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Trouble breathing through nose. Want expert opinion on x-ray results.

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Hello. This is an interpretation of an xray (Water's Projection) taken for my daughter XXXXXXX (3 years, 8 months) last week. XXXXXXX has trouble breathing through her nose. The original intepretation is in Spanish, and I have just translated it. If anything sounds odd, then please let me know and I'll try to clear up the confusion. I'm interested to get your expert opinion about what we should do given these results. Many thanks, XXXXXXX

In the Waters Projection the frontal sinus is still developing.
The ethmoid cavities present regular pneumatization.
The maxillary antrechea show symmetrical size and pneumatization, with a concentric, bilateral swelling of the mucous membrane mainly on the right side.
The nasal septum is central and there is bilateral swelling of the mucose in the middle and lower concha suggesting hypertrophy.
In the lateral neck projection to detect for spongy parts there is a moderate-to-severe obliteration of the airway of the nasopharynx due to remodeling as a side effect of growth of the adenoid tissue.
The sella turca is normal.
The retropharyngeal space does not show any alteration.
The bone structures are normal.
Posted Mon, 16 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 5 hours later

Thank you for your query.

1. The most common cause of nasal obstruction in children around the age of 4 years is hypertrophied Adenoid tissue.

2. Adenoid tissue hypertrophies in all children between the ages of 3 to 7 years. thereafter this Adenoid tissue regresses and usually disappears by the age of 12 to 15 years.

3. I would like to see the images of the X-rays rather than the report. This will enable me to accurately assess the compromise of the nasopharyngel airway.

4. If the afenoids are blocking the nasopharynx significantly, then medication such as anti allergic decongestants, mucolytics and nasal steroid sprays under antibiotic cover, as well as supervised steam inhalation will help reduce their size.

5. Hypertrophied Adenoids may cause many side effects such as underdevelopment of facial structures and bones, ear infections, failure to thrive and so on.

6. If the Adenoid hypertrophy is not significant, then the next area of nasal obstruction will be due to the hypertrophied nasal turbinates. This also causes the maxillary sinusitis. (Her ethmoidal sinuses seem clear and the frontal sinuses develop after the age of 6 to 7 years). Here too, the initial treatment is medication under supervision of your physician.

7. Surgery of the Adenoids or Radiofrequency ablation of the hypertrophied turbinates is a later option if medical treatment fails. Very little surgical intervention is always advised till the agfe of 15 to 17 years as the facial structures are in the growing phase.

I must emphasize that these are very common findings in X-rays of children. Treatment is only required if symptoms such as mouth breathing and nasal obstruction are severe.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Trouble breathing through nose. Want expert opinion on x-ray results. 1 hour later
Thank you Dr. XXXXXXX

Here are the x-rays as requested. (I hope it lets me attach them here)

Kind regards,


Answered by Dr. Sumit Bhatti 8 hours later

Thank you for writing back.

1. Her Lateral Skull X-ray shows significant obstruction of the nasopharynx just behind the posterior nares or septum. However there is an adequate air shadow between the soft palate and the adenoids.

2. If you treat her as per the guidelines mentioned in point no. 4 above, she should show significant improvement within a few weeks. Surgery may then be avoided.

Kindly let me know her progress after a month or two. You may attach a fresh X-ray for comparison after three months. I usually taper the use of the medication after one month.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them. Please accept my answer in case you have no follow up queries.

Wish you good health.

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