Snoring In Children And Its Advanced Treatment Options

26th Feb 2021 / Dr.Harika

Snoring is a noise that occurs during sleep when the child is breathing  and there is a  blockage in the air passage at the back of the nose. About 1-3% of children not only snore but also suffer from breathing problems during sleep. Children who are 3 yrs or older tend to snore during deeper stages of sleep. For up to 10% of children who snore it can be a sign of more serious problem ,like Obstructive sleep apnea syndrome(OSAS).primary snoring is defined as snoring that is associated with more serious problems such as OSAS or frequent arousals from sleep. Sometimes snoring is a sign of respiratory infection, stuffy nose or allergy but otherwise it may be a symptom of sleep apnea which is seen in more than 90%of cases. When snoring is accompanied with gasps or pauses in breathing or if accompanied by thrashing in bed ,they could be a sign of a more serious condition. Undiagnosed and untreated sleep apnea may cause day time sleepiness and behavioral problems including difficulties at school. So it is recommended that all children with snoring to be screened to know if the child has primary snoring or OSAS. What causes sleep apnea:
  • Obesity
  • Respiratory infections
  • Allergies
  • Enlarged tonsils and adenoids
  • Deviated nasal septum
What to look for at night in a child with OSAS:
  • Child snores for 3 or more nights per week
  • Child’s breathing is accompanied by gasps or pauses
  • Sweating profusely during sleep
  • Restless sleep with frequent awakenings
  • Sleeping with head in unusual positions
  • Sleeping with mouth open
  • Frequent bed wetting
What to look for during the day in a child with OSAS:
  • Excessively sleepy during the day
  • Difficult to wake up in the morning
  • Having any learning, behavioral or social problems
  • Often irritable, cranky, agitated or aggressive
  • Speak with nasal voice
  • Breathing primarily with their mouth
What if OSAS is left untreated:
  • Behavioral problems including difficulties at school with learning problems ,decreased focus and concentration and lowered IQ
  • Poor physical and mental development
  • Feeding problems
  • Decreased hearing due to Eustachian tube block(in children with huge adenoids)
  • Cognitive and psychological problems
  • Facial changes occur due to prolonged mouth breathing (Adenoid Facies)
Types of treatment:
  • Weight reduction if excess weight is the issue
  • Medical treatment includes avoiding the allergens and treating the upper respiratory infections and allergies which can cause the airway obstruction .
  • Surgical treatment is opted when medical treatment fails . if the problem is due to large adenoids and tonsils a surgery to remove adenoids and tonsils is recommended.
Adenotonsillectomy: There are various methods of performing the surgery. Newer and most advanced method being plasma mediated ablation COBLATION. This device melts the tissues at low temperatures( 60-70 degrees C) with minimal collateral thermal tissue damage ,hence also termed as Cold Ablation. Advantages being:
  • Less operative time
  • No intra operative blood loss
  • Less post operative pain
  • Early recovery
   
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About Nose

The nose is the primary organ for the sense of smell and serves as the prominent structure in the respiratory system. It plays a key role in the entire process of respiration by providing air for breathing, conditioning the air for better inhalation by filtering, warming, and moistening the air; along with the self-cleaning process by extracting the foreign particles from the inhalations.

The nose problems can arise due to a variety of reasons which can include allergies, viral or bacterial infections, abnormal growths like polyps, and abnormalities in the nasal structures that can be either congenital (birth defects) or due to an injury, that blocks the airways and interferes with breathing.

  • Here is a list of common nose problems which need expert care from ENT specialists and surgeons for evaluation, diagnosis, prevention, and treatment.

    Nasal Block: The nasal block is nothing but a stuffy nose. It is also referred to as nasal congestion or nasal obstruction which interrupts the entire respiration process and makes it difficult to breathe normally. A nasal block is often a symptom of upper respiratory infections such as sinusitis or nasal septum deviation or due to polyps in the nose. It can also be accompanied by other symptoms like runny nose and persistent headache which makes you feel tired and interferes with daily activities. Usually, the nasal block can be a result of a common cold or nasal allergy or deviated nasal septum, or an increase in the size of the adenoid.

Nasal Allergy: A nasal allergy is an inflammatory reaction to certain allergens when they come into contact with the airways and cause irritation. The nasal allergies are referred to as Allergic Rhinitis in medical terms, which is of two types, namely, seasonal and perennial. Seasonal allergies occur due to the response to seasonal changes during the spring or rainy season. While perennial allergies can occur any time in the year in response to dust, pollen, mold, and pet dander. The main symptoms of a nasal allergy can include runny nose, sneezing, stuffy nose, red and watery eyes, itchiness in the nose, ears, eyes, and throat, headache, etc. In the case of nasal allergies, the skin prick test is the gold standard test to diagnose allergy and immunotherapy should be considered for the cure.

Bleeding from the nose: Nosebleeds are common in children and adults. But frequent nosebleeds can indicate a serious medical condition that requires expert medical assistance. The treatment for nosebleeds depends on their cause. The nose contains a complex network of many thin blood vessels, all over its internal surface. The most common nosebleeds occur from the front of the nose, due to rupture or damage of blood vessels when they come in contact with dry and hot air during breathing or due to nose-picking in children. These types of nosebleeds occur usually in summers. While the nosebleeds that occur at the back of the nose usually occur due to high blood pressure commonly seen in adults

Sinusitis or Sinus infection: Sinusitis, often known as sinus infection is the inflammation of the air cavities present in the skull and facial bones. The main cause of sinusitis includes a virus, bacteria, or rarely fungus that may irritate the sinuses and causes inflammation. The common symptoms of sinus infection seen in adults are decreased sense of smell, fever, runny or stuffy nose, cough, headache, and fatigue. In children, a sinus infection can be identified if they have any symptoms like a cold that lasts more than a week with fever, swelling around the eyes, earaches, bad breath, coughing. Usually, a sinus infection goes away within one to two weeks with proper medication and care. But, recurrent sinus infections require surgical intervention to avoid the risk of future infections and restore your quality of life.

Headache: Headache is often a common symptom of nasal problems, especially in case of nasal block or congestion and nasal allergies. This is because of the inflammation of the sinuses that are caused by an infection or allergy. Since the sinuses are present in the skull and facial bones as well, the inflammation of sinuses from an infection can cause pressure in the cheeks, forehead, and around the eyes. Also, an allergy causes nasal congestion due to trapped mucus in the sinuses. So, the extra stress on sinuses in the skull can lead to headaches which can be managed when their cause is addressed and treated in the right way.

Snooring in adults: Snoring is a harsh sound that occurs when the airflow during sleep is constricted due to narrowed airways. This makes the soft tissues present along the airways to vibrate and causes snoring. Though snoring in adults is ignored thinking as it is very common, it often indicates an underlying medical condition. It is the most common symptom. of sleep disorder, known as sleep apnea. Apart from this, it is also common in people who are overweight or obese, in whom the extra fat in the neck tissue prevents air from flowing freely when they sleep. But, the main causes of snoring in adults can be a result of nasal problems which include deviated nasal septum, abnormal growths in the nose such as polyps, nasal congestion from infections or allergies, etc.

Snooring in children: Though snoring is not so common in children when compared to adults, it may occur in some children. It is common when kids suffer from nasal congestion because of cold or flu, but frequent or severe snoring is often a concern. The most common reason for snoring in children is adenoid hypertrophy that has to be addressed at an early age to prevent serious ailments in the future such as breathing difficulties, hearing loss, frequent ear infections, etc. Snoring in children affects their quality of sleep which leads to behavioral issues in the daytime. Some of the signs of snoring in children include increased irritability, crankiness or being aggressive, excessive sleeping during the day, difficulty waking up in the morning, bed wetting in older kids, and struggling to pay attention due to lack of quality sleep at night.

Loss of sense of smell: Also known as anosmia, is the condition in which people experience loss of the sense of smell partially or completely. This loss can be either temporary or permanent which can be determined by the cause of the condition. Temporary anosmia can be due to the irritation of the lining in the nose, which usually happens in the case of cold or allergies. In such cases, the sense of smell will be restored on its own once the allergy or the cold gets treated. But, there are some serious conditions that can cause permanent anosmia due to brain or nerve damage, such as brain tumors or head trauma from severe injuries.

Runny nose or nasal discharge: A runny nose is nothing but the discharge or dripping of mucus from the nostrils. It is caused when the nasal tissues get irritated. Though the runny nose isn’t a serious condition and very common, it increases irritability and can be annoying, especially in children. There are many causes which can irritate the nasal tissues and results in the runny nose which include, cold, allergies, sinusitis, flu, nasal septum deviation, nasal polyps, allergic reactions to some medications, overuse of nasal spray, etc

Foreign body in the nose:This is most common in children and a common complaint in emergency cases. It can also occur in adults with mental disabilities. A foreign body in the nose means the presence of an object in the nose which is often dangerous and can cause serious injuries and infections. Though parents are very attentive, it is a common habit of kids to place objects in their mouths, nose and ears while playing. This can lead to choking hazards and can be very serious if not addressed by the medical experts in time. The most common foreign objects which are usually found in children are small toys, pieces of eraser, tissue, dirt, tiny plastic or metal objects, food particles, etc. When any of the foreign objects are stuck in the nose, adults or kids will experience foul-smelling nasal drainage and difficulty in breathing.

More About Throat

The throat or pharynx is a ring-like muscular tube that extends until the voice box called the larynx and to the food pipe called the esophagus. The pharynx comprises 3 parts: an upper part - Nasopharynx, a middle part - Oropharynx, and a lower part - Hypopharynx

The larynx or voice box primarily helps with voice production and is the entrance of the windpipe that continues as the trachea. Above and at the front of the larynx, a stiff flap made of cartilage called epiglottis is located which prevents food and fluids from entering into the trachea.

More About Throat

Tonsils and adenoids composed of lymph tissue act as a defense mechanism of the body and fight against infections. Adenoids are present behind the nasal cavity while tonsils are located on either side of the throat. The throat plays a key role in both the digestive and respiratory processes, with proper coordination between breathing and swallowing functions.

The common conditions that develop in the head and neck regions include:


Thyroid Issues: The thyroid gland is a small butterfly-shaped organ located at the front of the neck and surrounds the windpipe. It is a part of the endocrine system which produces hormones that impact the overall well-being and functioning of the body. The thyroid gland produces a hormone called thyroxine, which controls various important functions of the body. When the thyroid gland doesn’t work properly, it disturbs the production of the thyroxine hormone. In such cases, the thyroid gland either produces too much thyroxine hormone or too little, than actually needed. This leads to thyroid-related issues such as hyperthyroidism and hypothyroidism, which further leads to other complications. The treatment for thyroid-related disorders involves medical management and surgical intervention to remove the enlarged thyroid gland based on the type of condition and complications.

Salivary Gland disorders: Salivary glands are the glands that produce saliva which helps to keep the mouth moist, protects our teeth from decay, and helps to digest the food properly. They are present around the inner linings of the cheeks, lips, and mouth. We have three pairs of major salivary glands known as parotid, submandibular, and sublingual glands. Salivary gland disorders usually occur when the ducts get blocked with stones or the gland gets infected which affects their functionality. The salivary gland disorders have to be evaluated and treated accordingly either with medical management or surgical intervention based on the type and extent of the condition.

Other swellings in the neck: Swellings in the neck area are common at all age groups. Any lump or mass found on the neck causes concern. Though most neck swellings or lumps aren’t harmful, some can indicate a serious health condition, such as infections or cancer. If the neck lumps are due to infections, they can be treated by proper medication. But, if they are cancerous growths, the treatment plan may include surgery, radiation, or chemotherapy based on the lump formed. Any swellings in the neck should be evaluated and treated at the earliest to avoid further complications

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