Common disorders of the nose
A nose bleed or epistaxis is
common in childhood. There is usually no ob-vious precipitating cause, but it
may be associated with minor nasal trauma (direct injury). Rarely an underlying
coagulation disorder may be present (e.g. acute lymphoblastic leukaemia or
haemophilia). Purulent, bloody na-sal discharge should raise suspicions of FB
impaction.
Initial management should include
sitting with the head tilted forwards and applying firm pressure to the
cartilaginous part of the nose with finger and thumb for 10–15min. If simple
measures fail to stop bleeding then referral to the ENT team for nasal packing
and cauterization under direct visualization. A blood sample for FBC, clotting
screen, and blood group testing is warranted in this situation.
•
Children
may present with a unilateral offensive discharge from the nose.
•
Removal
of FBs from the nose is more urgent than in the ear as the object may be
inhaled.
•
Removal
may be attempted if the patient is able to cooperate, by having them try to
blow their nose.
•
alternatively,
attempt removal directly by dislodging with a suitable instrument;
•
an
alligator type forceps should be used to remove cloth, cotton, or paper FBs;
•
pebbles,
beans, and other hard FBs are more easily grasped using bayonet forceps, or
they may be rolled out by getting behind it using an ear curette, single skin
hook, or right angle ear hook.
•
If
these measures are unsuccessful referral to the ENT team is required.
Infrequent in childhood. They are
associated with allergic rhinitis or cystic fibrosis. Signs include clear
watery rhinorrhoea, postnasal drip, and nasal obstruction. Increased snoring
intensity may also be a feature. Treatment with topical corticosteroids (e.g.
beclometasone) is required.
Abnormalities in nasal development
may be associated with a number of congenital or inherited conditions. Here are
some examples:
•
Achondrogenesis
syndromes.
•
Trisomy
21.
•
Foetal
valproate syndrome.
Mucopolysaccharoidoses.
•
EDS.
•
Fragile
X syndrome.
•
Waardenburg
syndrome.
•
Cornelia
de Lange syndrome.
•
Foetal
alcohol syndrome.
•
Osteogenesis
imperfecta type 2.
•
Williams
syndrome.
•
Ectodermal
dysplasia.
•
Cleft
lip sequence.
•
Coffin–Lowry.
•
Rubenstein–Taybi.
•
Smith–Lemli–Opitz.
CHARGE association.
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