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.
• Fragile X syndrome.
• Waardenburg syndrome.
• Cornelia de Lange syndrome.
• Foetal alcohol syndrome.
• Osteogenesis imperfecta type 2.
• Williams syndrome.
• Ectodermal dysplasia.
• Cleft lip sequence.