Brief Answer:
Yes, you may avoid surgery keeping in mind the following points.

Detailed Answer:
Hi.

Thank you for your query.

1. Adenoid hypertrophy usually occurs between the ages of 3-7 years in children, though it may start earlier in some.

2. The nasal blockage due to enlarged adenoids leads to frequent colds and sinusitis, causing a post nasal drip that infects the throat and tonsils.

3. What seems to be missing from her treatment is an anti-allergic, mucolytic and supervised steam inhalation. Mometasone is a better steroid to use than fluticasone and triamcinolone due to lower bioavailablity (absorption), while it has a local action.

4. I do get a lot of request, especially from single child nuclear families to avoid any surgical intervention. Many of these children, with sustained treatment do respond over a few months, as recorded by serial X-rays and can avoid surgery. A few who do not respond or worsen do undergo the surgery.

5. Tonsillectomy is avoided under the age of 5 years (unless they are so enlarged that they compromise the airway). It is required to build up immunity. If removed too early, the rest of the lymphoid tissue (tonsil-like tissue) in the throat tends to take over the function of the tonsil and adenoids and enlarges. This cannot be treated easily. This lymphoid tissue is spread over the base of the tongue, throughout the entire throat and is larger than the tonsils. Hence the number if sore throat episodes decreases but it does not mean that after a tonsillectomy, the child never gets a sore throat again. Tonsillectomy is indicated if there are more than 5-6 episodes of tonsillitis over 2-3 years. Dose she have any enlarged neck nodes? Does she refuse to eat and drink due to pain while swallowing?

6. If you upload an Adenoid X-ray, closeup image of the tonsils and clinical examination notes, I will be able to give you a better assessment.

7. Your doctor may also have taken into account the sleep apnea while making this decision. You can use pediatric nasal decongestant drops sparingly on nights of severe nasal blockage (not continuously). Upload the video. Is her weight with normal limits for age?

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

Regards.

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Brief Answer:
Upload the images again.

Detailed Answer:
Hi.

Thank you for writing back.

The images have not been uploaded. Kindly retry or contact YYYY@YYYY

Awaiting your reply,

Regards.

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Brief Answer:
Enlarged tonsils,mometasone is a steroid,ambroxol/bromhexine, plain water.

Detailed Answer:
Hi,

Thank you for writing back.

1. The images show enlarged tonsils (right more than left) with mild congestion. This is expected in her case and will contribute to the sleep apnea. Asleep study can be done if you are unsure as to the severity of the sleep disordered breathing. Here there are two reasons to operate: Frequent infections or severe sleep apnea. Hence the decision of whether to operate or not must be taken in context with her suffering and whether she quickly responds the the medical therapy. I would reasses every 2-3 weeks.

2. Mometasone nasal spray is a steroid spray with very low dose and absorption which will be safe to use for her. Use it for a month then taper off over the next two months.

3. A mucolytic such as ambroxol or bromhexine (usually in combination with an anti-histamine) will be fine.

4. Plain water should be used for the steam inhalation.

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

Regards.

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