By: Dr Shweta Gogia
We often come across parents who complain that their child has been mouth breathing and has a noisy breathing especially during sleep. Most of us don’t take this seriously, thinking that this could be normal. But these symptoms if persistent, point towards a serious problem which should not be ignored.
The most common reason for the mouth breathing and snoring in young children is adenoid hypertrophy. Adenoid tissue is basically a tissue located at the back of the nose, where the nasal passage opens into the airway. This tissue is normally present in all children and undergoes some degree of increase in size as the child grows and attains immunity against the common infections. But this is temporary and after sometime they regress in size and child doesn’t have any major issues in breathing.
But the problem arises in children who have persistent problems of nasal blockage which results in mouth breathing. Subsequently, these children also have recurrent episodes of throat infections along with fever, ear pain, decreased hearing. A number of these children also have the problem of bedwetting, abnormal body movements during sleep, learning difficulty, failure to grow properly. The child is uncomfortable and lacks interest in surroundings in severe cases. This can be related to the size of the adenoid tissue which may be completely blocking the back of the nose and causing extreme discomfort to the patient.
Due to the blockage of the back of the nose or nasopharynx, these kids have ear problems such as decreased hearing which can also affect the speech of young children. The reason for this is that the middle ear space is kept healthy by the passage of air through a tube which opens in the nasopharynx known as the eustachian tube. This has the function of aeration of the middle ear along with drainage of any liquid or fluid that builds up in the middle ear and is responsible for normal hearing. In cases where this tube is not functioning properly hearing abnormalities can occur and sometimes the person can also start having discharge from the ear.
Adenoid tissue enlargement causes the dysfunction of the eustachian tube, resulting in hearing problems in young kids. Since the children cannot express the problem, this can go unattended for a long period of time and result in permanent problems.
Another serious issue which can arise due the abnormal growth of the adenoid tissue is lack of proper oxygen supply to the body especially when the child is sleeping. This results in what is known as sleep aponea in children. The decreased oxygen levels in the body of the child who is growing has serious implications especially on the neurological developmental of the child. These children can have learning issues and also have behavioral issues.
Also because of the mouth breathing associated with the adenoid tissue enlargement, children have dental problems such as dental caries, bad breath from the mouth, misaligned teeth, high arched palate. These children start to develop a typical facial morphology known as the adenoid facies, wherein child has an open mouth even while breathing at rest or may have a noisy breathing, dull look on the face, nasal stuffiness, high arched palate and overriding teeth.
Therefore, it is very important to recognize the problem and treat it so that the children receive treatment and don’t face permanent deficits.
Adenoid tissue growth or adenoid hypertrophy is graded according to the space it occupies in the nasopharynx which is the space in the back of the nose. Grade 1 and 2 can be managed with medical treatment of the child and usually the children respond well to the treatment. However, in cases where the tissue occupies more than 50 % of the space, medical management may not provide complete relief and the child can continue having symptoms. These cases need to see an ENT specialist for discussing the management of the child. The severity of the case may require surgical management of the condition. The surgery for adenoid tissue enlargement is a sophisticated surgery wherein the tissue is removed endoscopically, without any cut or scar. The modern methods of removal of the tissue ensures complete removal of the tissue with minimal or no blood loss. It is a highly advanced and safe procedure which doesn’t require prolonged hospital stay and can be done as a daycare procedure. There is minimal postoperative care and child doesn’t experience any significant pain in the recovery. About a week or ten days later, the caregiver or the parents see a vast change in the child who is now sleeping comfortably, eating well and is in a much happier space.
The author is Senior consultant, Department of ENT, Sir Ganga Ram Hospital, New Delhi.