Nasal allergies and sinus infections are common in children. Symptoms include itchy, runny nose, nose bleeds, blocked nose, mouth breathing, snoring and drooling past appropriate age. Persistent nasal symptoms in children are related to conditions such as sleep apnea, asthma, ear infections, headaches, dental and facial malalignment. An ENT consult with a full head and neck examination including nasal endoscopy is advised if your child’s nasal symptoms are uncontrolled, persistent and/or recurrent.
Nasal Conditions
Nasal Procedures
Book an Appointment
At Adult and Child ENT Specialists, We are committed on providing Effective, Personalised & Holistic Care for all patients.
Nasal Conditions
Nose bleeds (Epistaxis)
Nose bleeds in children are commonly from broken, friable blood vessels situated in the front part of the nose close to the nostrils (anterior). Causes include minor trauma such as nose picking, rubbing, sneezing, upper respiratory tract infections or uncontrolled rhinitis. First line measures include manual compression (applying pressure at the tip of the nose) and ice gargle/suck on ice chips if your child can’t gargle. Treatment of underlying nasal allergies and infection commonly stops and decrease the frequency and severity of your child’s nose bleeds. Cauterization and/or nasal packing is required in severe cases.
Allergic rhinitis
Nasal allergies are common in Singapore. Your child should seek the attention of an ENT specialist if there are daily symptoms of itchy, runny and blocked nose, especially if these symptoms are severe enough to cause nose bleeds, habitual mouth breathing, snoring, sinus or ear infections. Management with Dr Soon will include a full head and neck examination, nasal endoscopy to look at the structural nasal anatomy and degree of mucosal edema. Treatment of allergic rhinitis include nasal steroidal sprays, antihistamines, nasal saline wash and decongestions. Allergy testing and immunotherapy maybe helpful in some children.
Inferior turbinate hypertrophy
Inferior turbinate hypertrophy is a condition whereby the lining on the side walls of the nose is enlarged and causes nasal obstruction. It is common in children with nasal allergies. If severe, it can lead to sinus infections, poor sense of smell, mouth breathing, sleep apnea and nose bleeds. Treatment of underlying nasal allergies is helpful in most patients. Surgical turbinate reduction procedure is required in some patients.
Adenoidal hypertrophy (Enlarged Adenoids)
The adenoid is a lymphoepithelial tissue situated at the back of your child’s nose. It can be enlarged to give problems of nasal obstruction, sleep apnea, chronic inflammation, sinus infections and ear infections. Chronic mouth breathing can predispose your child to dental, facial malalignment and can affect speech. Nasal endoscopy or lateral neck x-ray are used to visualize your child’s upper airway and to evaluate if there is airway obstruction. Most children do not need treatment as adenoids will shrink as your child grows older (by age 7 or 8). Adenoidectomy a procedure to remove adenoids is required in certain cases.
Sinus infections
Most sinus infections in children occur following a cold or with nasal allergies. Treatment is symptomatic with fluids, saline nasal wash and warm compress. Most cases will resolve but seek medical attention if your child’s symptoms such as blocked nose, thick nasal discharge, cough, fever, headache persist after a week. Management will include oral antibiotics and nasal allergy medications. If your child is cooperative, nasal endoscopy and a quick nasal toilet procedure by Dr Soon can be performed in clinic. This will suction away thick nasal mucus obstructing your child’s sinus drainage ways and can provide immediate relief. CT sinus scans, sinus x-rays and possible surgical intervention maybe required for chronic sinusitis.
Foreign body in nose
Your toddler may have inserted a foreign body in his nose out of curiosity. Do not attempt to remove it yourself. If the foreign body is superficial, Dr Soon will be able to remove the foreign body with special instruments in the clinic. In the event of poor visualization, or impacted foreign body, the procedure will have to be performed under anesthesia.
Nasal bone fractures
Isolated closed nasal bone fractures secondary to accidental falls or sports related injury are common in children. Symptoms include bruising and swelling around the nose and nose bleeds. Your child may need to visit emergency if there is significant bleeding, breathing difficulty or blurred vision to exclude associated facial bone fractures and septal hematoma which requires drainage. If stable, you can visit an ENT specialist after a few days, when the swelling subsides, to proper evaluate the nose. Xray nasal bone and nasal endoscopy will be performed by Dr Soon. Treatment is commonly conservative though surgery maybe required in severe cases.
Deviated nasal septum
The nasal septum is the wall partition between the nasal cavities. It is commonly deviated as a congenital abnormaly or from injury. It may cause nasal obstruction when severe. A full head and neck examination with nasal endoscopy is performed by Dr Soon to rule out other nasal conditions which can contribute to your child’s nasal obstruction (eg. allergic rhinitis, inferior turbinate hypertrophy, adenoidal hypertrophy) before discussing treatment options. Endoscopic septoplasty is commonly delayed till age 16.
Sino-nasal tumors
Sino-nasal tumors are rare in children and can be benign or malignant. Treatment is commonly multidisciplinary and involves surgery if the lesion is large or late stage. Thus, it is important to consult an ENT specialist early if your child experiences persistent nasal symptoms.
Nasal Procedures
Nasal endoscopy
Nasal endoscopy is a clinic procedure whereby Dr Soon will insert a flexible tube with a tiny camera and light into your child’s nose to visualise the upper airway (entire length of nose to throat level). A topical nasal spray which has decongestant and anaesthetic effects is first sprayed into your child’s nose. It may leave a bitter after taste. Reassure your child that the procedure will not hurt and is required for evaluation. Our slim flexible nasal endoscope will provide a comfortable examination and the procedure is quick when performed by Dr Soon. This procedure is registered as a day surgery procedure and is eligible for reimbursement through Medisave or personal insurance.
Nasal toilet
Nasal toilet is a procedure performed in clinic to suction away thick nasal secretions or blood clots in your child’s nose. It is performed by Dr Soon with either a rigid nasoscope or under direct visualisation with a headlight. It is a useful procedure to remove thick nasal mucus not relieved with nasal saline washes, and in children who can’t blow out their nasal secretions. The procedure can provide immediate nasal decongestion.
Cauterization of nose bleeds
In minor nose bleeds (commonly, little area bleed), silver nitrate cautery is applied to the anterior nasal wall after topical Ensure that your child does not rub his nose after the procedure. In major nose bleeds, nasal packing maybe inserted, or your child may require general anesthesia to cauterize and achieve hemostasis
Adenoidectomy
Adenoidectomy is a procedure performed to remove your child’s adenoids. It is performed with your child asleep with a transoral and/or trans-nasal approach. It is generally a safe and quick procedure with minimal bleeding. It can be done as day surgery.
Radiofrequency ablation inferior turbinates
This is a minimally invasive procedure performed to reduce turbinate size and decrease nasal obstruction. It is performed with your child asleep and as day surgery. It is generally a safe and quick procedure with minimal bleeding. Your child will be started on nasal douches thereafter. It is important to control nasal allergies post-procedure for longer lasting effects.
Endoscopic sinus surgery
This procedure is performed with your child asleep and involves widening the natural ostia of your child’s sinus. It is commonly performed for chronic sinusitis, to improve ventilation and drainage of the sinus passageways.
Removal of foreign body nose
This procedure is indicated under general anesthesia if your child has an impacted foreign body in the nose or there are problems visualizing/removal the foreign body with your child awake. With a rigid endoscope, Dr Soon will use special nasal instruments to dislodge and remove your child’s impacted nasal foreign body. Any bleeding will be stopped intraoperatively. Performing this procedure under general anesthesia minimizes accidental foreign body aspiration.
Manipulation and reduction of nasal bone fractures
This procedure involves shifting the nasal bones back into position and is done in certain cases of displaced nasal bone fractures (proven on lateral nasal bone x-ray). It is best performed within the first ten days after injury, after the initial nasal bruising and swelling have subsided. Your child may be required to wear a nasal splint after the procedure. Nasal packs maybe introduced to support and prevent further movement of the fractured segment. Bone healing will take place within two weeks.
