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Suggest Treatment For Persistent Runny Nose, Snoring, Blocked Nose And Ear Drainage In Infants

Posted on Fri, 18 Sep 2015

Question: Hello, my 15 month old son has had a runny nose, snoring, blocked nose, ear drainage, and mouth breathing for about 3 months. I took him to an ENT two months ago and they used a scope and said he had slightly enlarged adenoids. That's pretty much all he said. No course of treatment, no follow up, nothing. I wasn't happy so I wen to another ENT last week. She just looked into his nose and said he's got some swelling and inflammation and wanted to do allergy testing and treat his symptoms. So she put him on Singulair and Flonase and ordered blood allergy and wants to see him again in two weeks. After starting the Singulair, he developed and junky, nasty cough. After being on both the Flonase and Sungulair for four days, nothing has improved and he has this very bad junky cough and has a slight fever tonight. His symptoms are mainly one one side, his left nostril is always blocked and he has more drainage in his left ear. I'm so worried especially since my pediatrician said she's worried he may have something structurally wrong like a deviated septum or choanal atresia. The new ENT didn't seem to be worried about that but the fact that most of his symptoms occur on one side do concern me. I don't know what else to do. Should I seek a third opinion or continue the steroids and wait and see what the follow up appointment unveils? He's so young and I'm so worried, about the medications, about this new nasty cough he has, about the fever, about the diagnosis. All of the above. Please help!

Answered by Dr. Hariom Sharma (4 hours later)

Brief Answer:
Go for throat swab culture and antibiotic sensitivity

Detailed Answer:
Hi,

I have gone through your query and understand your concern. I am also aware of the fact that previous two ENT surgeons weren't of much help. However I am very glad an endoscope was performed. It's one important tests that essentially rules out choanal atresia. So please do not be worried about choanal atresia.
Further we don't see symptomatic deviated nasal septum commonly at this age. Therefore I don't think his symptoms are due to deviated septum.

Accordingly based on your description to me it sounds like he is suffering from the adenoid facies predominantly on the left side. Adenoids usually present with bilateral symptoms of nasal obstruction, mouth breathing, otitis media, snoring and restless sleep (and these changes are collectively clubbed under the term adenoid facies), but it isn't uncommon to see unilateral symptoms as in your case. Therefore in my opinion we need to explore and manage adenoid.

In this context, I am in favor of you visiting the first ENT surgeon who performed the endoscope. He/she might consider CT scan of PNS if you are worried about any other structural defects. But I am not sure there may be any.
I personally would suggest that we also go for throat swab culture and antibiotic sensitivity and start antibiotic based on test results. Continue conservative treatment for atleast a month. But if the problem persists beyond a month of conservative treatment, then I would recommend laser adenoidectomy.

In the interim it is important to avoid putting water, ear buds or any object in the ear canal and also avoid feeding in the lying down position.

Hope I was of some help. Let me know if you need clarifications

Thanks

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hariom Sharma (12 hours later)

Thank you very much! You have alleviated some of my concerns with structural problems. The second ENT did not do an endoscopy because she had seen the first ENTs notes and did not feel the need to perform another one. She was much more thorough in discussing a course of treatment involving allergy medications to relieve symptoms, removing the adenoids if necessary and allergy testing to see if there are allergens causing these symptoms. My son also has had mild eczema since he was 3 months old so the allergy testing made since. Could allergies exacerbate large adenoid symptoms? Also, before we visited the first ENT, my pediatrician prescribed Amoxicillin diagnosing him with a sinus infection and 9 days later he developed a C. Diff infection from it and did not improve his symptoms. He then took a course of Cefdnir which did not improve anything either so you can see why Im nervous about antibiotics but if you think we should re visit them; I will make an appointment with his pediatrician and do a throat culture. How long would Singulair and Flonase take to see any effect? Thanks again for your advice!

Answered by Dr. Hariom Sharma (12 hours later)

Brief Answer:
Yes, Allergies could exacerbate large adenoid symptoms

Detailed Answer:
Hi,
I have gone through your follow up query; and allergies could exacerbate large adenoid symptoms.

For your knowledge no remarkable side effect of using Flonase and Singulair continually up to 6 month to 1 years under the guidance of your doctor.

Better to go for throat swab culture and antibiotic sensitivity.

Thanks

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hariom Sharma (13 hours later)

Thank you very much for the advice. I took my son to see his pediatrician today. She did a throat culture but also diagnosed him with an ear infection. She said his ears have gotten much worse since she examined him a week ago. The right side is infected and the left side which is the side that is more blocked and he has always had more drainage now has pus in it. She thinks this could be the cause of the fever. She prescribed high dose Amoxil and wants to see him in 5 days. She knows my concerns about C diff so she will examine him to see if the Amoxil is helping after 5 days and will stop if not. I also will do probiotics. She said to continue the Singulair and Flonase so that once the acute inflammation is resolved, we can see how big the adnoids are at baseline and the ENT can recommend removing or not. Also, see what the allergy tests reveal. He has a cool mist humidifier and a germ purifier in his room and we use HEPA filters in the air conditioning unit. Are there anymore recommendations you may have? Do you this is a sensible course of treatment?

Answered by Dr. Hariom Sharma (10 hours later)

Brief Answer:
This is a sensible course of treatment

Detailed Answer:
Hi,
I have gone through your follow up query; and this is a sensible course of treatment.

With throat swab culture and antibiotic sensitivity, I also advised that your son may also go for the left aural swab culture and antibiotic sensitivity.

Thanks

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj