Enlarged tonsils may result from infections

Daisy Atukunda’s son, Godfrey suffered a fever mid last year when he was three-years-old. “We took him to Case Clinic in Kampala thinking that we would be given medicine to alleviate the fever. However, upon examination, Godfrey was found to have enlarged adenoids or tonsils, hence sent to see an ear, nose and throat (ENT) specialist,” she shares.

“The doctor asked if he snores while sleeping,” Atukunda says. However, I told her that when he gets flu, he snores and suffers from laboured breathing.

“Besides that, he always had restless nights, usually asking for water upon waking up,” she speaks of Godfrey’s symptoms.

Medication
After assessment, he was given treatment and Atukunda is thankful that he responded well.

“When we returned for review, the tonsils had reduced in size. However, their size was not totally normal, the reason more medication was given. We are to see the specialist again this month,” she explains.

However, they had been cautioned that if Godfrey suffered any adenoid induced infections, he would have to undergo an operation to have them cut.

“The thought of an operation scared me as I wondered how it would be done. But I was relieved when I learned that it is not complicated,” she adds. While Godfrey has not suffered any infections, they await the doctor’s recommendation at their next visit.

At birth
Dr Amina Seguya, an Ear, Nose and Throat (ENT) surgeon, says adenoids are small tissues located in the passage that connects the back of the nose to the throat.

“We are all born with adenoids and they continue to grow as the child grows. However, they start shrinking at about five years and disappear by the child’s teen years,” she shares.

In younger children, Dr Seguya says, adenoids are part of the immune system that helps fight off bacteria and viruses entering the body through the nose and mouth.

“They become less important as the child grows because the body develops other means of fighting infections,” he adds.

Why they enlarge
Seeing that adenoids fight off disease-causing bacteria and viruses, every time they trap viruses or bacteria or are involved in an allergic reaction, they enlarge. “While the norm would be for them to return to normal size after the infection or allergic reaction stops, in some children, they remain enlarged hence adenoid hypertrophy, which simply means enlargement of the adenoids,” Dr Seguya elaborates.
Signs
However, while someone that has nursed a child with this complication may know the signs, others may not.
Dr Boniface Joseph Otto Ssegujja, a peaditrician with Children’s Clinic, Naalya, says enlarged adenoids are a fairly common problem in children.

“With common occurrence, recognising some of the signs and symptoms by parents or caretakers is important. A child with enlarged adenoids may present with a combination of signs and symptoms which are mainly due to obstruction of the upper airways,” he says.

The children tend to have trouble breathing through the nose. Most times, there may be no active runny nose. However, this becomes even worse among those with a concurrent runny nose. With troubled breathing, they will breathe through the mouth which leads to dry lips and mouth.

They would also have a nasal speech where they talk as if the nostrils have been pinched.
They also tend to have noisy breath as you can hear them breath even if they are seated a few metres away. Some parents describe it as loud, more so at night as they snore.

Sometimes they have bad breath, especially due to infection in the throat.

Sometimes, they stop breathing for a few seconds during sleep, a condition referred to as obstructive sleep apnea, which can lead to disturbed sleep. This in turn can cause some behavioural problems as the children tend to be hyperactive, sleepy during day, have difficulty learning, heart problems, and others may sometimes start wetting the bed.

Associated complications of recurrent ear infections and sinus infections may present with fevers, and headaches.
Dr Seguya adds that upon seeing the above signs, see an Ear, Nose and Throat (ENT) specialist who will examine your child to confirm presence of adenoid hypertrophy.

Treatment
Dr Seguya says treatment is dependent on how severe the condition is. “If mild, your child will receive medicine. However, in severe cases, an operation is required to remove the adenoids,” Dr Seguya reveals.

However, she is quick to calm parents who may think that the operation may have far reaching effects. “Removing the adenoids does not affect your child’s growth or immunity,” she points out.

Self medication
With medicines such as paracetamol easily accessible from pharmacies and drug shops, parents may give their children pain relieving medicine to ease the discomfort. While that may help in the short run, Dr Ssegujja says parents should avoid self-medicating their children.

“The doctor needs to carry out a physical examination to confirm the diagnosis and prescribe the right medication or make referrals to ENT surgeons for further management and follow up. Self medicating only leads to delays, which are associated with other complications,” he says.

Dr Seguya shares that children with enlarged tonsils may present the same symptoms as adenoid hypertrophy.
“Therefore, it is important to see a specialist to find out what the child suffers from as the child could have both enlarged tonsils and adenoid hypertrophy,” he concludes.

Caution
Many times, a child will suffer with enlarged adenoids yet either not receive treatment or get the wrong treatment. Either way, the real ailment is not being treated and the effects continue. Dr Boniface Joseph Otto Ssegujja, a peaditrician, points out some of the complications that may arise due to late diagnosis:
• Recurrent ear infections due to blockages of drainage from the ears. This is medically known as eustachian tube dysfunction)
• Recurrent infections of the adenoids with bacteria called Streptococcus pyogenes which can lead to severe infections that affect the heart, joints, kidneys and the nervous system often with lifelong sequelae.
• Prolonged obstruction of the airway (obstructive sleep apnea) due to the enlarged adenoids leads to interruption of oxygen supply to the different organs of the body, especially the brain of a growing child which leads to several behavioural problems such as attention deficit, hyperactivity, and learning problems.
• The prolonged obstruction of the airway also puts a strain on the lungs and the heart resulting in a disease called pulmonary hypertension which presents with difficulty breathing, chest pain, fainting, and fatigue.
• With parents treating either symptom or associated complications, money will be wasted.

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