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Suggest Treatment For Allergic Rhinitis

Posted on Mon, 20 Mar 2017

Question: Hi Dr. My son is 2.6 years old. Since about 3-4 months ago I have noticed that he is mouth breathing while sleeping and snores. Most times he is mouth breathing and some times he breathes noisily but normally. Does not wake up though. Has gasps in between. Gets cold and cough at least once or twice a month. Showed Homeopath and Paeditrician and taking both medicines. Allopathic treatment is Metaspray twice daily one puff in each nostril, MontairLC Kid syrup 5ml daily at night. Now, a month has passed but not great relief for him. The first Dr recommends Metaspray and Montair treatment for one more month. A Second opinion is to go for X Ray and probably surgery for adenoids. It seems he has Tonsilitis +++ also. I wish to know which Dr to follow. Should I ideally wait and see or wait till he grows older as Adenoids shrink in older children or go for surgery? How harmful will any or either situation would be. Thank you for your reply in advance.

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
I suggest you to wait another 4 weeks on Metaspray

Detailed Answer:
Hi.... I understand your concern. By what you say I feel that your kid might be having upper airway resistance syndrome. This results from moderate to severe persistent allergic rhinitis.

None of the situations is harmful. Both are accepted modalities of treatment. But when you have a non invasive medical treatment like intranasal steroids, we should keep an invasive surgery like adenotonsillectomy as a second option. This is my opinion on your kids further management.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sumanth Amperayani (9 hours later)

thanks Dr. but you know, my dilemma is this. I can see my son struggling to breathe properly. it is like in gaps. they have also asked for antibiotic for just in case... but on the other hand I've also read that adenoids and tonsils when removed can grow back within a year and bring the same trouble. I'm so worried and confused. can you guide me about this concern?

Answered by Dr. Sumanth Amperayani (3 hours later)

Brief Answer:
Suggestions on Upper airway resistance syndrome

Detailed Answer:
HI...Greetings from XXXXXXX You are right...There is no guarantee that the adenoids wont grow back but tonsils won''t grow back.

I suggest you not to use antibiotics for allergy related issues. It can lead to development of resistant bugs.

Coming to the issue of whether it is intranasal steroids or surgery...my professional opinion is to give a trial of 6-8 weeks of intranasal steroids and the administration technique has to be correctly taught to you on hands by a pediatrician.

The logic is simple - when you have a non invasive medical treatment like intranasal steroids, we should keep an invasive surgery like adenotonsillectomy as a second option.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Sumanth Amperayani (29 minutes later)

I agree, Dr and even for us, surgery is the last resort. I am only very concerned because when I see him breathe in gaps and gasps even with his mouth fully open, I feel there is something seriously wrong. Do you think so too? Also, this doctor here says that since METASPRAY was used for a month without much effect, it may not be working. And suspecting a bacterial infection in the tonsils the Dr gave CLAMP antibiotic. I am only worried because of his breathing difficulty not coming down. I worry that he should not stop breathing or something and not lead to any serious problem. I hope you understand what I am going through which is causing all this confusion? Will it not harm my son if he continues to breathe abnormally for another a month or so as you advise? Kindly help me understand my fear. Thanks again in advance.

Answered by Dr. Sumanth Amperayani (59 minutes later)

Brief Answer:
If it si so severe that you fear he will stop breathing - surgery is better

Detailed Answer:
Hi...I ma really concerned you say ..that you feel that it looks as though he might stop breathing. If that is the case - I suggest it is better to go ahead with surgery as you have already used 4 weeks of intra nasal steroids.

But is it possible for you to come for a direct consultation with me.

I am a consultant in XXXXXXX Kamakoti CHILDS Trust Hospital, XXXXXXX

If you can bring the kid for a direct consultation, I would assess the kid and tell you.

Regards - Dr. Sumanth

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Above answer was peer-reviewed by : Dr. Nagamani Ng