a stuffy nose

Question

I have a boy of about 2 years, diagnosed at 3 months with cystic fibrosis. In his culture he has staphylococcus aureus, from December he has stuffy nose for about 2 months. He had treatment, he does not cough, but especially at night has a stuffy nose and breathe on mouth.I noticed that he breathes a little harder. What can I do for him to breathe on his nose? thank you.

Answer

Hello,
To answer your question, they are many reasons for nasal obstruction, any of them can be the single cause, or it can be a combination of several causes. The most frequent reason for nasal obstruction are adenoids, which do often go along with recurrent acute infections of the middle ear, and which may make an operative treatment necessary. Other reasons may be allergic rhinitis (e.g. allergy against house-dust), the chronic use of decongestant nose-drops, or it may be triggered by the staphylococcus aureus.
Recommendations related to treatment infections with staphylococcus include antibiotic therapy (in doses recommended by your pediatrician specialised in cystic fibrosis). It is very important to prevent and treat the pulmonary infections, being wellknown that the respiratory exacerbation in CF children could influence the disease`s outcome.
Coming back to the nasal obstruction, it has furhtermore to be taken into account that in CF patients there is often an inflammatory involvement of the upper airways with a chronic sinusitis, which is frequently associated with a nasal polyposis. Nasal ducts and the openings to the sinuses are blocked so that many patients show a nasal obstruction due to swelling of the mucosa, secretions or polyposis. Nasal polyposis can occur in children with CF even in the preschool age. In general the frequency and intensity of complaints increase with age, however chronic inflammation of the upper airways can be a leading symptom of CF in any age class. This CF specific problem requires an intensive conservative treatment in order to avoid a later operative treatment. Unfortunately there is a lack of scientific data to support a uniform evaluated concept in the treatment of CF specific chronic rhinosinusitis. The gold-standard for removal of secretions is the classical nose shower, application of cortisone containing nose drops are a therapeutic option in nasal polyposis and allergic rhinitis. Inhalations with the nebulizer through the nose, probably with drugs such as DNAse or hypertonic saline, are often only an option in older children. In order to make a diagnosis, it is sometimes necessary to do a nasal endoscopy or an imaging of the sinuses. The most important recommendation we can give to you is that you should present your child at an ENT-specialist in order to make a proper diagnosis, initiate a treatment and discuss all remaining questions with him.
Best regards,
ECORN Romania Team

06.07.2009