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Child diagnosed with enlarged tonsils, deviated septum and rhinitis. Any effective treatment?

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Pediatrician, Neonatology
Practicing since : 1970
Answered : 891 Questions
My 11 year old son has had continuing issues with snoring and breathing since birth he was diagnosed with enlarged tonsils, a deviated septum and rhinisitis. He was also diagnosed with deferred skeletal maturity and is tracking around 2 3/4 years behind his peers. My concern is his ENT prescribed Avamys which is a steroid spray which is know to have side affects related to growth. Is there an alternate treatment, I am pro surgery however they are saying that the septum cannot be repaired until he reaches maturity which with his condition is likely not going to be until his twenties. He is very under weight and cannot put any weight on regardless of how much he eats. He is currently under the 5th percentile for weight.
Posted Sun, 17 Feb 2013 in Ear, Nose and Throat Problems
Answered by Dr. Uma Rajah Ananth 3 hours later
Welcome to HCM!

I agree with you that he is not going to outgrow his problem of deviated septum.!

But your doctors want to wait because he is a growing child especially now at puberty and want to wait for sometime.

For his low weight in 5 the centile and delayed skeletal maturity ,there must be other reasons. I am sure you had endocrinological and other relevant consults to diagnose.

Can you give him some high protein and high calorie diet to compensate till that time.
He may also have an allergic element to his upper respiratory problem and can get some allergen tests done to detect them.

Of course prolonged steroids as spray are known to cause growth retardation and we have to weigh the possibilities of intermittent use.
There is a drug called monteleukast which works in some instead of steroids.

What I am trying to say is that septoplasty alone may not improve all his symptoms and a comprehensive management is needed for him.

Good luck
God bless
Dr Uma
Above answer was peer-reviewed by
Follow-up: Child diagnosed with enlarged tonsils, deviated septum and rhinitis. Any effective treatment? 7 hours later
Thank you for your response. Just wanted to clarify that you are suggesting that there may be underlying issues regarding his skeletal maturity and weight issues. I have only ever seen paediatricians regarding this and he was diagnosed by used of a wrist X-ray. He has not had any other tests besides blood tests performed. Can you suggest alternate testing? I try to supplement his meals with higher calorie foods and encourage the consumption of dairy and protein. Any other advise would be appreciated.
Answered by Dr. Uma Rajah Ananth 19 minutes later

Definitely ! That is more important than his deviated septum !

Why should a child should have delayed skeletal maturity?
This bone age study is done to evaluate him for growth retardation and automatically with this delay he should have growth hormone and other male sex hormones study especially as he is reaching puberty!
The pediatric endocrinologist is the one to evaluate him clinically and by blood tests.

Secondly does he have a good appetite or not?
Does he have thyroid problems?
A nutritionist or dietician should be involved to make a dietary plan for him after diagnosing the the cause for this low weight.

Is he otherwise a mentally normal child with normal intelligence and normal physical features?

You can increase the calories with some extra butter,oil,cheese, sweets and juices
Protein can be increased with extra commercially available protein powders added to milk,egg,lentils,chicken,etc.

Glad to be of help
God bless
Dr Uma

Above answer was peer-reviewed by
Follow-up: Child diagnosed with enlarged tonsils, deviated septum and rhinitis. Any effective treatment? 37 minutes later
Recently at a paediatricians appointment his genitalia was examined and I was told that he is expected to have a delayed maturity also of about 2 to 3 years in line with his growth issues. He is a good looking child despite being very thin and had average intelligence and very good motor skills he enjoys sports however struggles to keep up with his peers. He does have a limited appetite at times however he lives between his fathers place and mine and I cannot control what he eats when not at my house. His thyroid has been tested with normal results on a few occasions over the years. I am anxious about the growth hormorne as he is such a sweet boy and I would hate to think that it would alter his personality. What would I expect if this was to occur. It has never been suggested as something that needed doing?
Answered by Dr. Uma Rajah Ananth 4 hours later

I understand your situation and your concern.
Do not worry.
Even now it is not late!
Take him to a pediatric endocrinologist and get him evaluated .

puberty,decreased growth velocity,decreased muscle mass,low energy,etc.

The hormone studies and advice from ped endo will help you in either way to diagnose or rule out the problems.

Good luck and my best wishes for your little son
God bless you both.
Dr Uma
Above answer was peer-reviewed by
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