Brief Answer:
This situation is fairly common.

Detailed Answer:
Hi,

Thank you for your query.

1. This situation was common when blind curetting (the earliest method) was used for adenoidectomy. The concept was of shaving the excess tissue in the mid-line. The entire adenoid tissue is not removed. Hence the remaining tissue could reappear. This situation is still fairly common in areas where newer techniques are still not used (usually due to lack of training or cost constraints).

2. Adenoid tissue can swell up or hypertrophy quite fast when infection or inflammation sets in. It is not uncommon to see sudden changes on endoscopy in some adult patients (as they allow nasal endoscopy easily).

3. The best way to proceed is a trial with medical therapy that includes anti-allergy medication, nasal steroid sprays and supervised steam inhaltion for a few weeks. Adenoids hypertrophy in all children between the ages of 3 to 7 after which they normally regress and disappear by the age of 12 to 15 years (except in less than 5% people). Tonsil tissue is usually not removed till after the age of 5 years as this lymphoid tissue is thought to play a role in development of immunity. Adenoids can be removed earlier in severe cases.

4. If the repeat lateral skull X-rays show persistent adenoid enlargement and symptoms, then a revision adenoidectomy under endoscopic vision with a coblation wand is recommended. Blood loss is minimal, if any. A microdebrider assisted endoscopic adenoidectomy can also be done but intra-operative bleeding is much more.

5. This time insist on sending some of the removed adenoid tissue for culture and histopathology.

6. If you upload clear images of the X-rays (taken on an X-ray viewer), I will be able to give you a better assessment.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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Brief Answer:
Medication is fine. Add a mucolytic. X-ray shows adenoid hypertrophy.

Detailed Answer:
Hi,

Thank you for writing back.

1. Nasonex (mometasone) nasal spray is ideal for children as the bioavailability (absorption into the body) is very low (<1%) and hence side effects are not expected.

2. A mucolytic such as ambroxol syrup should be added along with chlorohistol.

3. The X-ray images show adenoid hypertrophy and there is reduced air space in the nasopharynx (behind the nose).

4. Continue the treatment for a month and repeat the X-ray. Upload the image and symptom progress either here or directly at bit.ly/Dr-Sumit-Bhatti If the medication is effective on comparing the X-ray and symptoms, I will recommend tapering off the medication over 2-3 months.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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Brief Answer:
Stop nasal steroid spray for a few days. Use decongestant drops.

Detailed Answer:
Hi,

Thank you for writing back.

1. If he has an active infection, cold or flu, stop the steroid nasal spray for a few days.

2. Use OTC nasal decongestant drops for a few days to help him breathe easier. Do not use the drops for more than two weeks continuously.

3. You can restart the nasal steroid spray after a few days.

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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