Sinus and Nasal Problems
Sinus Treatment in Albany, NY
Nasal obstruction can have multiple causes in children. Structural problems can contribute including septal deviation, turbinate hypertrophy, and adenoid hypertrophy. In the pediatric population, congenital nasal masses can produce nasal obstruction. While congenital nasal lesion are less common, any infant or child with persistent nasal obstruction should have a complete evaluation by an otolaryngologist to be sure there is not a more serious underlying problem.
Nasal obstruction in children can also be due to chronic rhinitis (inflammation of the nasal mucosa). There are multiple causes of chronic rhinitis including chronic infection, allergic rhinitis, and non-allergic rhinitis related to other environmental factors.
Allergic rhinitis is a common problem in children and adults. Exposures to environmental (pollen, grass), indoor (dust mite, pet dander), or food (milk, peanut) allergens may produce symptoms. Treating allergy includes environmental modification, medical treatments, and immunotherapy (allergy shots or drops). In order to treat allergies effectively, it is often helpful to identify the allergens responsible for the patient’s symptoms.
There are several techniques for allergy testing in the pediatric population. Most tests for “allergy” are actually tests for allergic sensitization or the presence of allergen-specific immunoglobulin E (IgE). Most patients who experience symptoms upon exposure to an allergen have demonstrable allergen-specific IgE that specifically recognizes that allergen, making these tests essential tools in the diagnosis of allergic disorders.
- IVAT or Invitro Allergy testing – Blood testing for IgE sensitization. This is used in combination with the clinical presentation to help determine whether or not an allergen is causing symptoms
- Skin Prick Testing – During this test a few drops of the concentrated allergen are gently pricked onto the skin surface. This may generate a hive (Skin becomes raised, red and itchy) that can be measured to determine if the skin is reactive to the substance. The larger the hive the more sensitive the patient is to that particular allergen.
- Intradermal Testing – In children, intradermal testing may be used in addition to skin prick testing to more accurately assess the severity of each allergy. By using skin prick testing and intradermal testing in combination, we are able to complete allergy testing in a short period of time with minimal discomfort for the patient.
Allergy testing is an extremely valuable tool for evaluating patients. But the results must be considered in the context of the patient’s symptoms and how his or her allergies impact other medical problems including asthma, chronic sinus disease, or chronic ear disease.
Chronic nasal and sinus complaints are typically quite different in children than they are in adults. This is because we are not born with fully developed sinuses. Adults with chronic nasal congestion and discolored nasal drainage typically have sinusitis. But in infants and young children these symptoms are more likely to be related to chronic nasal inflammation (rhinitis), adenoid disease, and environmental factors. Because the underlying causes of these symptoms are different in children than adults, the treatments are also. Treatment of these problems is much less likely to involve surgery in children, and when surgery is considered less invasive techniques are usually pursued.
Sinuplasty is an example of this. This technique allows balloon dilation of the sinus outflow tracts without removing any of the bone or tissue surrounding these tracts. In children this can be a particularly valuable option because it does not risk changes in facial development that can be a concern with traditional sinus surgeries.