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: Enlarged adenoids a common cause of mouth
breathing in children
DEAR DR.PAUL: My four-year-old year old daughter has had
a long struggle with ear infections and was given antibiotics
many times. It was recommended to me by several doctors to have
her adenoids removed. My question is, what exactly are adenoids
and how are they related to ear infections? Thank you very much.
PEDIATRICIAN DR.PAUL Answers: This is a common concern
of parents and I am glad you asked me this question. Adenoids
are tonsil-like glands located at the back of the nose. We do
not understand the exact function of adenoids. It may be related
to some sort of protection from infection, but people can live
normally without them.
Children are born with adenoids which are quite small. As a
child grows, so do the adenoids, reaching their maximum size
when the child is 10 to 12 years old. From that point on, the
adenoid tissue starts to shrink on its own. It's during the
growth phase that adenoids can potentially cause problems. Enlarged
or "hypertrophied" adenoids, can block a child's nasal passages
and result in nasal congestion, mouth breathing, and increased
snoring, In severe cases, where the adenoid block the nasal
passage completely, they can cause sleep disturbances.
Another clue is a child who is tired all the time as a result
of interrupted sleep related to the nasal blockage which typically
worsens at night. Very rarely, these complications can be quite
dangerous, causing sleep apnea, failure to grow, and even heart
failure. Fortunately, however, in the vast majority of children
with enlarged adenoids, the main symptoms are just a chronically
stuffy nose and/or mouth breathing.
Also, it is important to note that enlarged adenoids are not
the only cause of persistent nasal congestion in children. Aside
from the symptom history, the best way to assess the size of
the adenoids is to do a simple X-ray of the neck region because
the adenoids are hidden behind the nose and cannot be seen by
direct physical examination. This X-ray tells us two very important
details: whether the adenoids are enlarged and, most importantly,
to what degree they block the nasal passage.
The only treatment for enlarged obstructing adenoids is to surgically
remove them. Antibiotics and other medications do not help.
The decision to remove the adenoids must come from weighing
the benefits of waiting for the adenoids to shrink on their
own against the degree of disruption to a child's life and health.
Obviously, in extreme cases, the decision to remove the adenoids
is easy to make. In children without the extreme symptoms, the
decision is usually made on a case-by-case basis, with consultation,
among the parents, their pediatrician and an Ear, Nose and Throat
specialist.
The relationship between enlarged adenoids and recurrent ear
infections is controversial. We know that chronic nasal blockage
can contribute to increased rates of ear infections and persistence
of fluid in the middle ear area, but there are no definitive
studies to support the removal of adenoids in all children with
recurrent ear infections. Practically speaking, experts agree
that in a child with recurrent ear infections removal of enlarged
and obstructing adenoids may help reduce the number of ear infections.
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