Looking after your Ears, Nose and Throat

Note: children are not meant to snore and not meant to mouth breathe. The concept of letting them grow out of it has potentially serious long term effects on their brain development, heart function, as well as increasing the chance of needing braces and orthodontics.

If you are worried about your child’s airway, only a Specialist ENT surgeon experienced in assessing children can provide definitive advice. It is important to note that on the topic of tonsils, the presence or absence of a history of tonsillitis is completely irrelevant if the child has breathing problems.

Is surgery the answer?

Not every child needs surgery to fix their snoring. However, the mainstay of surgical management for children that snore is the removal of tonsils and/or adenoids and in otherwise normal healthy children, this will fix about 80% of cases. Unfortunately this standard approach is not suited for all situations, and we will carefully assess all aspects of airway issues, including deciding on whether all that is needed is a nasal spray and whether an orthodontic opinion is also warranted.

Are they too young?

We offer surgery for children over 12 months of age, but can operate on children younger than this for exceptional reasons. We can also provide advice on partial tonsil surgery (sub-total tonsillectomy).

But they have had their adenoids out.

It is frequently stated that adenoids can grow back. In a study published in 2009 (ANZ J Surg 79(11):809-811), assessment of the common technique of scraping adenoids out showed that in close to 70% of the time, tissue was left behind and in close to one third of these, there was so much left behind that the operation could be considered ineffective. Our surgeons do not use this method. Compared to a published primary failure rate of 24%, we have a 100% initial success rate, with less than 2% of children regrowing their adenoids and needing them out again.

What are the tonsils and adenoids?

The tonsils lie at the back of the throat and the adenoids lie at the back of the nose. The role of the tonsils and adenoids is to help our body’s immune system. They play a minor role in comparison to the body’s overall defences, which is why they can be removed.

Why do ENT Specialists remove the tonsil and adenoids?

Depending on the health problem, it may be recommended that either the tonsils or adenoids be removed alone, but often they are removed at the same time. The most common reason for removing the tonsils and adenoids is when they are causing blockage to breathing at night- this is a condition known as “Sleep Disordered Breathing” or SDB for short. This condition can be so bad that the blockage prevents children from breathing all-together. This is known as “Obstructive Sleep Apnoea” or OSA.

The other reasons for recommending removal of the tonsils is when there have been several episodes of tonsillitis. It is the frequency and severity of the infections that acts as a guide to the benefit of tonsillectomy. Other types of infections that tonsillectomy may be indicated for include an abscess near the tonsil and a low grade chronic sore throat. Rare indications for tonsillectomy include Psoriasis (and other certain skin diseases), PANDAS, and prion disease.

The adenoids lie at the back of the nose and may cause nasal blockage. This may result in a runny nose, snoring, mouth breathing and altered speech. The adenoids also lie near the tubes that go from the back of the nose to the ears. It is because of this close relationship that the adenoids may be removed, to help reduce middle ear infections.

What are the risks of removing the tonsils and adenoids?

The risks of any operation is something you should be aware of. There are many potential problems that may occur, but fortunately these are mostly rare. The one guaranteed problem afterwards is pain. This may last for up to 2 weeks but is usually about a week in children. The other main risk, especially with tonsillectomy, is bleeding after the operation. These risks, and others are explained in detail to you at your visit to an ENT Specialist.

Sleep Disordered Breathing (SDB) and Obstructive Sleep Apnoea (OSA)

Snoring is a noise that is made when there is a blockage to airflow whilst we are asleep. ENT Surgeons have long been aware that sleep apnoea can have serious health effects including heart problems, impaired growth, altered facial growth, and altered chest wall development. It is very scary for parents to witness their child stop breathing at night.

We now know that breathing disturbances at night resulting in snoring may have an effect on children during the day as well as at night. This may be evident by day time tiredness, poor concentration, poor school performance, behavioural problems (including Attention Deficit Disorder or ADD or ADHD) and bed wetting. If you have concerns about your child and their snoring, you should firstly talk to your GP. Our waiting times from assessment to surgery are very short. We are happy to offer you an appointment.

What about tongue ties?

This describes a situation where the movement of the tongue is restricted by its attachment to the bottom of the mouth. There is research that shows that tongue ties may affect breastfeeding (which is a problem for the babies nutrition, and a problem for the mother’s comfort), speech, and also the development of the jaw and face. Whilst not all tongue ties cause problems, in the instances where that looks to be the case, the release of the tongue tie can make a big difference. Depending on the age and co-operation of the child, this can be done with the child either awake or asleep.