosebleeds usually only involves looking into the nose. The front area of the septum is evaluated and often the problem blood vessels are clearly seen. Occasionally we will discuss placing a fine flexible video camera into the nose if we suspect an unusual cause of your child’s nosebleeds.

Treatment
Treating nosebleeds involves treating the episode of bleeding itself and then trying to prevent further bleeds. The best way to treat an active nosebleed is to stay calm and firmly, fully pinch the bottom portion of the nose continuously for at least 10-15 minutes. Your ENT for Children physician may suggest spraying Afrin^TM decongestant into the nose during a bleed episode which will help shrink down the bleeding vessels. We do not recommend blowing the nose or stuffing tissue paper into the nose.

Preventing episodes of epistaxis involves humidifying the nasal septum so that it is not dry. This involves frequently using a nasal saline spray into the nose. We may also recommend using a humidifier at night as well as a moisturizing ointment into the nose at night. If episodes are still occurring despite these measures, your surgeon may recommend cauterizing the blood vessels of the septum. This can be done in the office or under anesthesia depending on the age of your child and the severity of the episodes, blood vessels. In the office setting, we numb the surface of the septum with a topical numbing medication. The blood vessels are then cauterized using a special chemical applicator on a thin stick. Some children are not amenable to cauterization in the office due to age or cooperativeness, and may require a general anesthetic for control of the nosebleeds. Complete healing from cautery procedures usually takes 2-3 weeks.

Inferior Turbinate Reduction

The nasal turbinates are outpouches of tissue and bone in the nasal passages that provide important functions. The turbinates will warm and humidify the air we breathe as well as filter particles out of the air before they enter our lungs. The inferior turbinate is the largest of the 3 sets of turbinates and sits in the bottom of the nasal passages. One possible cause of nasal obstruction can be that the inferior turbinates are too large and taking up too much space. This can impair breathing through the nose.

Symptoms
Symptoms of enlarged turbinates are related to nasal obstruction. There may be difficulty breathing through the nose, a feeling of constant congestion, or constant mouth breathing. The condition can be exacerbated by upper respiratory infections, sinus infections, or environmental allergies.

Diagnosis
You ENT for Children physician will place a fine flexible video camera into the nose to view the entire inferior turbinate as well as the overall anatomy of the nasal passages. When evaluating nasal obstruction in your child we will not only look at the turbinates, but also assess the septum and adenoids, which are also common causes of nasal obstruction in children.

Treatment
When treating enlarged inferior turbinates, we will always try a non-surgical approach first. Treating sinus infections or allergies can often be helpful to improve breathing. Medications in the form of nasal sprays are also commonly used, especially if the enlargement is due more from tissue and not bone.

If these approaches do not help your child, your surgeon will discuss surgery to shrink the turbinates down. Due to the important functions of the turbinates, they are not removed but only reduced in size. Your surgeon will discuss the various methods to shrink the turbinates ranging from removal of some the bone to shrinking down the tissue of the turbinates or both. Surgery is done through the nostrils using special instruments and cameras. The surgery is usually done in an outpatient setting and healing from surgery takes 2-4 weeks.

Septoplasty

The nasal septum is the wall that divides the two sides of the nose. It starts in the front of the nose and travels the entire length of the nasal passages to the back of the nose. A deviated septum is a condition where the septum is not straight and thus causes a blockage of one or both sides of the nose. A deviated septum can develop slowly over time or can occur as a result of a trauma to the nose.

Symptoms
A deviated septum can cause problems with blockage of nasal breathing on one or both sides, recurrent sinus infections or constant nasal drainage. The deviation can be in the front near the nostrils or further back in the nose.

Diagnosis
A deviated septum is best diagnosed by looking inside the nose. Looking from the outside can assess the front part of the septum. However, to best evaluate the entire septum and the rest of the nasal cavity anatomy, your pediatric ENT surgeon may place a fine flexible video camera into your child’s nose to get a magnified view of the entire septum. This will allow us to evaluate for other possible causes of nasal blockage.

Treatment
Surgery is usually the best, long-term treatment for a deviated septum. However, depending on the age of your child and the severity of the deviation, your surgeon may not recommend surgery. This is because the septum and nose of your child will continue to grow and we do not want to risk altering the growth of your child’s nose. If surgery is recommended, it is done under anesthesia and performed entirely through the nostrils. The deviated section of bone or cartilage is either straightened or removed. At the end of surgery, there will be plastic splints placed in the nose to keep the septum straight and promote healing. These splints are removed in the office 7-14 days after surgery. Complete healing from surgery usually takes 4-6 weeks.

Nasal Fracture

Nasal fractures are the one of the most common fractures of the body and the most common fracture of the face. Nasal bone fractures are a result of direct trauma to the face and can occur at any age. Fractures result from accidents, falls, sports injuries, or any form of direct force to the nose. Trauma to the nose can result in fractures to the outer nasal bones or to the inside cartilage of the septum. Careful diagnosis and proper management can help properly treat these injuries and avoid possible complications.

Symptoms
The symptom of a nasal fracture can vary depending on the severity of the injury. There can be bleeding from the nose, swelling and bruising of the nose and eyes, trouble breathing through the nose, or watery nasal drainage. There may be an obvious deformity of “crookedness.” However, swelling can occur quickly after an injury and may make it difficult to see if the nose is still straight.

Diagnosis
The most important step in diagnosing nasal fractures is a very careful examination and history of the trauma. Nasal bone x-rays may be performed at the emergency room or urgent care center, however x-rays do not always properly diagnosis fractures. It is also very important to examine the inside of the nose to look for fractures of the septum or for a septal hematoma (trapped blood inside the septum that has to be drained.) In severe trauma, your ENT for Children surgeon may recommend getting a CT scan of the facial bones to look for other fractures of the face. It is also recommended to bring in recent, pre-injury photographs of your child that can be helpful to see if a deformity is present.

Treatment
Treatment of nasal fractures includes the initial treatment and later treatment. The initial treatment involves making sure that there is no other serious head trauma, to make sure that any nose bleeding has stopped and to make sure that there is no hematoma of the septum which would have to be drained. If there is a concern for nasal fracture then your child’s doctor may have you see a pediatric ENT surgeon. If a nasal fracture is present, treatment will depend on the severity of the injury. Some nasal fractures do not need surgery if there is no external or internal deformity and the breathing is unaffected. However, if there is a deformity or blocked breathing then your surgeon may recommend surgery.

The timing of surgery is very important. Due to swelling early after the trauma and the fractured bones starting to heal later, surgery is usually recommended 7-14 days after the trauma. Most cases of surgery are done to manipulate the bones back into position without making any incisions. There is an external splint/cast that is placed after surgery that is removed 7-10 days after surgery. Full healing of the nasal bones does not occur for 6-8 weeks, thus it is important to protect the nose from further trauma during the healing period (i.e. sports.) If the fractures are allowed to heal in place, then surgery may have to be delayed at least 6 months and require a more formal, “open rhinoplasty” surgery by a facial plastic surgeon.

Choanal Atresia Repair

Choanal atresia is a congenital disorder where the back of the nose is not open to the throat. This condition can cause complete obstruction of one or both sides of the nose. This will impair breathing and normal drainage of secretions. It is thought that the condition occurs when the tissue or bone between a child’s nose and mouth remains during fetal development. Children who are born with this disorder often exhibit it in one of following ways:

• Bilateral Choanal Atresia: Both the nasal passages are blocked in children who suffer from bilateral choanal atresia. The condition is noticed immediately after birth as it causes extreme difficulty in breathing.
• Unilateral Choanal Atresia: Only one nasal passage is blocked for a child who has unilateral choanal atresia. This is more common than bilateral atresia and can often go unnoticed until later in childhood. Infants who are born with this condition are still able to breathe through the side that is not blocked but will usually have constant one-sided nasal drainage.

Symptoms
Other symptoms that are associated with the disorder include the following:

• Noisy breathing
• Feeding difficulties during infancy
• Persistent one-sided nasal drainage
• Recurrent one-sided sinus infections
• Breathing difficulties following birth unless the infant is crying

Diagnosis
This condition is best diagnosed by placing a fine flexible video camera into the nose to view the back. The back of the nose should connect to the back of the throat. In the setting of an atresia, the nasal passage ends in a blind wall. Surgery is required to repair this condition.

Surgery
Your ENT for Children physician will likely obtain a CT scan to plan for surgery. This better characterizes the atresia and also allows assessment of the overall nasal anatomy. Your pediatric ENT surgeon will choose either one of two approaches to repair the blockage depending on the anatomy of the nasal passage. A procedure might include making an incision at the roof of the mouth or accessing the blockage directly through the nostrils with the help of very small instruments and cameras.

Your surgeon may decide to place temporary nasal stents or nose drops into your child’s nasal passages during the healing period. Healing from atresia surgery is usually 4-6 weeks. Brief follow up procedures may be required to dilate the newly opened passage(s) to keep them open long term.