PEDIATRIC ENT
Rhinitis

Rhinitis is a condition of the nose characterized by inflammation of the nasal lining. It is often accompanied by a blocked nose, clear or thick mucus draining from the nose, or sneezing.

Rhinitis is often subdivided into allergic and non-allergic. Allergic rhinitis is an allergic reaction of the nasal airway, and is suspected in case of clear mucus draining from the nose, with sneezing and itching of the nose and eyes. Non-allergic rhinitis is almost the same type of reaction, without a demonstrable allergy. Sometimes, children have a blocked nose and a constant stream of thick mucus draining from the nostrils.

This is commonly caused by enlargement and/or infection of the adenoid, in which case we would rather speak of adenoiditis than rhinitis. Because of the similarity of symptoms, this problem is discussed here as well. When mucus is foul-smelling and draining from one nostril only, something might be stuck in your child’s nose that is not supposed to be there. This is called a foreign body. In young children, the sinuses are not yet fully developed, which is why infection of the sinuses (sinusitis) does not happen very often. In some cases, however, mucus draining from the nose may be a sign of sinusitis. 

During your child’s consultation for rhinitis, examination may include one or more of the following:

Anterior rhinoscopy-this is an examination of your child’s nostrils and nasal cavities, carried out with a small nasal speculum, especially designed for children, and a headlight. Depending on your child’s age and history we will also check for anything stuck inside the nose that is not supposed to be there. On occasion a nasal swab might be necessary. 

Flexible endoscopy-this involves inserting a small camera into your child’s nasal cavity to inspect their nostrils, some of the openings to their sinuses, the back of the nose, and adenoids. The adenoid is a small patch of tissue sitting at the back of the nose. When the adenoid is inflamed, this can cause a blocked nose or chronic mucus drainage from the nose in children. Flexible endoscopy is done awake, but a local anesthetic (numbing) spray can be used. In children, a smaller size endoscope is used. Flexible endoscopy is not always necessary, especially when there is a strong history of sleep apnea, and surgery has already been decided on. We may in those cases choose to assess your child’s adenoid while under anesthesia.

Nose Diagram
  1. nasal cavity
  2. throat
  3. oral cavity
  4. tongue
  5. flexible tube
  6. endoscope
    Illustration used with permission from MedicalVisuals.

Allergy testing- if an allergy is suspected, we can refer your child to an allergy specialist at Nostra Senyora de Meritxell Hospital for consultation and allergy testing. The test may involve a blood sample or a skin test with pricks or adhesive patches. 

The following treatments may be offered:

Antibiotics- in younger children with recurrent colds or chronic inflammation of the adenoid leading to constant rhinitis, a course of antibiotics of variable duration can be prescribed. There are children who benefit from a longer course of antibiotics, anywhere from 6 weeks to 3 months. 

Nasal spray-we may prescribe your child a nasal spray to use daily for around 6 weeks. This spray contains a tiny amount of steroid, a medication that helps against inflammation, or antihistamine, and anti-allergic medication. If after 6 weeks this is effective, we will assess if your child can do without the spray, or needs it for a while longer. Nasal sprays have proven to be effective for both allergic and non-allergic rhinitis. 

Adenoidectomy- this is a surgical procedure during which we remove your child’s adenoid. Adenoidectomy always happens under general anesthesia in a hospital setting. Your child should be able to go home the same day after a few hours of observation. More information can be found in our patient information folder.