Adenoidectomy for nasal obstruction in a child

Adenoidectomy for nasal obstruction in a child

Q: My 8-year-old son has had sinusitis off and on since he was a toddler. The family doctor said his adenoids were enlarged and sent me to a pediatric ear, nose and throat doctor. This doctor saw my son twice and looked in his nose and throat thoroughly. The back of his throat was filled with a lot of mucus, dripping from his sinuses. My son does breathe through his mouth more than he should and he seems to talk through his nose, especially in the morning. The ENT specialist said that taking the adenoids out could possibly help him with his breathing. Do you think taking them out would help? Or should I leave well enough alone and hope that my son will outgrow this problem?

A: Adenoids are located behind the nasal cavities, high in the throat (above and behind the roof of the mouth.) If large, they can obstruct the nasal airway from behind. This causes mouth-breathing, voice changes, nasal obstruction, and nasal drainage. (Why nasal drainage? Mucus is constantly being produced by the tissue lining the sinuses and nasal cavities; usually, this mucus drains down the back of the throat. If the adenoids are large enough, however, this mucus has no place to go... except out the nostrils.)

Adenoids usually get smaller over time. Yes, your son will probably outgrow this problem. Unfortunately, I have seen many adults with kid-sized adenoids (BIG, in other words.) I am certainly not going to promise you that he will outgrow this problem. Also, even if he does outgrow it, how long will it take? It may take 5, 10, 15 or more years for the adenoids to spontaneously shrink.

Assuming that your ENT’s diagnosis is correct (the information that you have given me is certainly consistent with his diagnosis), what are the pros and cons of surgery?

Pros:

The operation should improve your son’s nasal airway, voice, and nasal drainage problem. This, in turn, will improve his quality of life.
Extremely large adenoids are believed to cause abnormal growth of facial bones; removal of the adenoids should allow for normal facial growth.
You have not mentioned abnormal breathing during sleep, but some children with large adenoids can develop airway obstruction at night. If sufficiently severe, a child may even stop breathing for long periods of time, and this can occur many times each hour. This problem, known as obstructive sleep apnea (apnea = "no breath"), can cause bedwetting, high blood pressure, headaches, chronic fatigue, hyperactivity, and in extreme cases, serious heart and lung disease. Removal of the obstruction (adenoids and/or tonsils, depending upon what is enlarged) is curative.

Cons:

Assuming your child does not have obstructive sleep apnea, then it is safe to say that he is at no risk of dying from big adenoids. Children can, however, die as a result of an operation– just about any operation has a risk of serious complications, including death. Fortunately, this risk is small, and avoidance of all risk in life is simply impossible. Nevertheless, you may wish to view surgery as an unnecessary risk.
Surgery can be frightening and painful for a child. You may wish to spare your child this trauma. At the age of 8, though, he is able to understand much of what is happening to him, provided someone explains things to him. Pain can be controlled with proper medications.
The diagnosis could be incorrect, in which case your son will continue to have problems after surgery.

Have this "pro and con" discussion with your son’s ENT. A good doctor will not object to a spirited discussion of this type. Even if you learn nothing factually new from this discussion, you will learn a great deal about this ENT’s bedside manner.

This letter originally appeared in Dr. Hoffman's column on allHealth.com.
Copyright (c) 1998 - 2000, Douglas Hoffman, MD all rights reserved
Reprinted with permission from The Medical Consumer's Advocate
http://www.doctorhoffman.com