ENT Conditions

QUESTION:

Dear Dr Dunlop,

My 2.5yo has always been a mouth breather and I'm starting to research the effects of this.

His turbinates have always been on the larger side and he's always produced massive boogers that obstruct his nasal passages. I've been told by a Dr that his tonsils are on the large side however they weren't overly concerned.

I will be booking him into the doctor to try and get a referral to an ENT.

Are there any other symptoms I should be looking for? Thank you

ANSWER:         

Dear A,

Thanks for your question and for visiting Kids Consult.

Mouth breathing is a problem if it is affecting your son's sleep quality in particular ie contributing to obstruction overnight that minimises deep sleep and leaves him unrefreshed each morning.

Enlarged adenoids can certainly do that, although as you say enlarged turbinates from allergic rhinitis can also be problematic.

Both could be treated with a nasal steroid spray, and that would certainly be worth a try before considering surgical intervention.

With any luck you may be able to avoid ENT involvement and be managed by your GP or Paediatrician.

Regards,

Dr Scott Dunlop
Consultant Paediatrician

QUESTION:

Dear Dr Dunlop,

Just wondering - my daughter is complaining of a sore throat, she’s pale, off her food, irritable.. got appt tomorrow afternoon with GP but I managed to look in her throat and saw her tonsils. They are quite big and red but they have these small veins all over them. No pus. I’ve never seen veins on tonsils before. What is this and is this a concern or normal?

Cheers

ANSWER:         

Dear M,

Thanks for your question and for visiting Kids Consult.

The veins are likely the normal blood supply to the tonsils, and probably exaggerated because the tonsils are inflamed.

Your GP will obviously take a look tomorrow and decide whether antibiotics are required.

Regards,

Dr Scott Dunlop
Consultant Paediatricia

QUESTION:

Dear Dr Dunlop.

My friend recommended your Facebook page. Thanks for doing online consults!

I have a healthy 4 year old son who has always been a mouth breather and my husband and I thought nothing of it. After seeing an ENT after nasal stuffiness and what we thought was a dust or tree allergy earlier this year, the ENT has recommended mometasone nasal spray.

After 5 weeks of this spray twice daily, his nose has not cleared and we thought he just had a series of head colds that will pass. He is a bit grumpy in the morning but we put that down to him being hungry when he wakes. He is happy after breakfast.

The ENT now wants to perform surgery and remove our son’s apparently enlarged adenoids. There has been no scan and surgery seems a bit drastic in our opinion. Our ENT says mouth breathing is bad for future jaw development and says surgery is required. Is mouth breathing in a preschooler bad in your view? We have booked a 2nd opinion ENT 6 weeks away. I just thought there might be more solutions to fix mouth breathing in a child but our ENT thinks surgery is the only option...

ANSWER:         

Dear M,

Thanks for your question and for visiting Kids Consult.

Mouthbreathing is very common in kids and may or may not be problematic. It is most commonly caused by nasal obstruction, either from allergy (with enlarged inferior nasal turbinates) or enlarged adenoids.

The question is whether the mouthbreathing is causing any problems. If sleep quality is affected, then something should definitely be done. Using Mometasone spray is fine to try and clear nasal congestion, but if it doesn't achieve what you want, then surgery for adenoid removal might be necessary. We don't always image adenoids (with an XRay) prior to surgery if there is enough on the history to suggest adenoids need to come out.

It sounds like you're following a very reasonable path with a second opinion.

Regards,

Dr Scott Dunlop
Consultant Paediatrician