What are adenoids and what is their purpose? Adenoids are lymphatic tissue that is found in the back of the throat above the tonsils. The lymph system is generally used to fight and protect a person from disease. Adenoids that become enlarged or inflamed impede the general flow of air in the nasal passageway causing airflow obstruction. Enlarged adenoids also block fluids from draining from the inner ear and sinus cavities causing higher frequency of sinus and ear infections. Overall, enlarged adenoids can cause breathing difficulties and increased risk for sinus and ear infections in young children.
My son and our family were visiting Florida when he had his first ear infection. He was two years old at the time. It wasn’t until he was 4 and went to preschool that the barrage of ear infections continued. At that time, we saw an Ear, Nose and Throat (ENT) doctor. They had encouraged me that he was a candidate for ear tubes and possibly adenoidectomy. In the interim, we saw the allergist to pursue other treatment options for the increase in infections. My children went through the battery of allergy tests. He only turned positive for dogs, but the allergist said he is concerned that he would convert a little later to have other allergies. We tried a trial of Flonase (steroid nasal spray) and Zyrtec (antihistamine) with only mild benefit. Before proceeding with surgery, many surgeons require a trial of steroid nasal spray for 2-4 weeks to see if there is some benefit to the child’s symptoms. When summer came, the kids were healthy for a month or two. I put the thought of surgery on the back burner. It was not until my son was six and had multiple ear infections that we decided to go forward with surgical treatment.
My other child has struggled with snoring, mouth breathing and sinus allergy issues since she was four. She is now eight and cannot breathe through her nose six months out of the year even with allergy medicine. Both children have slightly different issues, but both are candidates for adenoidectomy. One child has the effects of the adenoids obstructing the eustachian tubes causing frequent ear infections, and both children have sleep obstructive qualities of enlarged adenoids, namely, snoring.
OK moms, it does not matter if you are a health care professional or not, the fear of putting your child through surgery is real. Willingly putting your child through a procedure goes against every fiber of my being. The problem is at what point does my fear of surgery hinder my child from getting the vital treatment they need?
When is it better to wait and treat conservatively? Many children who are two and three who have repeated ear infections, may have ear tubes placed, but they might not need adenoidectomy. In many young children, after they turn four, their eustachian tubes grow and shift so that after a couple years. This growth will decrease ear infection frequency which makes the need for surgical intervention unnecessary. Also, some research shows that children who are younger than five are 2.5 times greater for having their adenoids grow back and need a second surgery later on. (See article below) So, for children ages two or three, it does not hurt to wait on adenoidectomy until after they are four or five years old. In my son's case, even after he turned six, he continued to have ear infection issues.
By this point, I had already seen our primary and the ENT specialist multiple times. I had to make the decision on whether or not to move forward with surgery. In order to help me make a logical decision, I laid out the data for myself. I found an article from the National Institute of Health (NIH) website that was beneficial in helping me make an informed decision of how to move forward.
According to the NIH website, if a child meets any one of the criteria below, they are a candidate for adenoidectomy. This is from the American Academy of Otolaryngology (2017):
Four or greater episodes of recurrent purulent rhinorrhea in prior 12 months in a child < 12 years of age.
Persisting symptoms of adenoiditis after two courses of antibiotic therapy. One course of antibiotics should be with a β-lactamase stable antibiotic for at least 2 weeks.
Sleep disturbance with nasal airway obstruction persisting for at least 3 months.
Hyponasal speech.
Otitis media with effusion for over 3 months or associated with additional sets of tubes.
Dental malocclusion or orofacial growth disturbance documented by orthodontist or dentist.
Cardiopulmonary complications including cor pulmonale, pulmonary hypertension, and right ventricular hypertrophy associated with upper airway obstruction.
Otitis media with effusion (age 4 or greater).
If your child has experienced any of the symptoms mentioned above, they are candidates for adenoidectomy. If you have not seen your primary care, that is a good place to start in discussing if your child is in need of further intervention for treatment. A sleep study might be ordered if your doctor feels your child struggles with sleep apnea or tonsil blockage of the airway during sleep.
Benefits for adenoidectomy:
1) Adenoidectomy decreases risk for infections, both sinus related and ear infections. Decreased infections will lead to less oral antibiotic use. I cannot emphasize enough the importance of this benefit. Especially since my children have allergies to the main antibiotics for ear infections.
2) Adenoidectomy increases airflow to nasal passages and decrease mouth breathing. It significantly decreases sleep obstruction in young children ages 4-12. Mouth breathing comes with risk of oral deformation and teeth shift. It also comes at a higher risk for asthma because if the nose’s ability to humidify and filter air. This could possibly improve risk for development of asthma and the other risks that come for mouth breathing.
3) This procedure also possibly can improve sleep due to increased airway.
Risks of adenoidectomy:
1) Adenoidectomy requires general anesthesia, so they do have to be fully sedated.
2) Very small percentage of adenoidectomy patients have issues with bleeding or infection post-surgery.
3) The surgery itself may not completely correct the issue.
4) Adenoids could possibly grow back post-surgery.
Overall, I have concluded that my children are candidates for adenoidectomy. The article mentioned above also goes through the full list of the risks of surgery, which are fairly minimal. It gave me a peace of mind to review the information and to realize that the risks were fairly minimal in comparison to the benefits that they may receive from completing the surgery.
Comments