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Adenotonsillar hypertrophy in children - Surgical management

Updated: Jun 25, 2019

The adenoids and tonsils along with the lingual tonsils are part of Waldeyer’s ring. A collection of lymphoid tissue that plays a major role in the development of immunity in children. Frequently though, hypertrophy of this tissue or recurrent infections can cause significant morbidity to children and needs to be removed surgically.

Adenoid hypertrophy can cause complete nasal obstruction and mucopurulent nasal discharge. Persistent mouth breathing can lead to deformity of the hard palate and misalignment of the teeth. The hearing can be affected leading to poor speech development and mispronunciation. All these occur around the time when children start school, an already difficult adjustment period for children and parents alike with bullying at school being more prevalent than ever, even at this young age.

Tonsillar hypertrophy can cause significant airway obstruction, especially when the adenoids are enlarged. This results in simple snoring or it can affect the quantity and quality of the sleep the child is getting at night. It can vary in severity from sleep disordered breathing (SDB) to obstructive sleep apnoea syndrome (OSAS). Such children will have problems with concentration at school, which affects their learning. They can be irritable and occasionally get labelled as “naughty” by teachers and parents. There is a suggested link in the literature between children diagnosed with attention deficit hyperactivity disorder (ADHD) and OSAS. Surgical intervention in such children helps the ADHD symptoms and prevent long term medical treatment. Children that suffer from recurrent tonsillitis will also miss many school days with a negative impact on their learning.

There is no medical treatment for adenotonsillar hypertrophy. The only cure is early surgical excision. Time or conservative approach is sometimes suggested as an option but we must ensure that there are regular reviews to avoid the permanent detrimental effects on the child’s development. As the child grows, the symptoms lessen but parents spend significant amount of time and money attending dentists, speech therapists, medical visits etc to reverse the consequences of not intervening early.

All health professional involved in looking after children, whether it is the paediatrician, speech therapist, audiologist, dentist or even teacher should be able to recognise the signs of adenotonsillar hypertrophy and be aware of the long-term consequences if left untreated. They should inform the parents and involve the ENT surgeons early. ENT surgeons have a variety of specialised tools (flexible endoscopes, tympanograms, audiograms, X-rays) to evaluate each child’s unique needs and tailor the management accordingly. Relatively low risk, short operations (or their combination) can cure the child and stop the progression.

The ENT surgeon might suggest and discuss with the parents and the child the following operations:

  • Adenoidectomy

  • Adenoidectomy and grommets

  • Adenotonsillectomy

  • Tonsillectomy

Dr. Panayiotis Symeonides MBChB MRCS DOHNS

Ear, Nose & Throat – Rhinology and Anterior Skull Base Surgeon

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