Adenoiditis, Adenoid Surgery, Snoring, Block nose/Runny nose in children

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3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510

Dr Kevin Soh explains how enlarged adenoids, block nose, and snoring in children cause ear, lungs, speech and school problems.

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If you prefer to read, rather than watch the video, here’s the transcript.

0:12 – The adenoids are located in the postnasal space (or nasopharynx). The Eustachian tube opens near the adenoids. The adenoids are part of the mucosal lymphoid immune system that also includes the palatine tonsils and lingual tonsils.

0:42 – If we look at the size of the adenoids, in relation to age, we will find that: From the age of 0 to 3 years, the adenoids are small in size. From age of 3 to 6 years, the adenoids grow rapidly to maximum size. From 6 to 9 years, the adenoids slowly become smaller. It shrinks completely at age 12 years.

1:16 – The adenoids become a liability when: a) they become infected (adenoiditis), b) they grow too large in size (adenoid hypertrophy).

1:28 – Video: Inferior turbinate, enlarged adenoid, nose bleeding from Little’s area, enlarged tonsils, tonsillitis, airway narrowing, snoring, sleep apnea.

2:42 – As the adenoids enlarge and becomes infected, complications occur! The Eustachian tube becomes blocked. Adenoid hypertrophy causes block nose, poor drainage of mucus from the nasal cavity and nose, retained mucus becomes thick and viscous, viscous mucus becomes infected, yellow pus is produced, and yellow nasal discharge seen. The infection spreads into the sinuses, and secondary sinusitis results.

3:39 – Adenoid hypertrophy also affects the throat. Infected nose mucus drips backwards (postnasal drip). The adenoids become inflamed and discharge pus. This results in secondary throat inflammation, involving tonsils, pharynx and larynx, causing coughing, sorethroat, and difficulty eating.

3:56 – The nose and the lungs form part of the same respiratory system. Adenoid disease will lead to lung inflammation, bronchitis, asthma, and recurrent chest infections. This occurs via mouth breathing, which causes unfiltered, unwarmed unhumidified air to enter the lungs. Infected mucus from nose, sinus and adenoids can be aspirated into the lungs. Nose infection induces nerve reflex narrowing of the airways, which leads to reflex induced broncho-constriction and airway narrowing. Acid from the stomach refluxes up to the throat, and into the lungs (laryngopharyngeal reflux disease, LPRD or gastroesophageal reflux disease, GERD). Paradoxical vocal cord dysfunction due to vocal cord irritation by infected mucus and acid, which causes vocal cords to close (instead of open) during inspiration.

4:41 – Adenoid problems can cause hearing loss and ear infections. An enlarged adenoid will cause Eustachian tube obstruction. This causes fluid to build up in the middle ear (middle ear effusion, otitis media with effusion, glue ear). The fluid acts as a good culture medium for bacterial growth. Acute ear infection with pus formation occurs (acute otitis media). A tympanostomy tube (grommet tube) is used to treat middle ear infection. The tympanostomy tube allows pus to drain out from the middle ear (drainage function). The tympanostomy tube also allows air to enter the middle ear (ventilation function).

5:51 – Adenoid hypertrophy can cause physical growth retardation. The child becomes small size and thin. This is caused by increased energy expenditure for breathing, reduced food and caloric intake.

6:25 – Adenoid enlargement can cause cognitive, academic, intellectual, behavioural problems, speech and language delay, poor school performance!

6:58 – A HAPPY CHILD DOES NOT HAVE AN ADENOID PROBLEM!

7:04 – How to diagnose and treat adenoid problems: direct visualization with fiberoptic endoscopy, microdebrider adenoidectomy, curettage, coblation.