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Sometimes he wakes up in the middle of the night to catch his breath and he can only breathe through his mouth. Please what is happening to my son?

Worried mum.

Looking at the symptoms you have described above, your child is most likely suffering from adenoidal hypertrophy.

Adenoid hyperplasia (adenoid hypertrophy) is an enlargement of the lymphoid tissue located at the back of the nose.

A lymphoid tissue serves as part of the normal immune system and every child is born with one in that location.

It's a very common childhood condition contributing significantly to the number of visits made to the paediatrician or the ENT surgeon.

Normally, adenoidal tissue is small at birth, measuring 2 to 3.2 cm and causes no problem at all. This tissue grows until the child reaches adolescence, and then slowly begins to regress and shrink away.

In adenoid hyperplasia or hypertrophy, this tissue continues to grow, giving rise to a lot of symptoms that can have a significant impact on the life of the child. It is a tissue that is closely linked with the tonsils.

The adenoids, along with the tonsils, help prevent agents such as bacteria and viruses from entering the body. The adenoids are made up of a group of blood cells that create antibodies - proteins that neutralise foreign substances in the body.

When infection or inflammation occurs, the adenoids can enlarge. Since they are seated at the back of the nasal cavity, the swollen adenoids can block airflow through the nose.

Most often, tonsil and adenoid hypertrophy are simply caused by the normal growth pattern for that type of tissue. Less often, the hypertrophy is due to repeated throat infections by viruses and bacteria. The acute infections are usually referred to as tonsillitis; the adenoids getting little recognition because they cannot be seen without special instruments. Allergies may also cause the adenoids to enlarge.

Typically, adenoid hyperplasia produces symptoms of respiratory obstruction. Parents may report that the child breathes through the mouth; snores at night; experiences frequent, prolonged nasal congestion; and a history of frequent ear infections (recurrent otitis media) with some hearing loss.

Sometimes parents complain of the child not breathing during sleep (sleep apnea) and this is a very serious observation.

Chronic nasal congestion, daytime sleepiness, fatigue, fever and nasal discharge are also common. The child may mention a decrease in appetite due to alteration in taste and smell.

Inspection confirms mouth breathing. The child's voice may sound nasal and muffled. There may also be foul breath (halitosis) and dry oral mucous membranes (xerostomia).

Signs of night-time respiratory insufficiency may be apparent, including prominent and marked inward movement of the ribs during breathing, nasal flaring and poor weight gain. Lymph nodes around the neck and back of the ear may be enlarged.

To categorically diagnose adenoidal hypertrophy, a special instrument called rhinoscope is used for visualisation of abnormal tissue mass at the back of the nose. X-rays (lateral pharyngeal films) show narrowing of the nasopharyngeal air column and lymphoid hypertrophy.

Antibiotics initially may be used for recurring infection of the adenoids and adenoid hypertrophy.

If medical management isn't effective, surgery is indicated. Adenoidectomy (removal of the adenoids surgically), the treatment of choice for adenoid hyperplasia, is commonly recommended for the patient with recurrent or prolonged mouth breathing, nasal speech, adenoid facies, recurrent otitis media, constant nasopharyngitis (inflammation of the nose and back of the throat) and nocturnal (night-time) respiratory distress. This procedure usually eliminates recurrent nasal infections and ear complications and reverses secondary hearing loss.

Adenoidectomy should be performed in conjunction with tympanotomy tube placement when the adenoidal hypertrophy contributes to ear disorders. Antibiotics may be used to treat infection.

Decongestants may be used to decrease edema. Prevention can be directed towards prompt evaluation and appropriate treatment of sore throats to prevent overgrowth of adenoid tissue.

Avoiding other children with acute respiratory illness also reduces the spread of these common illnesses. In your case, a visit to the ENT surgeon is warranted.

Email: astom2@yahoo.com
The Mirror Doctor is a member of the Paediatric Society of Ghana.