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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.

The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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