Adenoid hypertrophy: Consider corticosteroid nasal drops
Adenoid hypertrophy is a common cause of chronic nasal obstruction in children. Although adenoidectomy is commonly performed to correct the problem, current evidence regarding the efficacy of the procedure is inconclusive.10 Evidence demonstrates corticosteroid nasal drops significantly reduce symptoms of nasal obstruction in children and may provide an effective alternative to surgical resection.18 Studies have also demonstrated that treatment with oral LRAs significantly reduces adenoid size and nasal obstruction symptoms.12,13
Foreign bodies: Don’t forget “a mother’s kiss”
Foreign bodies are the most common cause of nasal obstruction in the pediatric population. There is a paucity of high-quality evidence on removal of these objects; however, a number of retrospective reviews and case series support that most objects can be removed in the office or emergency department without otolaryngologic referral.31,32
Techniques for removal include positive pressure, which is best used for smooth or soft objects. Positive pressure techniques include having the patient blow their own nose or having a parent use a mouth-to-mouth–type blowing technique (ie, the “mother’s kiss” method).32 Refer patients to Otolaryngology if the obstruction involves:31
- objects not easily visualized by anterior rhinoscopy
- chronic or impacted objects
- button batteries or magnets
- penetrating or hooked objects
- any object that cannot be removed during an initial attempt.
Nasal tumors: More common in older men
Nasal tumors occur most often in the nasal cavity itself and are more common in men ≥60 years.33 There is no notable racial predominance.33 Other risk factors include human papillomavirus (HPV) infection, tobacco smoke, and occupational exposure to inhaled wood dust, glues, and adhesives.34-37
Benign tumors occurring in the nasal cavity are a diverse group of disorders, including inverted papillomas, squamous papillomas, pyogenic granulomas, and other less common lesions, all of which typically present with nasal obstruction as a symptom. Many of these lesions cause local tissue destruction or have a high incidence of recurrence. These tumors are treated universally with nasoendoscopic resection.38
Malignant nasal tumors are rare but serious causes of nasal obstruction, making up 3% of all head and neck cancers.39 Most nasal cancers present when they are locally advanced and cause unilateral nasal obstruction, lacrimation, and epistaxis. These symptoms are typically refractory to initial medical management and present as CRS. This diagnosis should be suspected in certain patient groups, such as those who have been exposed to wood dust (eg, construction workers or those who work in wood mills).36
Computed tomography is the gold standard imaging method for CRS; however, if nasal cancer is suspected, referral for biopsy and histopathologic examination is necessary for a final diagnosis.39 Because of the nonspecific nature of their initial presentation, many nasal tumors are at an advanced stage and carry a poor prognosis by the time they are diagnosed.39
CORRESPONDENCE
Margaret A. Bayard, MD, MPH, FAAFP, Naval Hospital Camp Pendleton, 200 Mercy Circle, Camp Pendleton, CA 92005; margaret.a.bayard.mil@mail.mil.