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Child has chronic cough, nasal congestion. Medication has not worked. Should we get his adenoids removed?

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My 8 year old has had a chronic cough and nasal congestion for over a year. Nothing has worked, antibioitcs, allergy medicine, hypoallergenic bedding, humidifiers. Our ENT is reluctant to remove his adenoids because they we're not enlarged. He said it may or may not help. My husband wants it done, but I'm not sure. He is also, mouth breathing, wakes up coughing during the night, has some speech, problems, and is tired and has a short attention span. What should we do?
Posted Wed, 23 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. The most common cause of nasal congestion obstruction, snoring/mouth breathing during sleep and chronic cough in children around the age of 8 years is hypertrophied Adenoid tissue.

2. Adenoid tissue hypertrophies in all children between the ages of 3 to 7 years. thereafter this Adenoid tissue regresses beyond 8 years of age and usually disappears by the age of 12 to 15 years.

3. You should get her X-ray skull lateral view for adenoids done. This will enable your doctor to accurately assess the compromise of the nasopharyngel airway. You may get a sleep study done if the adenoids are within normal limits (not compressing the nasopharyngeal airway). A plain CT PNS (Para Nasal Sinuses) will help if there is no obvious cause. Radiation is an issue, though, weighed against the severity of his problems.

4. If the adenoids are blocking the nasopharynx significantly, then medication such as anti-allergic decongestants, mucolytics and nasal steroid sprays under antibiotic cover, as well as supervised steam inhalation will help reduce their size.

5. Hypertrophied Adenoids may cause many side effects such as underdevelopment of facial structures and bones, ear infections, failure to thrive and so on. Nasal obstruction and sinusitis may cause a Post-Nasal Drip (PND) which infects the throat and Tonsils.

6. If the Adenoid hypertrophy is not significant, then the next area of nasal obstruction will be due to deviated nasal septum, hypertrophied nasal turbinates or sinusitis. Here too, the initial treatment is medication under supervision of your physician.

7. Surgery of the Adenoids or Radiofrequency ablation of the hypertrophied turbinates is a later option if medical treatment fails. Very little surgical intervention is always advised till the age of 15 to 17 years as the facial structures are in the growing phase. Tonsillectomy is not advised as there is no history of chronic tonsillitis.

I must emphasize that these are very common problem in children. Surgical treatment (Adenoidectomy and not Tonsillectomy) is only required if symptoms such as mouth breathing, snoring and nasal obstruction are severe. Some surgeons advise an AdenoTonsilectomy to avoid two separate general anesthesia sessions.

by the age of 8 years, the adenoids may have already caused the damage and regressed. If you can share images of his facial features, X-ray and a plain CT PNS, I will be able to give you an accurate assessment.

I hope I have answered your query. If you have any further questions I will be available to answer them.

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