Can adenoid tissue cause hypernasality? Should it be removed now or see if it involutes?

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Posted on Mon, 11 Jun 2012 in Ear, Nose and Throat Problems
Question: adenoid tissue

My 3 year old son had a T and A about 4 months ago. He has been having nasal congestion from allergies and his ent decided to scope him. There is a pocket of asymmetric adenoid tissue that was left located inferiorly. He said it was about 25 % of the initial adenoid. Can this cause problems with his voice such as hypernasality from the soft palate not closing correctly around it? And if so, should it be removed now or wait and see if it involutes. My son has not submucosal cleft palate, I just did not know if asymmetric tissue left over or that regrows from small amount left over could cause hypernasality. thanks for your help. If your answer is yes, how would you test for hypernasality?
doctor
Answered by Dr. Naveen Kumar 3 hours later

Hi

Thanks for the query

Adenoidectomy is a procedure to either remove the entire tissue or a part of it. The indications for its removal are nasal obstruction, poor feeding, ear problems, etc. There are various methods followed to remove adenoids, such as blind procedure through the nasopharynx and endoscopic removal combining with the former technique or with the use of a microdebrider.

If the adenoids are removed through a blind approach, there are always the chances of leaving behind a remnant of the adenoid tissue. Secondly, even after complete removal of adenoids, occasionally there can be recurrent growth of the adenoids when associated with nasal allergy.

Q: He said it was about 25 % of the initial adenoid. Can this cause problems with his voice such as hypernasality from the soft palate not closing correctly around it? And if so, should it be removed now or wait and see if it involutes.

A: Initially, when there is nasal obstruction it will be hyponasality of the voice and after removal of the obstruction it will become hypernasality. The 25% of the remnant tissue will not cause any problem, particularly nasal obstruction. Yes, there will be hypernasality of the voice and that is because of increased space in the post nasal region (behind the nose). This will become normal after a period of time, probably within a year. There is no need for second surgery, as the removal of the remnant tissue will increase the post nasal space much more, leading to increase hypernasality of the voice.

Well, there is a possibility of the recurrence of the adenoid tissue over a period of time, because of the nasal allergy. So the child would require medicines such as steroid nasal spray and antihistaminic for a long term usage.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Naveen Kumar 3 days later
Could the hypernasality be secondary to the asymmetric tissue inferiorly positioned toward the right side, and if so, wouldn't removal help the hypernasality go away because then the soft palate would be able to close on a flat surface rather than asymmetric one? I read an article that said incomplete removal of adenoids (adenoids) could actually cause vpi without palatal defect. thanks for your help.
doctor
Answered by Dr. Naveen Kumar 4 hours later
Hi

Welcome back.

Hypernasality is the excessively nasal speech resonance, as a result of velopharyngeal insufficiency with emission of too much air through the nose, whereas the hyponasality is just the opposite of it.

Velopharyngeal insufficiency happens when there is cleft palate, damage to the posterior tonsillar pillar, resection of the uvula and post adenoidectomy. So, if you analyse it properly, the more the space created in the post nasal space (the space where the adenoids are present) the hypernasality will increase. Hence, if the remnant of the adenoids is also removed then the hypernasality will worsen.

Hyponasal speech results from too little air escaping through the nose (as if talking with a stuffy nose). The most common reason for this type of speech are enlarged adenoids that block the air passage to the nose and is usually corrected with adenoidectomy.

Q: Could the hypernasality be secondary to the asymmetric tissue inferiorly positioned toward the right side, and if so, wouldn't removal help the hypernasality go away because then the soft palate would be able to close on a flat surface rather than asymmetric one?

A: No, hypernasality is not related to the asymmetric tissue, and removal of it will increase the hypernasality.

Wishing you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Radhika
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Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

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