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Suggest Treatment For Significant Encroachment Of The Respiratory Tract
Question: Hello,
I need your help please, we live in Scotland and my son is going to be 2 years old this December. For several months he has been suffering from bad snoring and difficulty in breathing while asleep, big tonsils size, and high wax volume and irritation in his left ear.
For long months here is Scotland since he moved here since last March (he used to live in Egypt since he was born untill last March), he has been catching diseases specially when he started going to the nursery, he got the croops twice and was given steroid to easy it down, also he was always coughing most of the time, temperature high with other symptoms like less eating or throwing up on a regular basis, to the point that he was prescriped at least 4 courses of antibiotics (Amoxicillin) in a period of 5 months.
But during all this time no real diagnosis of why all these symptoms were showing was identified and we were told that it is normal viruses in the air, and his ear has an increased amount of wax but that is normal and it will go away eventually.
Now he is back to Egypt and we decided also to perform some examinations on him, the following was discussed with the doctor:
1- his tonsils were found out to be big in size, first the option to reduce its size with laser surgery was discussed, but then a blood test was performed and it was found that (Streptococcus) level is high (please refer to attached blood test report), the doctor said this might cause him (Rheumatic heart disease) and he recommended to remove the tonsils ASAP.
2- his adenoid was checked by x-ray and found out that it needs to be removed also the cartilage was found to be in big size that needs treatment, and the doctor said it should have been treated long time ago, but unfortunately no one diagnosed it (please refer to attached x-ray report).
3- an ear test was done (please find attached report) and the doctor said there is high volume of wax and volume of water in the ear that also needed to be treated long ago, but now we will try drops in his ear for ten days otherwise if it doesn't get better then they will have to insert some kind of tube to reduce that water in his ear.
Please I need to know what is your opinion looking at the attached reports, as now I am in front of two completely different opinions between the doctors in Scotland and in Egypt. I don't know if here in scotland these issues were ovelooked and underestimated and not treated accordingly, or is the doctor in Egypt exaggerating about the current condition.
Your help is very much appreciated as now I am very worried about my son.
Unfortunately the application didn't accept my uploading of the files, and the help contact centre is not reachable at all, please let me know if there is any other way to send you the reports.
Regards,
XXXX.
I need your help please, we live in Scotland and my son is going to be 2 years old this December. For several months he has been suffering from bad snoring and difficulty in breathing while asleep, big tonsils size, and high wax volume and irritation in his left ear.
For long months here is Scotland since he moved here since last March (he used to live in Egypt since he was born untill last March), he has been catching diseases specially when he started going to the nursery, he got the croops twice and was given steroid to easy it down, also he was always coughing most of the time, temperature high with other symptoms like less eating or throwing up on a regular basis, to the point that he was prescriped at least 4 courses of antibiotics (Amoxicillin) in a period of 5 months.
But during all this time no real diagnosis of why all these symptoms were showing was identified and we were told that it is normal viruses in the air, and his ear has an increased amount of wax but that is normal and it will go away eventually.
Now he is back to Egypt and we decided also to perform some examinations on him, the following was discussed with the doctor:
1- his tonsils were found out to be big in size, first the option to reduce its size with laser surgery was discussed, but then a blood test was performed and it was found that (Streptococcus) level is high (please refer to attached blood test report), the doctor said this might cause him (Rheumatic heart disease) and he recommended to remove the tonsils ASAP.
2- his adenoid was checked by x-ray and found out that it needs to be removed also the cartilage was found to be in big size that needs treatment, and the doctor said it should have been treated long time ago, but unfortunately no one diagnosed it (please refer to attached x-ray report).
3- an ear test was done (please find attached report) and the doctor said there is high volume of wax and volume of water in the ear that also needed to be treated long ago, but now we will try drops in his ear for ten days otherwise if it doesn't get better then they will have to insert some kind of tube to reduce that water in his ear.
Please I need to know what is your opinion looking at the attached reports, as now I am in front of two completely different opinions between the doctors in Scotland and in Egypt. I don't know if here in scotland these issues were ovelooked and underestimated and not treated accordingly, or is the doctor in Egypt exaggerating about the current condition.
Your help is very much appreciated as now I am very worried about my son.
Unfortunately the application didn't accept my uploading of the files, and the help contact centre is not reachable at all, please let me know if there is any other way to send you the reports.
Regards,
XXXX.
Brief Answer:
Getting a second opinion would help.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have very carefully gone through the details provided, however I do not find the reports attached. You can reattach the reports although I find the mentioned details enough for the purpose of answering your queries.
There is a considerable difference between the weather in Scotland with that in Egypt. Some children might not fare well with such weather changes. Cold temperatures depress immunity and thus make them more prone to catching infections. In such cases tonsillar enlargement or adenoid hypertrophy can be observed. However, generally the size of tonsils regresses following the age of 3 years and unless the frequency of infections is too high, infections are deferred. I cannot comment on the increased size of cartilage as mentioned, but cartilages are not visible on X-Rays, so I doubt if the finding is a correct one.
Most often tonsillar infections are either due to Streptococcus or due to certain viruses like Epstein Barr Virus. Although rheumatic heart disease is caused due to infection by a certain variety of Streptococcus, it does not necessarily mean that Streptococcal sore throat mandates a tonsillar surgery. So, I would not really speak in its favour. There seems to be a certain degree of exaggeration involved and I would suggest you to get a second opinion in this regard. It is only if the obstructive symptoms are severe enough to cause respiratory blockage, that a surgery is deemed essential.
The increased volume of ear is not a cause of concern. It is the body's own way of dealing with things. You need not worry.
Let me know if I could be of further assistance.
Regards
Getting a second opinion would help.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have very carefully gone through the details provided, however I do not find the reports attached. You can reattach the reports although I find the mentioned details enough for the purpose of answering your queries.
There is a considerable difference between the weather in Scotland with that in Egypt. Some children might not fare well with such weather changes. Cold temperatures depress immunity and thus make them more prone to catching infections. In such cases tonsillar enlargement or adenoid hypertrophy can be observed. However, generally the size of tonsils regresses following the age of 3 years and unless the frequency of infections is too high, infections are deferred. I cannot comment on the increased size of cartilage as mentioned, but cartilages are not visible on X-Rays, so I doubt if the finding is a correct one.
Most often tonsillar infections are either due to Streptococcus or due to certain viruses like Epstein Barr Virus. Although rheumatic heart disease is caused due to infection by a certain variety of Streptococcus, it does not necessarily mean that Streptococcal sore throat mandates a tonsillar surgery. So, I would not really speak in its favour. There seems to be a certain degree of exaggeration involved and I would suggest you to get a second opinion in this regard. It is only if the obstructive symptoms are severe enough to cause respiratory blockage, that a surgery is deemed essential.
The increased volume of ear is not a cause of concern. It is the body's own way of dealing with things. You need not worry.
Let me know if I could be of further assistance.
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello Dr, Diptanshu,
Thanks a lot for your answer.Please find attached the reports, as I mentioned in my first email the app wasn't allowing me to upload them.
Regards,
XXXX.
Thanks a lot for your answer.Please find attached the reports, as I mentioned in my first email the app wasn't allowing me to upload them.
Regards,
XXXX.
Brief Answer:
Checked the reports
Detailed Answer:
Thanks for your response. The attachments took time to upload and were not there for more than an hour after you posted the query. However, I can see it at present.
The X-Ray shows significant encroachment of the respiratory tract and hence can mandate a surgical intervention, but that is in order to take care of any respiratory compromise, if it is there.
The adenoids are probably occluding the eustacian tubes that run from inner throat to the middle ear cavities. Blockage of these tubes interferes with hearing and the tympanometry reports seem consistent with the same. The problem is likely to resolve with the problem of adenoids resolving. Lateral projection here does not mean bony or cartilaginous projection. It means projection of the image from the lateral side.
Presence of Streptococcus does not really matter but ASO titre means that the body might have something to say in this regard.
The disruptive effect of the adenoids/tonsils is evident and the overall details increase the justification of a adenoid surgery but I would still insist on a second opinion.
Regards
Checked the reports
Detailed Answer:
Thanks for your response. The attachments took time to upload and were not there for more than an hour after you posted the query. However, I can see it at present.
The X-Ray shows significant encroachment of the respiratory tract and hence can mandate a surgical intervention, but that is in order to take care of any respiratory compromise, if it is there.
The adenoids are probably occluding the eustacian tubes that run from inner throat to the middle ear cavities. Blockage of these tubes interferes with hearing and the tympanometry reports seem consistent with the same. The problem is likely to resolve with the problem of adenoids resolving. Lateral projection here does not mean bony or cartilaginous projection. It means projection of the image from the lateral side.
Presence of Streptococcus does not really matter but ASO titre means that the body might have something to say in this regard.
The disruptive effect of the adenoids/tonsils is evident and the overall details increase the justification of a adenoid surgery but I would still insist on a second opinion.
Regards
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Above answer was peer-reviewed by :
Dr. Prasad
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