Health Problems Related to Enlargement of Tonsils and Adenoids in Children

Pediatric Adenoid and Tonsil Hypertrophy




Tonsils and adenoids begin to grow in the first years of life and usually grow gradually until the age of 5. Different mechanisms such as external environmental factors, genetic predisposition and allergy may affect this growth. Tonsil and nasal flesh usually begin to shrink after the age of 9.

In children with excessive tonsil and adenoid enlargement, various health problems may occur due to excessive airway narrowing. The following signs and symptoms may occur in these children:

- Sleep apnea symptoms (breathing pause during sleep, morning headache, night sweats, incontinence at night, snoring)

- Decreased appetite due to the inability to smell food or due to the lack of oxygen in the brain

- Structural changes in the jaw in the long term due to hours of mouth breathing in the open position of the mouth

- Continuous opening of the mouth, pulling up on the upper lip, tired and meaningless gaze (adenoid face), slowing down in thought rate may cause the child to look mentally disabled.

- As a result of chronic hypoxia (lack of oxygen) and hypercapnia (excess carbon dioxide), permanent deterioration in the cardiovascular structure and cor pulmonale (enlargement in the right heart and heart failure) is the most dangerous health problem due to tonsil-adenoid enlargement.

In new scientific publications, it is emphasized that children with sleep apnea due to tonsil and adenoid enlargement, as the amount of time spent without treatment increases, the age of developing hypertension and heart diseases decreases in their later life. Performing tonsil surgery and adenoid surgery in the early period is recommended to prevent the risk of heart disease in these children (sources: Effect of adenotonsillar hypertrophy on right ventricle function ... / Pulmonary arterial hypertension in children with adenoid and ...).

In American Academy of Otolaryngology-Head and Neck Surgery, Clinical Practice Guideline For Tonsillectomy - 2019 , it was emphasized that the most important indication for tonsil surgery (tonsillectomy) is tonsil enlargement (tonsil hypertrophy) and drew attention to the importance of tonsil growth. In this guide, it was emphasized that it is more advantageous to completely remove the tonsils instead of partial resection and that the airways of the child should be relieved in the best way.

Obstructive Sleep Apnea Syndrome (OSAS) in Children

Obstructive Sleep Apnea Syndrome (OSAS) in Children
Sleep apnea syndrome in children is mostly due to the enlargement of the tonsils and adenoids. Although these tissues shrink especially after the age of 9; Current publications indicate that early treatment of children with sleep respiratory arrest reduces the risk of future heart disease and hypertension. In new publications, it is emphasized that complete removal of tonsils rather than partial tonsillectomy, laser reduction or radiofrequency reduction is more beneficial for the patient in patients with sleep apnea and large tonsils.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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