Bethwel W., 4

Bethwel is a four-year-old boy living with his parents in a remote rural setting marked by significant financial hardship. His father, the sole provider, earns a modest and unpredictable income as a boda boda rider, which is often insufficient to meet the family’s basic needs such as food, shelter, and clothing. As a result, healthcare and other essential services are frequently unaffordable. This economic strain places Bethwel at risk of missing out on proper medical care, adequate nutrition, and critical early childhood support necessary for his growth and development. Any illness within the household becomes a heavy burden, as the family lacks the financial capacity to seek timely care. Consequently, Bethwel remains vulnerable to preventable health conditions, underscoring the urgent need for support from Helpster Charity to ensure access to healthcare, nutrition, and essential services that would allow him to grow and thrive. Bethwel was brought to the health facility by his mother with a one-month history of persistent nasal blockage and chronic cough. The mother reported that the nasal obstruction, predominantly affecting the left side, had progressively worsened. An X-ray conducted in February 2026 revealed the presence of a mass within the left nasal cavity. His symptoms were accompanied by recurrent episodes of rhinorrhea, intermittent low-grade fever, mouth breathing, and increasing difficulty breathing through the nose. The mother also noted loud snoring at night, restless sleep, and episodes suggestive of sleep apnoea, characterized by brief pauses in breathing followed by gasping. Additionally, Bethwel had a reduced appetite and experienced daytime fatigue, likely due to poor sleep quality. While there was no history of significant nosebleeds, occasional blood-stained nasal discharge was observed. He exhibited mouth breathing and audible nasal obstruction. Mild facial fullness was noted, along with a hyponasal speech pattern. An otorhinolaryngological examination revealed a pale, firm mass occupying the left nasal cavity, partially obstructing the nostril, with surrounding mucosal congestion and mucopurulent discharge. Airflow through the left nostril was significantly reduced, while the right nostril remained relatively clear. Examination of the oral cavity showed markedly enlarged tonsils (Grade III–IV), nearly meeting at the midline and causing narrowing of the oropharynx. The tonsils appeared chronically inflamed but were non-ulcerated and without active exudate. There was also cervical lymphadenopathy, with small, mobile, non-tender lymph nodes in the anterior cervical region. Chest examination revealed transmitted upper airway sounds without wheezing or crepitations, while cardiovascular and abdominal findings were normal. Overall, the clinical picture was indicative of a left-sided nasal mass causing significant obstruction, along with tonsillar hypertrophy contributing to upper airway compromise and features of obstructive sleep apnoea. Given the extent of airway obstruction, recurrent infections, and sleep-related breathing disturbances, emergency surgical intervention was recommended.

Bethwel was brought by his mother with a 1-month history of persistent left-sided nasal blockage and chronic cough. An X-ray in February 2026 showed a left nasal cavity mass. He had rhinorrhea, low-grade fevers, mouth breathing, loud snoring, restless sleep, and sleep apnoea episodes. Appetite was reduced with daytime fatigue. Occasional blood-stained nasal discharge was noted, but no significant epistaxis. Examination revealed a pale, firm mass occupying the left nasal cavity with reduced airflow, plus Grade III–IV tonsillar hypertrophy causing oropharyngeal narrowing. Small, mobile, non-tender cervical lymph nodes were present. Chest, cardiovascular, and abdominal exams were unremarkable. Due to airway compromise, recurrent infections, and sleep-disordered breathing, he underwent emergency removal of the nasal mass and tonsillectomy under general anesthesia. The procedure was successful with no complications. He responded well and was discharged in stable, good condition.

Bethwel’s condition is serious and requires urgent medical attention. The presence of a mass in the left nasal cavity, combined with significantly enlarged tonsils, is causing marked upper airway obstruction. This explains his persistent nasal blockage, mouth breathing, chronic cough, and symptoms suggestive of obstructive sleep apnoea such as snoring, restless sleep, and episodes of paused breathing. The prolonged obstruction has already begun to affect his overall well-being, as seen by his reduced appetite, daytime fatigue, and chronically ill appearance. If not addressed promptly, the condition places him at risk of worsening breathing difficulties, recurrent respiratory infections, poor growth, and potential complications related to low oxygen levels during sleep. With timely and appropriate surgical management, Bethwel’s prognosis is good. Most children with similar conditions experience significant improvement after surgery. However, if treatment is delayed, the prognosis may worsen due to risks of severe airway compromise, recurrent or chronic infections, poor nutritional status and growth delay and long-term effects of untreated sleep apnoea