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Sniffing: Allergies or Tourette Syndrome?

EDITOR’S NOTE: The following blog entry originally was submitted on Life’s A Twitch, a website run by Canadian psychologist Dr. B. Duncan McKinley.

Question: Our daughter Lil T. had a winter season plagued with numerous head colds and sinus infections. She also came down with 2 bouts of strep throat….In January of this year Lil T. started to sniff excessively! Her dad and I would remind her to use a tissue if her nose was running. She would answer that her nose felt like there was something in it. Then in May of this year we noticed the sniff being replaced with the constant eye blinking and nose twitching.

So we took Lil T. to an allergist and had her tested for allergies. (She said her eyes itched and they were blood shot!) They were negative according to the doctor. He suggested that we have a cat scan of her sinus cavity to check for polyps. Once again nothing showed up. From there we went to the family physician and he checked up her nose and said it all looked fine, but to have Lil T.’s eye checked by an eye specialist. The eye specialist said her eyes are fine and gave us some saline drops to put in her eyes.

Lil T. is still blinking her eyes and twitching her nose, (at times excessively). When her dad and I correct this tic/twitch she says that her nose itches up inside and sometimes her eyes burn. The weird part is that she doesn’t take her hand and rub either. My husband and I are having arguments between us about this being a “tic” or if we should have her looked at by an ears, nose, throat specialist.

Lil T. is upset because we are constantly reminding her to stop the twitching!!!!!!!!!! People around us have commented on Lil T.’s eye blinking, nose twitching. A friend asked me if she has TS. I thought TS was the verbal , very noticeable body jerking. I am not expecting a miracle, just some help in diagnosing what is going on with our beautiful 8 year old daughter. I want the constant nagging to stop if our Lil T. can’t help this! Sorry for the long letter, but I have had this pent up inside for quite awhile. God Bless, from Lil T.’s mom!

Answer: Good morning “Lil T.’s mom.” Please don’t apologize for needing to vent — you ARE allowed to be human, you know!! 🙂 Also, such thoroughness in your report to me allows me to better answer your question.

Something that I should perhaps make more clear in my media exposures, and which I’ll clarify right now, is that the symptoms I present with are an extreme version — the vast majority of TS cases have much milder (often hardly noticeable) symptoms such as excessive eye-blinking. I am further up the spectrum of severity than most, plus I make no effort to suppress in most situations anymore. To be diagnosed with TS, though, one only needs to have one “noisy” or “phonic” tic in addition to multiple movements — and nose-sniffing DOES qualify.

Use of the vocal cords in a tic is not required by the standard criteria. I recall Dr. Mort Doran (the plane-flying surgeon with TS) once saying that the differentiation between movement tics and noise tics is purely semantic. In other words, it just so happens that once in a while the “rut” you find yourself stuck in involves an area of the body that is DESIGNED to make noise. There is nothing qualitatively different in these tics.

I had to smile as I read through your email, only because the course you describe is virtually text-book: for this reason I left most of your text above for others to read and learn from/commissurate with.. Symptoms starting after a bout of strep-throat (I have an article about this at www.lifesatwitch.com/pandas.html that you will find interesting).

Eye-blinking being the first symptom. Her 8-year old way of trying to describe that she feels “compelled” somehow to do these things, and in a stereotyped way (always blinking and not rubbing). The ‘front-line’ medical community missing the boat (they are not trained in disorders such as these) and instead suggesting allergies, eye doctors, and ear/nose/throat specialists (in fact I KNOW an ear/nose/throat specialist that sees so many cases of undiagnosed TS that he has written an article about it — you can see this article at www.lifesatwitch.com/msn_health.html).

In short, while I obviously can’t be making online diagnoses for ethical and legal reasons, I would urge you to get an appointment with a TS specialist (psychiatrist, neurologist, or psychologist). Psychiatrists and neurologists often have longer waiting lists and require a medical referral. Psychologists are often covered by employment insurance, have shorter wait-times, and do not require a medical referral (this is important since I’ve heard many stories about parents being obstructed by their family doctor who, unfamiliar with when the diagnosis of TS should be explored, dismisses the symptoms and refuses to make a referral).

One final thing: please look at the Diagnosis archives of my “Ask Dr. Dunc” archives, and in particular read http://www.lifesatwitch.com/response41.html — this is the response to another question I was once sent. In this response I talk about how to ensure that the appointment you DO set up with the psychiatrist/neurologist/psychologist is a successful one (i.e. sometimes the child doesn’t tic when you WANT him/her too — namely at the appointment! What do you do?).

I hope all this helps — good luck, and take good care! Remember, putting a name to something is an enormous part of the battle: it opens many, many doors to education, understanding, coping, and acceptance. Life gets better from here — good luck!

Dr. Dunc.

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2 Comments

  1. Have you heard of PANDAS? It looks like she got what looks like Tourettes after she had a bout of strep. I would get her tested for strep and every other child that has what appears to be Tourettes or Tourettes tics.

  2. Lil T.’s Mom…

    You have just spit back the life story of my 9 year old son, Aidan. We went through an identical situation – had seen every doctor, been given every test (even X-rays!), etc. Same symptoms as you mentioned, scenario, everything! He also had a dry cough that was driving HIM so crazy that I said, “Enough!” and scheduled an appt with the finest pediatrician in town. He mentioned TS and then sent us on to a Neurologist, “just in case”, to rule our seizures, etc. Final diagnosis: Tourette Syndrome. I do feel better knowing, as it was maddening to not be able to help or know what was really wrong. However, knowing there isn’t much I can do about it, except educate those around us is heartbreaking at times. In our case, I hope that he’ll remain a “mild case”. I say this because his father had tics when he was younger and no longer has problems with them now. I wish you only the best, this article caught my eye because of our identical our stories were. I sympathize with you and your husband’s feelings, as before we knew the diagnosis, we would often tell our son to “stop”. I feel horrible now for doing that, as it only makes them WORSE. Ignoring the actions is best. They really can’t help it.

    Lil T.’s Mom, I hope you read this! Sounds like TS to me, verify by seeing a Neurologist.

    Regards,
    Kristin

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