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Suggest Treatment For Recurring Ear Infections
Question: Hi. My 4-year old had recurring ear infections over the past year, snores & has sleep apnoea. He is booked in for adenoidectomy and grommets, but also tonsillectomy. I am questioning the tonsillectomy as - even though he has large tonsils - he has never had tonsilitis & has not yet complained about sore throat. The consultant did not have much time to talk to me about this.
Could you please advise when a tonsillectomy is advised and whether large tonsils are a good enough reason to combine the various procedures into one rather than wait to see if the adenoidectomy solves the problems?
Thank you so much!
A
Could you please advise when a tonsillectomy is advised and whether large tonsils are a good enough reason to combine the various procedures into one rather than wait to see if the adenoidectomy solves the problems?
Thank you so much!
A
Brief Answer:
Yes, you can avoid tonsillectomy at present.
Detailed Answer:
Hi,
Thank you for your query.
1. It is better to avoid a tonsillectomy before the age of 5 years. When the tonsils are removed early, there may be hypertrophy of the other lymphoid (tonsil-like) tissue in the throat as it tries to take over the function of the tonsils, leading to further problems.
2. If a child has more than 5 to 6 episodes of tonsillitis for more than 2 to 3 years, besides other features of chronic tonsillitis, then a tonsillectomy is advised. Unless the tonsils are very large such as those that meet in the mid-line, they are unlikely to cause sleep apnea. The enlarged adenoids are the predominant cause.
3. The incidence of tonsillectomy has fallen by 90% while that of adenoidectomy has fallen by 50% over the last few decades. Better medication, including newer generation anti-allergy medication, steroid nasal sprays have helped reduce the requirement for surgery.
4. If he has no throat complaints or has never had tonsillitis, you do not need to make him undergo a tonsillectomy.
5. The grommet procedure is indicated if you have an Impedance Audiogram (Tympanogram) and a PTA (Pure Tone Audiogram) that shows a problem such as a persistent serous otitis media despite maximum medical treatment.
6. In many cases, sustained medication over many weeks also obviates the need for adenoid surgery. This must be weighed against the benefit of avoiding future complications of adenoid nasal blockage.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Yes, you can avoid tonsillectomy at present.
Detailed Answer:
Hi,
Thank you for your query.
1. It is better to avoid a tonsillectomy before the age of 5 years. When the tonsils are removed early, there may be hypertrophy of the other lymphoid (tonsil-like) tissue in the throat as it tries to take over the function of the tonsils, leading to further problems.
2. If a child has more than 5 to 6 episodes of tonsillitis for more than 2 to 3 years, besides other features of chronic tonsillitis, then a tonsillectomy is advised. Unless the tonsils are very large such as those that meet in the mid-line, they are unlikely to cause sleep apnea. The enlarged adenoids are the predominant cause.
3. The incidence of tonsillectomy has fallen by 90% while that of adenoidectomy has fallen by 50% over the last few decades. Better medication, including newer generation anti-allergy medication, steroid nasal sprays have helped reduce the requirement for surgery.
4. If he has no throat complaints or has never had tonsillitis, you do not need to make him undergo a tonsillectomy.
5. The grommet procedure is indicated if you have an Impedance Audiogram (Tympanogram) and a PTA (Pure Tone Audiogram) that shows a problem such as a persistent serous otitis media despite maximum medical treatment.
6. In many cases, sustained medication over many weeks also obviates the need for adenoid surgery. This must be weighed against the benefit of avoiding future complications of adenoid nasal blockage.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you bery much for your answer.
His tonsils are rather large and I assume do contribute to some snoring - however, again, no bouts of tonsilitis to date.
Will he grow 'into hos tonsils', ie. ashe grows, the tonsils will be smaller/in better proportion to his body/throat?
Thanks again.
His tonsils are rather large and I assume do contribute to some snoring - however, again, no bouts of tonsilitis to date.
Will he grow 'into hos tonsils', ie. ashe grows, the tonsils will be smaller/in better proportion to his body/throat?
Thanks again.
Brief Answer:
Needs further investigation/follow-up before surgery. Try medication first.
Detailed Answer:
Thank you for writing back.
1. The tonsils have very little contribution to snoring unless they are very large and meet in the mid-line.
2. Since there are no throat complaints, it is difficult to justify the tonsillectomy.
3. Yes, as he grows, the tonsils will appear smaller in proportion to his body/ throat size.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Needs further investigation/follow-up before surgery. Try medication first.
Detailed Answer:
Thank you for writing back.
1. The tonsils have very little contribution to snoring unless they are very large and meet in the mid-line.
2. Since there are no throat complaints, it is difficult to justify the tonsillectomy.
3. Yes, as he grows, the tonsils will appear smaller in proportion to his body/ throat size.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you again! I think you have given me good information to meet my son's trigger happy Consultants with.
One last question if I may, please.
My son has now developed a mild cold (no frver so far, cough & sniffles), and his operation is on Tuesday. Will this have to be postponed? My plan is to wait till Monday to see if the cold develops or goes away, then call the hospital a day before if he still has it!?
One last question if I may, please.
My son has now developed a mild cold (no frver so far, cough & sniffles), and his operation is on Tuesday. Will this have to be postponed? My plan is to wait till Monday to see if the cold develops or goes away, then call the hospital a day before if he still has it!?
Brief Answer:
Yes, if there ia a cold, advance the date of surgery till he is better.
Detailed Answer:
Hi,
Thank you for writing back.
1. If there is a cold or URTI (Upper Respiratory Tract Infection), elective surgery must be avoided till he is better.
2. This is because there is a possibility of causing a LRTI (Lower Respiratory Tract Infection). This is a standard protocol for non-emergency cases.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Yes, if there ia a cold, advance the date of surgery till he is better.
Detailed Answer:
Hi,
Thank you for writing back.
1. If there is a cold or URTI (Upper Respiratory Tract Infection), elective surgery must be avoided till he is better.
2. This is because there is a possibility of causing a LRTI (Lower Respiratory Tract Infection). This is a standard protocol for non-emergency cases.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
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