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Dear Dr. Spector,

My 3-year-old son has enlarged tonsils that disrupt his sleep. It is worse in the spring and fall. He gets some relief from Rhinocort, but when he gets a cold it is especially difficult for him to sleep. Will he outgrow this? How do you decide if he should have his tonsils out?

Thanks,

Julie

Apex, North Carolina

Dear Julie,

Problems with breathing during sleep are unfortunately very common in children, with one out of ten experiencing some level of difficulty. In ten percent of these children (for a total of one percent of the pediatric population), sleep apnea will be present, and should be treated.

Sleep apnea in children most commonly involves obstruction to airflow at the level of the tonsils and adenoids, leading to a prolonged cessation of breathing (apnea) and decreased levels of oxygen in the bloodstream. The ramifications of this problem, when persistent, are varied and often multiple. These include conditions such as daytime fatigue, behavioral problems (including aggression or lack of concentration), and poor school performance. Some less predictable effects, however, include bed wetting, growth retardation, a growing correlation with attention-deficit hyperactivity disorder, as well as other more serious problems.

In your particular circumstance, the response to Rhinocort is likely due to this nasal steroid's ability to shrink the tonsils and adenoids, although as you have discovered, often only temporarily. The fact that his sleep obstruction is seasonal seems to identify the possibility that allergy is a contributing factor in his adenotonsillar enlargement, which is commonly noted. The fact that his symptoms recur with upper respiratory infections, however, would indicate that even if allergies could be controlled, the sleep obstruction may not fully resolve. If the nasal steroids completely remedied the problem, this would be an acceptable, non-surgical treatment. It may, however, need to be continued for many years, until the tonsils and adenoids naturally shrank away, which commonly occurs during puberty.

The only universally accepted method for the diagnosis of sleep apnea is a sleep study, often performed in a sleep laboratory, or with a take-home test that involves connecting monitors to the patient. I have a three year old son, however, and I'm fairly certain that he, like many others his age, would not tolerate this study. So, while on occasion I do obtain a sleep study in this age group, I generally rely on the parent's history of loud snoring (with special attention to pauses in breathing) associated with any of the above noted problems commonly seen with sleep apnea. If this is the case, I have found tonsillectomy and adenoidectomy to be a very reliable method of curing this problem. As always, an in-office consultation with a qualified Otolaryngologist will identify any other associated factors, and determine whether this is a good choice for your son.

Thank you for your question!

Jared E. Spector, MD

Back to Ask Dr. Spector

As a new feature of our website, we at Mann ENT would like to introduce "Ask Dr. Spector."

Dr. Spector is Board Certified in the specialty of Otolaryngology/Head and Neck Surgery, and will review all questions submitted through this website related to the specialty commonly known as "Ear, Nose and Throat."

This site is intended to help the public gain information on topics such as sinus surgery, allergy, snoring, voice problems, ear disorders, tonsillar problems, facial cosmetic procedures and so on, in order to foster a better understanding of the topic and to guide future evaluation.

At regular intervals, Dr. Spector will choose one question, and provide a thorough response. This response will be posted on this website for all to read.

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Any information received from Dr. Spector through this website is not intended to diagnose, treat, or cure any medical problem.   Mann ENT, Dr. Spector and www.entman.com present all data as is, without any warranty of any kind, and is not liable for its accuracy, nor for any loss or damage caused by a user's reliance on information obtained on our site.

All information obtained from this site must be confirmed with a standard, in-office medical consultation with a qualified physician.