Dr Kenny Pang

Snoring can occur in children too. Snoring is a symptom of obstructive sleep apnea. It may represent the likelihood that the upper airway is narrow. These children could be noted to have gasping and or choking during their sleep at night, and their mouths may be open as their noses are blocked. During the day, they are either tired, have a poor concentration span, or they could be hyperactive from the excessive sympathetic overdrive. A thorough physical examination is required. There should be attention given to the nose, sinus turbinates, the adenoids, and the tonsils in the mouth.

This sounds like your son might have allergic rhinitis and likely swollen sinus turbinates and adenoids. He is snoring because of his blocked nasal passages and narrow airway. He is likely a mouth breather that would aggravate the situation and narrow the airway further. This can lead to obstructive sleep apnea and lack of oxygen at night, which in turn can lead to poor quality sleep, disruptive sleep and daytime tiredness, poor concentration and poorer school results. He would need an ENT consult and assessment soon.

Hello, Thanks for the D2D. Absolutely. You are a fairly young gentleman to have high blood pressure (hypertension). This could be also be due to a strong family history of hypertension, a high salt diet and certainly aggravated by Obstructive Sleep Apnea. Scientific studies have shown that a young gentleman (below 50 years of age) who snores badly and has hypertension, would likely have a 80% chance of having Obstructive Sleep Apnea. It might be wise to see a Sleep specialist.

Thanks for the D2D. Snoring is due to the excessive soft tissues in the airway, including swollen sinus turbinates, deviated nose septum, swollen adenoids, a thick long floppy palate or uvula, thick side walls of the mouth, and/or a big bulky tongue. A blocked nose will cause the patient to open the mouth to breathe (survival instinct) and this would cause the tongue to fall back further with resultant blockage of the airway. Snoring is the “alarm” for a possible sleep disorder called Obstructive Sleep Apnea.

Nose bleeds are not a normal occurrence. It should be taken seriously and would be prudent to consult an ENT specialist as soon as possible. Nose bleeds may be a sign of a tumour or growth (although not the commonest cause), this needs to be excluded. The ENT specialist would do a Nasoendoscopy and take a look at the post nasal space. Other causes include prominent small blood vessels in the Littlest Area (in front of the nose) and allergies of the nose or nasal polyps.

It would be prudent to continue monitoring your thyroid modules. Multi modular thyroid goitre is fairly common in females. As surgeons, we only consider surgery if there are any compressive symptoms like swallowing or breathing difficulties, any voice change. Or if there are any concerns or suggestions of cancer change in the nodules. Or if the swelling is not aesthetically acceptable. The likelihood of malignant change (cancer change) is low, however there is still a real risk.

Thanks for the D2D. Yes. Snoring is due to an anatomical floppiness of the soft tissue and vibration in the upper airway. Studies have shown that most snoring originates from the vibration of the soft palate, other areas include the side walls of the mouth, the tongue base and / or epiglottis. Snoring can be aggravated by a blocked nose, as this results in mouth breathing and mouth breathing worsens snoring. You would need a sleep specialist to examine your upper airway with a flexible Nasoendoscope.

Hello, Thanks for the D2D. Yes. It is likely that he might have Obstructive Sleep Apnea. He seems like he has stoppages in breathing at night and he might have nose congestion which explains his mouth opening during sleep. Because of the stoppages in breathing at night, his brain does not get enough oxygen at night, hence this affects his daytime concentration, he has a short attention span and poorer memory with poorer academic performance. In children, because of the sympathetic overdrive, they are hyperactive during the day and cannot focus on any task.

Thanks for the D2D. The reason why you might “automatically” open your mouth at night is because your nose is blocked, hence it’s a survival instinct to open your mouth to breathe. Please do not use the Chin Strap until you have seen a sleep specialist or nose doctor who will examine your nose and perhaps shrink your sinus turbinates and/or remove any obvious obstructions in the nasal passages.

This would depend on how deep the neck cyst is located. There are skin cyst like sebaceous cyst that are superficial and can be treated very easily. There are deeper neck cyst that may require surgery. These neck cysts are usually due to congenital developmental brachial cleft cysts. These can be imaged with contrast X-rays and can be excised in its entirety. It might be prudent to consult an ENT specialist soon.

This is likely due to gastro-esophageal reflux. The acid from the stomach reflux back upwards to the larynx to cause inflammation and swelling , also known as laryngo-pharyngeal reflux. However, it would be prudent to see an ENT specialist to exclude any other sinister conditions.

I understand. It is a common complaint from my patients that I see in my practice. It is likely that you might have poor sleep quality. The commonest cause for excessive daytime sleepiness is Obstructive Sleep Apnea (OSA). This occurs when the patient has a very narrow airway and this narrow airway closes in and collapses during sleep when the muscles are all relaxed and paralyzed during dream sleep. This results in stoppages of breathing and low oxygen at night with resultant increased heart rate and high blood pressure.

Hello, Thanks for the D2D. This is very discerning of you. Yes. There are a lot of scientific evidence that CPAP is not useful in a real life setting. CPAP is only effective as long as you keep the mask on your face. There are many issues and problems with CPAP, like compliance , mask air leak, inadequate pressures, or even too high pressures. Scientific studies show that CPAP may not be as efficacious as surgery. Weaver et al (2004) compared 18,000 CPAP users and 2,000 OSA patients who had surgery done and followed up for 6 years.

The white “stuff” is actually not a lump but a food particle or food residue stuck within the tonsils deep crypts. These food residues may solidify and form “stones”, also known as tonsil stones or tonsilloliths.

Hay fever is commonly due to allergies. These allergies can be tested for with either skin prick test, dermal patch test or blood tests. Consult your Paediatrician or ENT specialist about these tests.