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Q&A with Australian Health Practitioners
Does my 4yo have large adenoids?
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My 4yo daughter is so congested in her nose I am currently awaiting a call back from a ENT specialist but would like opinions from other ENT's. My daughter snores so loud I can hear it from the other side of the house, the breathing is just constantly through her mouth. I have tried just about everything from nasonex to vapourisers and antibiotics etc but not even the slightest bit of relief, she has constant dark circles under her eyes. I'm not sure if it's the lack of sleep or her congestion but she will wake with night terrors etc from not breathing properly in her sleep and is having trouble pronouncing words because of her blocked nose. Is it most likely enlarged adenoids or are there other things I should enquire about and if adenoids what is to follow after diagnosis? Thanks in advance -
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Dr Alexander Lozynsky
Allergy Specialist & Immunologist
Consultant allergist and immunologist, with particular interest in allergic rhinitis and sinusitis, allergic respiratory disorders, food allergies and sensitivity and allergic skin conditions, including atopic … View Profile
You refer to nasal congestion and snoring which can indicate both chronic rhinitis related to an allergic condition or very enlarged adenoids. Enlarged adenoids would be more likely, especially if she has been experiencing ear infections or middle ear effusion ('glue ears"). She appears to be having episodes of sleep apnea.
Also, enlarged adenoids are often associated with big tonsils, both being lymphoid tissue and usually due to recurrent viral or bacterial infection. Infection with EB virus (glandular fever or infectious mononucleosis) can be a factor and is often not diagnosed in young children because no blood tests are done to check for this.
The dark circles are related primarily to impaired venous drainage from a chronically congested nose and not to lack of sleep.
It is important to check if she has an allergy to environmental factors, which at her age, are likely to be house dust mite or animal dander if a cat or dog is present in the household. A family history of allergic rhinitis, "sinus problems" and asthma are helpful in assessing if she could have an allergic (atopic) predisposition
It is important to note that if she does have allergic rhinitis with enlarged adenoids, then adenoidectomy will not provide complete relief of her upper airways obstruction. She will still require further treatment, probably with a combination of nasal steroid spray, nasal irrigation with saline and even a nasal decongestant spray, which should only be used for a short period.
If she does have an allergy to dust mite, appropriate environmental control measures would need to be undertaken to reduce the level of exposure.
Therefore, she should be assessed by both an ENT surgeon and an allergist.
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Dr Sim Choroomi
Ear Nose and Throat (ENT) Surgeon
With a combination of loud snoring and mouth breathing - large adenoids are the most likely cause. Large turbinates (the air filters we have inside our nose) is the next likely cause. Certainly referal to an ENT specialist is recommended. If you have already tried various sprays and this sleep disordered breathing is not improving then an operation would likely be recommended.
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