Kids have a special place in my heart.  As a father, I am constantly amazed at their view the world with all their wonder and how they see life with their beautiful and sometimes funny honesty.  I've been fortunate that my chosen specialty often allows me to impart immediate positive effect in their development. 

Whether it's ear tubes for chronic ear infections to improve hearing and decrease infections or tonsil and/or adenoid surgery to cure obstructive sleep apnea and other breathing problems, I find joy seeing them improve and grow. 

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One of the first things to know is that kids are not little adults.   They are growing, changing, developing so rapidly that when certain windows of opportunities are missed, what may have been a simpler issue can become a bigger problem as they grow. 

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An example of that is nasal congestion and obstructive sleep apnea.  Chronic mouth breathing in children has been shown to negatively affect facial skeletal growth and also contribute to dental problems.  OSA has been associated with attention deficit, learning difficulties, behavioral problems, hyperactivity, listlessness, bed wetting, and some are misdiagnosed as having ADHD when the problem was actually OSA.  Although there are exceptions, the cause in preschool and elementary aged children is often enlarged tonsils and/or adenoids.  While close observation may be a reasonable option in mild situations, surgery is generally highly effective and safe. 

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Causes of Chronic Nasal Congestion in Kids

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Chronic nasal congestion causes in kids includes:

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• Chronic adenoid inflammation/enlargement

• Allergic and non-allergic rhinitis

• Environmental factors, such as smoke or dust, daycare.

• Chronic sinus infection

• Swollen nasal tissues

• Deviated Nasal Septum (the wall separating the two nasal cavities)

• Foreign body in the nasal passageway

• Choanal Atresia (congenital disorder where the back of the nose fails to open during development)

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Chronic nasal congestion in children may cause

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• Recurrent illness

• Poor sleep

• Skeletal growth problems

• Dental decay

• Negatively impacted quality of life

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Treatment of congestion

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• Nasal steroid spray such as nasonex

• Nasal saline mist

• Manage allergy if any

• Sinus saline irrigations

• Adenoidectomy when adenoids are enlarged and symptomatic

• Tonsillectomy when tonsils are enlarged and symptomatic

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Surgical treatment of snoring and apnea in children.

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Adenoidectomy and/or Tonsillectomy

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Requisites

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Adenoidectomy and/or tonsillectomy may be an option for you if your adenoids are found to be abnormally enlarged.  Following requisites are important prior to undergoing the procedure.

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• You are in reasonably good health with no critical unstable medical condition.

• You have had an evaluation with a qualified surgeon to determine appropriateness of the procedure. 

• You have discussed the procedure with your surgeon and understand potential risks & benefits of the procedure.

• Be able to stop any blood thinning products prior to the procedure.

 

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Generally, recovery from adenoidectomy alone is much easier than tonsillectomy.  If both tonsillectomy and adenoidectomy is performed, post surgery guidelines for tonsillectomy should be followed.

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Risks of Adenoidectomy Surgery

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Although every surgery and treatment has risks, adenoidectomy risks are very low.  Risks include the following.

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• Bleeding and infection.  Universal risk with all surgeries.  Some blood tinged nasal drainage may occur after surgery.  Severe bleeding and infection are rare. 

• Pain.  Typically the pain is very mild.  Usually tylenol or ibuprofenis sufficient if needed.

• Injury to the teeth or the mouth.  Adenoids are removed through the mouth.  Injury to the mouth or teeth may occur but is uncommon.  Existing dental disease can increase risk.

• Numbness of the tongue.  Tongue depressor is used to keep the tongue depressed to visualize the adenoids.  Temporary numbness may occur.  Permanent numbness is rare. 

• Velopharyngeal incompetence.  The ability of your soft palate to close off the nasal cavity from your mouth when drinking or speaking may be compromised after removal of large adenoids.  This can lead to fluid or sounds leaking out of your nose when drinking or talking.   This is usually temporary.  Your muscles in  your palate did not have to work much to close the mouth from the nose when large adenoids were present, they'll need to after removal. 

• Need for further treatment.  Remaining congestion problems due to allergies or other problems will need continued treatment.  Other unexpected outcome may require additional treatment. 

• General Anesthesia if applicable.  Although risk is not zero, modern anesthesia is overall very safe.  Nausea and other anesthesia related problems may occur and may need further treatment. 

 

What to expect

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• Surgery is performed under general anesthesia in the operating room. 

• Most patients are discharged home the same day to convalesce at home.

• Most patients return to work or school within 2 days. 

• You can eat your normal diet.

• Light physical activity (walking) is encouraged during the recovery period. 

• You should avoid blowing your nose, heavy lifting, strenuous activities, and contact sports.

• Keeping the head of the bed elevated during sleep can help manage secretions..

• Using nasal saline spray can help clear debris. 

• Followup appointment will be 2-3 weeks after surgery. 

• On call physician is available 24-7 for any post surgery emergencies.  On call MD can be contacted 24-7 by calling our office.

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Risks of Tonsillectomy Surgery

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Although every surgery and treatment has risks, tonsillectomy risks are low.  Risks include the following.

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• Bleeding and infection.  Universal risk with all surgeries.  1-3% of patients will experience post-operative bleeding.  This most commonly occurs 5-10 days post procedure.  If bleeding is not self limited, return to the operating room maybe necessary to control the bleeding.

• Pain.  Pain is expected after tonsillectomy.  It can be best managed by using tylenol and or ibuprofen with focus on hydration.   Periodic/temporary use of narcotics maybe necessary. 

• Injury to the teeth or the mouth.  tonsils are removed through the mouth.  Injury to the mouth or teeth may occur but is uncommon.  Existing dental disease can increase risk.

• Numbness of the tongue.  Tongue depressor is used to keep the tongue depressed to visualize the adenoids.  Temporary numbness may occur.  Permanent numbness is rare. 

• Need for further treatment.  Remaining congestion problems due to allergies or other problems will need continued treatment.  Other unexpected outcome may require additional treatment. 

• General Anesthesia if applicable.  Although risk is not zero, modern anesthesia is overall very safe.  Nausea and other anesthesia related problems may occur and may need further treatment. 

 

What to expect

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• Surgery is performed under general anesthesia in the operating room. 

• Most patients are discharged home the same day to convalesce at home.  Children with other medical concerns, the very young, and those with severe OSA will likely require 1-2 day inpatient stay. 

• Most patients return to work or school within 10-14 days. 

• Distant travel should be avoided for 3 weeks post surgery due to risk of delayed tonsillectomy bleed that will need timely specialist management. 

• You should eat a soft diet with focus on hydration.  Ice cream, popsicles, soft, easy to swallow foods are encouraged.

• Light physical activity (walking) is encouraged during the recovery period. 

• You should avoid blowing your nose, heavy lifting, strenuous activities, and contact sports.

• Keeping the head of the bed elevated during sleep can help manage secretions..

• Using nasal saline spray can help clear debris. 

• Followup appointment will be 2-3 weeks after surgery. 

• On call physician is available 24-7 for any post surgery emergencies.  On call MD can be contacted 24-7 by calling our office.

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