“Doc, she’s snor­ing! Is that a prob­lem?”

With all the Sa­ha­ran dust in the at­mos­phere, snor­ing is prob­a­bly, to­geth­er with cough­ing and/or a run­ny nose, the most com­mon com­plaint I see nowa­days. Is there a re­la­tion­ship? There sure is. It is one of the few rea­sons I ac­cept for chil­dren wear­ing that mon­stros­i­ty, the mask, that was forced up­on us dur­ing COVID. It does pro­tect the nose against ir­ri­ta­tion and block­age.

Out­door air qual­i­ty in T&T is gen­er­al­ly quite good, but it fre­quent­ly drops to un­healthy lev­els be­cause of in­dus­tri­al emis­sions, traf­fic con­ges­tion, high­way dirt, Sa­ha­ran dust and now, at the end of the dry sea­son, smoke from fires de­stroy­ing pre­cious veg­e­ta­tion that re­moves pol­lu­tion from the air, wors­en­ing the prob­lem.

Snor­ing is the forced pas­sage of in­haled air through nar­rowed nasal and throat pas­sage­ways, caus­ing tis­sues in your throat, mouth and nasal pas­sages to vi­brate. It is al­ways ab­nor­mal.

The idea that the child snores be­cause the fa­ther snores, so “is a fam­i­ly thing”, is in­cor­rect. Snor­ing is ab­nor­mal at any age and is a risk fac­tor in adults for heart at­tacks, high blood pres­sure and stroke, and all men (or women) who snore should hur­ry down now to the near­est ENT sur­geon for an eval­u­a­tion.

Snor­ing is al­so a prob­lem in chil­dren in T&T. Chil­dren should not snore. In the ma­jor­i­ty of cas­es, it means some­thing is block­ing the free pas­sage of in­haled air through the up­per air­way, ba­si­cal­ly the back of the nose and throat. Par­ents have a habit of try­ing to look in­to their child’s nose, see­ing a clear space at the front and say­ing, “noth­ing wrong with the nose.” You can­not see the back of the nose.

That some­thing block­ing may be sim­ple con­ges­tion of the lin­ing of the nose, or it may be a mass block­ing the nose. That mass may come from out­side the nose (a for­eign body) or in­side the nose (thick­en­ing of the lin­ing of the nose or thick mu­cus), or it may be a tu­mour at the back of the nose or at the ex­it to the nose (ade­noids), or it may be some­thing the child was born with.

The most com­mon rea­son is sim­ple con­ges­tion or en­large­ment of the ade­noids (di­a­gram above).

But what­ev­er it is, the block­age does three things. One, it cre­ates dif­fi­cul­ty in get­ting oxy­gen in­to the lungs. Two, it caus­es dif­fi­cul­ty get­ting the mu­cus that is nor­mal­ly pro­duced by your mid­dle ears to drain out through the tube that leads from the mid­dle ear to the throat. And three, it caus­es poor ap­petite. It re­duces the sense of smell, which is in­ti­mate­ly linked to taste. Poor taste equals poor ap­petite equals a child who does not eat well. This is very com­mon.

Apart from the aes­thet­ic as­pect, snor­ing is as­so­ci­at­ed with low blood oxy­gen lev­els, which con­tribute to heart at­tacks and brain ir­ri­ta­tion, not on­ly in adults but in chil­dren, es­pe­cial­ly when it caus­es sleep ap­noea.

Ap­noea is the ces­sa­tion of breath­ing. When it oc­curs dur­ing sleep, it is called sleep ap­noea and some ob­ser­vant par­ents will no­tice it dur­ing their child’s sleep be­cause the snor­ing stops for ten to fif­teen sec­onds and then re­sumes in an ex­plo­sion of breath­ing.

This can hap­pen many times dur­ing the night, and the more it hap­pens, the worse the ef­fect is on the heart and the brain. In ad­di­tion, if a child does not sleep well, they will be tired and fret­ful when they wake up in the morn­ing and in school. Tired, fret­ful pri­ma­ry or sec­ondary school chil­dren do poor­ly in school, so snor­ing con­tributes to school fail­ure and “mis­be­hav­iour” and can be mis­di­ag­nosed as “AD­HD” or “con­duct dis­or­der”.

Be­cause of the link be­tween the mid­dle ear and the nose, the mu­cus pro­duced by the mid­dle ear that does not drain in­to the nose can ac­cu­mu­late in­side the mid­dle ear (di­a­gram be­low) and be­come in­fect­ed, caus­ing ear­ache and hear­ing loss.

Un­less prop­er­ly treat­ed, the mu­cus can ac­cu­mu­late and in­ter­fere with the move­ments of the tiny bones in­side the mid­dle ear that have to move to set up an elec­tri­cal cur­rent to take sounds to the hear­ing part of the brain. If the bones can­not move prop­er­ly, hear­ing is re­duced and an op­er­a­tion may be nec­es­sary to drain the trapped mu­cus.

The com­bi­na­tion of lack of sleep, in­ter­mit­tent hy­pox­ia, poor ap­petite, chron­ic ear pain or hear­ing loss is one of the ma­jor caus­es of poor growth, poor school re­sults and/or be­hav­iour­al prob­lems in chil­dren.

Chil­dren with per­sis­tent snor­ing should be seen im­me­di­ate­ly by a med­ical prac­ti­tion­er. Treat­ment can be med­ical or sur­gi­cal. Med­ical treat­ment is tire­some but ef­fec­tive and easy in most cas­es.

Dif­fi­cult cas­es need surgery, which can be cu­ra­tive.