Adenoids
Here’s why your child snores and what you need to do
“My child snores just like his father” or rarely “just like his mother”. This is a joint statement that we have all heard. Snoring in children is a common and often ignored condition. It is not normal for a child to snore persistently; thus, this should be considered. One of the most common causes of persistent snoring in children is adenoid enlargement.
Adenoid is a small mass of lymphoid tissue in the posterior aspect of the nose in the upper airway. Their usual function is to aid in fighting infections in early childhood by trapping germs entering the body through the nose or mouth. The immune cells within the organ then develop a criterion that differentiates harmful and non-harmful microorganisms and develops immune cells for the harmful ones.
The enlargement of this organ can occur because of recurrent infections and, more often, because of allergies. Other causes of enlargement are reflux of stomach acid and as well as inhaled irritants such as cigarette smoke.
Children with adenoid enlargement may have a variety of signs and symptoms. Minor enlargement may not exhibit much symptomology. However, in severe enlargement, children develop severe nasal obstruction. This leads to mouth breathing that can lead to foul breath and a dry mouth.
Nasal obstruction can lead to disturbed sleep breathing and even obstructive sleep apnoea. Obstructive Sleep apnoea is a disorder that leads to pauses in breathing because of severe obstruction. The brain then wakes the person up to breathe. This is a sign of severe obstruction, which means a remedy is required.
The adenoid tissue can also lead to Eustachian tube obstruction and consequently middle ear fluid. Children with this complication may have delayed speech development or regression and may also perform poorly in school because of hearing loss, and poor concentration occurring with daytime somnolence.
Children with adenoid enlargement may also have major complications that include dental carries and dental malocclusion, pulmonary hypertension, and, in extreme cases, heart failure. Changes in facial bone structure can also occur because of chronic mouth breathing. This is known as adenoid facies. In long-standing airway obstruction, the child’s metabolism may be affected, leading to poor weight gain and failure to thrive.
Diagnosis of adenoid hypertrophy is only through clinical review and examination. A history of the child’s sleeping pattern and a good examination of the child suffice to make a diagnosis. An X-ray of the posterior aspect of the nose or endoscopic examination of the nose can aid in the diagnosis. In the assessment, the doctor will assess the ears to ensure that there is no middle ear fluid retention.
The initial treatment of adenoid enlargement is by managing the causes, which include infections and allergies. Sometimes, especially if not long-standing, this can be successful in creating sufficient space for the child to breathe.
In cases of persistent obstruction and where complications of adenoid enlargement are present, surgical removal of the adenoid may be necessary to improve breathing, and sleep and relieve obstruction of the airway and or the Eustachian tubes. The surgical procedure is known as adenoidectomy and may also be done together with a tonsillectomy and ventilation tube insertion, where indicated. The surgery is done trans-oral under general anaesthesia and often as a day case. And it often brings about a dramatic improvement in the child’s well-being.
Adenoid enlargement and upper airway obstruction should not be ignored, as it has the potential to bring about more persistent and long-term complications. Many children are failing to reach their full potential because they are not sleeping well and have complications of adenoid hypertrophy.
Author: Dr Gakuo Karuga - E.N.T Surgeon
