pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Adenoidectomy – Speech

[A mother researched the internet to find information that led her to refuse an adenoidectomy when her son had “tubes” in his eardrums due to chronic infections. Now other doctors are recommending the same thing and asks for yet another “opinion” about what she should do. She also claims she’s worried about the hospital being “clean” and wants to go into the operating room with him because she’s a nurses aid.]

We have been to see our pediatrician and have gone through three speech pathologists. The first ENT I took my son to suggested an adenoidectomy. I researched the procedure and it’s pros and cons. I opted for tubes in his ears– the earaches are gone and his speech was somewhat corrected. We are now seeing a second ENT who works for Children’s Hospital in Buffalo, NY. She has also suggested an adenoidectomy. She explained to me that it may not help his speech, but is very confident that it will greatly reduce the mouth breathing, bad breath, dental issues, snoring, tossing\turning and quite possibly the night terrors. I wonder if this is too good to be true, but she is the second surgeon to say so. I want very much to make the right and, just as important, informed decision for my son. If this is not detailed enough I can provide more. Are there other websites I can visit? And if I choose to have the surgery, how can I be sure that the environment is clean? I am a nursing student (I have finished my surgical rotation), working my way through college as a CNA (certified nurses aid). Would I be allowed in the room?

It is quite common, once the criterion for PE Tubes have been met, to remove the adenoid tissue during the same surgery. If during surgery the doctor saw that there was substantial adenoid tissue he should have removed it while the child was under anesthesia. (It’s the ‘tonsil’ portion of the T&A you probably read in the internet about that sometimes doesn’t need to be done.)

The most frequent cause for recurrent ear infections, especially those which don’t quite clear well, is having parents that smoke and/or being on a bottle long after they need to be. The reason this is the case is: that the tube which drains the middle ear (Eustachian tube) becomes inflamed and inadequate to equalize the pressure on the eardrum like it’s supposed to do. Smoke, even second hand, causes congestion and inflammation of tissues thereby closing off the child-size tube.

Tilting the child’s head back to suck on a bottle does, essentially, the same thing. It is also felt that adenoid tissue, because it is placed so close to the back-of-the-nose opening of the Eustachian tube, could cause blockage if it is enlarged. The problem is, that you can’t see the full adenoid tissue unless you hold the child’s tongue out and use special instruments with mirrors to look “around the corner” at the back of the throat. Something that the ordinary child won’t put up with – if he is at all awake and has any choice in the matter. So, once a myringotomy with tubes becomes medically necessary, I usually suggest that parents:

1) see an ENT specialist that they can trust to be honest,
2) give permission for the doctor to examine the child under anesthesia, and
3) take the adenoids out, at the same time the tubes are placed, if they are encroaching on the Eustachian tube orifice.

I’m not sure what you mean by “dental issues and night terrors” but it would be rare for them to be related to adenoid tissue. Mouth breathing, might be – IF the adenoid tissue mass was extensive. Perhaps you have an ENT specialist that you trust (and a child who might cooperate by being sleepy) so a good exam of the adenoid tissue can be made in the office. If the nasal choanae are completely obstructed by tissue it either could be removed, or you could wait until the child’s passages grow and lymph tissue shrinks.

[As an incidental note:
– There have been studies which have shown that T&As (removal of tonsils and adenoids) do NOT reduce snoring;
– It’s not a good idea for a parent to go into the surgery – even if you want special treatment for being medically associated;
– Information from the internet is too suspicious to ever be used to “over-ride” a “live” doctor who you can trust and who has examined your child; and lastly,
– “Being clean” is such a basic tenet of a hospital that if you have to “wonder” about it you should go to a different hospital.]

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