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VCU Department of Otolaryngology, Virginia Commonwealth University VCU Department of Otolaryngology VCU Medical Center VCU

VCU Department of Otolaryngology

Pediatric Otolaryngology - Nose

The nose warms, moisturizes and cleanses the air that is breathed in before it gets to the lungs. Babies suffer the most when the nose is blocked because they must breathe through their noses when they suck. Young children are able to breathe through the mouth but the result is a dry mouth, bad breath, drooling, crankiness, headaches and sleep disturbances.

Surgical procedures may be done after medical treatments such as antibiotics and nasal sprays have failed to restore normal nasal breathing. Keeping the nasal passages moist with nasal saline is the most common postoperative challenge for parents. The most common surgical procedures are discussed below.

Cautery of the inferior nasal turbinates: This procedure is commonly done in addition to tonsil and adenoid removal if the nasal turbinates are enlarged. The turbinates are small bony structures covered with mucus tissue located towards the side area of each nostril. The turbinates are likely to be large if the child has allergies and had many sinus infections. Cautery of the turbinates is done when the surgeon uses a special heated instrument while the child is asleep during surgery.

Sinus surgery also known as Functional Endoscopic Sinus Surgery (FESS): A FESS is needed when the child continues to have sinus infections that never seem to clear up after repeated antibiotic courses. A typical child who may need a FESS is one who has allergies and asthma. Special lighted instruments are used to make the normal drainage passageways between the sinus cavities bigger. When the passageways are able to drain the mucus from the sinuses to the nose, fewer sinus infections occur.

Septoplasty: The septum is the bony tissue that divides the two nasal cavities. Children may be born with a deviation to one side or may have had a broken nose that did not heal straight on the inside. The result of this deviation can affect the ability of the nose to breathe through both sides. Occasionally, the surgeon needs to straighten the septum if the child is prevented from sleeping with the mouth closed. Special instruments are used to shave away excess bone on the restricted side. It is not necessary to "break" the nose to do a septoplasty.

Nosebleeds (Epistaxis): Nosebleeds can be common in children aged 2-10 years old. The most usual causes are trauma to the nose occurring during play and "picking the nose" because it has dry crusts inside that are irritating. More serious problems, causing nosebleeds are blood related. Once the child has been referred to the otolaryngologist, the treatment is usually simple cautery using silver nitrate tipped applicators to the blood vessel inside the nose that has been bleeding. Rarely, does the surgeon have to pack a child's nose or take the child to surgery to stop the bleeding.