CAID vs. Tonsils and Adenoids

. Posted in SPECIAL PATIENTS

Tonsil and adenoid issues can also occur with chronic sinus infections with acute exacerbations. For kids with a constant yellow-green mucus and stuffy and runny nose, the infection can drain to the lymph nodes, which includes the neck nodes, tonsils, and adenoids. These children typically can’t ever breathe through their nose.

A sinus infection with adenoidal enlargement in a child creates a vicious cycle. It is often difficult to tell which infection came first, and both eventually lead to a worsening of the other. For instance, a chronic sinus infection in a child can lead to swollen, infected adenoids, which
leads to further nasal obstruction and then worsening of the sinus infection as the infected pus backs up. This constant nasal obstruction can lead to a sore throat, dry mouth, and worsening of a sinus infection.

Some pediatricians believe that this infection begins in the tonsils and adenoids and then backs up into the sinuses, but this makes no sense to me. Instead, I believe that the tonsils and adenoids become infected and swollen from the sinus infection. I call this secondary tonsillitis/adenoiditis. Most pediatricians and ENTs will decide to operate on the tonsils and adenoids without treating the sinus problem correctly. Unfortunately, many of these children are never treated by their pediatrician or their ENT with an antibiotic course longer than 2 weeks and neither the sinus nor the tonsil/adenoid infection clears. In my experience, many of these children would have improved without surgery had they been given a longer course of medicines.

For these children, I try the longer course of medications first. If their infections do not resolve within 3 - 8 weeks of antibiotics, then I recommend a CT scan of the sinuses. For children with a negative CT scan, I typically recommend another course of medical therapy. If this medical course fails, then I may consider surgery of the tonsils/adenoids.

There is a second type of tonsil and adenoid infection which I call primary tonsillitis/adenoiditis, in which the infection starts in the tonsils or in the throat, but these children typically have no problem breathing through their nose and won’t have the yellow and green discharge that is common with a sinus infection. Typically, 2-4 weeks of antibiotics will resolve the infection. If this does not resolve with medication, your child may meet the criteria for tonsillectomy/adenoidectomy, depending on how many infections they have had in the past.

When coughing and wheezing are present in children, you may hear your doctor use the term asthmatic bronchitis. The coughing can be a barking, persistent cough with a wheeze, and the child may complain about tightness in his or her chest. These symptoms need to be addressed using the same methods that are used for treating adults. Typically, chronic sinusitis with asthmatic bronchitis requires a 3- to 8- (up to 12-) week course of antibiotics and other medicines. Usually when the sinus and nasal issues are resolved, the pulmonary conditions will
clear. However, many pediatricians are reluctant to prescribe such a long course of medical therapy. Many parents are also afraid to give too many antibiotics to their children. However, undertreatment will only lead to recurring symptoms and infections.

Lastly, nasal obstruction and tonsillo-adenoidal (TA) enlargement can cause your child to snore or worse, suffer from sleep apnea. In recent studies, sleep apnea in children secondary to TA enlargement has been shown to affect daytime behavior, including inattention, hyperactivity, and/or sleepiness. Tonsillectomy and adenoidectomy in these children has been very effective in resolving sleep apnea. Furthermore, in these cases it has been shown that these children are significantly more likely to improve in their behavior and with their sleep problems.


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