Ask the doctor: Should my granddaughter have her adenoids removed? – Independent.ie

Question: My three-year-old granddaughter lives in another European country and has been sick a lot lately. The doctor there has suggested that she have her adenoids removed but my son is against it as he wants more information before they get it done and there is a bit of a language barrier. She is sick a lot with viruses but arent all kids? Why would a child have their adenoids out, what is the impact of it and should he go ahead or wait until she grows out of whatever it is?

Dr Grant replies: Most surgeons opt for a conservative approach or to watch and wait. In other words, they will not perform any surgery unless it is absolutely necessary or in the best interest of the child. Both tonsillectomy (removal of the tonsils) and adenoidectomy (removal of the adenoids) are among the most common surgical procedures performed in children. The decision to undergo surgery depends on the childs specific complaint, the surgeons recommendations and the guardians of the child.

Each country will vary on their guidelines and criteria, as will surgeons depending on where they currently work and where they trained in the past. The two main indications for tonsillectomy and/or adenoidectomy are upper airway obstruction and recurrent infection.

The general trend has seen a decline in the number of tonsillectomies and adenoidectomies performed for infectious indications, while the number performed for obstructive indications has increased. Expanding more on the upper airway obstruction, Obstructive Sleep Apnoea (OSA) is common in children and can lead to chronic snoring, poor sleep and in the longterm, poor overall growth and performance.

During the first few hours of sleep, children release most of the growth hormone allowing their bones to grow and if their sleep is chronically disturbed due to snoring and breath holding, it may affect overall growth. Poor sleep, we all know, leads to irritability and fatigue and adversely affects your cognitive abilities.

Long-term sleep apnoea can put additional, unnecessary strain on the cardiovascular system at night when the body is supposed to be healing and repairing. When it comes to recurrent infections, the benefits of tonsillectomy (with or without adenoidectomy) in children with recurrent throat infections (i.e. tonsillitis, pharyngitis, tonsillopharyngitis) depends on the frequency and severity of previous episodes.

For example, one criteria for surgery states the child should have +3 episodes in each of three years, +5 episodes in each of two years, or +7 episodes in one year. My own 11-year-old child had up to four severe episodes of tonsillitis per year for a number of years, and was truly miserable each time. It takes up to one week to fully recover and as a parent, it is difficult seeing your child in pain, but we held off and my child has been symptom-free for over four years now. Adenoidectomy is considered when the adenoids are enlarged (hypertrophied) and/or infected resulting in nasal obstruction, rhinosinusitis, eustachian tube dysfunction and otitis media.

Nasal obstruction may lead to chronic mouth breathing, hypo-nasal speech, and impaired olfaction (sense of smell). Severe obstruction due to adenoidal hypertrophy is an absolute indication for surgery. In summary, the decision should be made on a case-by-case basis after weighing the benefits and risks of the surgery as well as the values and preferences of the family and child.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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Ask the doctor: Should my granddaughter have her adenoids removed? - Independent.ie