Why Might It Have To Be Removed
When you sleep, your uvula vibrates. If you have an especially large or long uvula, it can vibrate enough to make you snore. In other cases, it can flap over your airway and block the airflow into your lungs, causing OSA. Removing the uvula can help prevent snoring. It may help symptoms of OSA.
Your doctor might recommend an uvulectomy if you have a large uvula that interferes with your sleep or breathing.
More often, the uvula is partially removed as part of uvulopalatopharyngoplasty . This is the main surgery used to shrink the palate and clear the blockage in OSA. UPPP removes excess tissue from the soft palate and pharynx. Your doctor may also remove the tonsils, adenoids, and all or part of the uvula during this procedure.
In some African and Middle Eastern countries, uvulectomy is performed much more often as a ritual in babies. Its done to try to prevent or treat conditions ranging from throat infections to coughs. However, theres no evidence it works for these purposes. It can also cause
Why Do Children Snore
Approximately 2 to 4 percent of the pediatric population suffers from obstructive sleep apnea. The main culprit? Enlarged tonsils and adenoids. If your child snores, it would be wise to take them to an ENT specialist to rule out these problems. Untreated sleep apnea in children can cause mood disturbances, depression, learning deficits, ADHD, bedwetting and developmental delays.
A small percentage of children inherit naturally short airways, and certain disorders are associated with shortened airways, including Down syndrome and Pierre Robin syndrome. Other facial structure abnormalities can also cause sleep apnea. The rest of the snoring pediatric population is likely suffering from childhood obesity.
Consultant In Paediatric Respiratory Medicine
also specialist in Food Allergies & Disorders of Sleep
A:The Royal Brompton Hospital, London, SW3 6NP
Snoring in children is often caused by enlarged tonsils or adenoids at the back of the throat, so it should go away once they have been removed. However, there can be other reasons for snoring so it is still possible for your child to snore without their tonsils or adenoids, especially if they also have sleep apnoea that is affecting their breathing at night.
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The surgical removal of the tonsils is a fairly standard operation performed by an ENT and often also includes removal of the andenoidspatches of tissue that sit in the back of the nasal cavity and work in conjunction with the tonsilsas well. But the surgery itself has been on the decline. According to the American Academy of Otolaryngology, the number of tonsillectomies has dropped significantly since the 1970s, as has the central reason doctors recommend the treatment. Thirty years ago, approximately 90 percent of tonsillectomies were preformed for recurrent infection now it is about 20 percent for infection and 80 percent for obstructive sleep problems. While some studies show modest benefits for kids suffering from recurrent tonsil issues, the surgery has mixed results in its effectiveness for adults. “Tonsillectomies should be a last treatment resort for all tonsil issues because there can always be complications with surgery,” says Gallups. Plus, he says, surgery isnt always a guaranteed solution to your problems. If youre suffering from regular sore throats or these other tonsil problems, find a board-certified ENT who is willing to explore all non-surgical options first.
Are There Any Risks To Surgery
Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks…but we still cross the street. Dr Singh will explain the risks of your child’s operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.
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What Is The Connection Between Enlarged Tonsils And Adenoids And Dental Problems
Their enlargement leads to chronic mouth-breathing which may result in abnormal facial development, misalignment of the teeth, and tooth discoloration. Admittedly, not all children with these enlarged tissues develop a poor bite requiring orthodontic work. Orthodontists have differing opinions on the need for tonsil and adenoid removal to prevent or assist with dental braces.
What Else Should I Know
There are also other available treatments such as oral appliances, nasal devices, positional therapy, and a variety of over-the-counter products. Careful patient and procedure selection is critical to successful management of snoring. Talk to your Ear, Nose and Throat doctor for a complete evaluation and to learn what treatment may be best for you.
Boston Medical Center is a 514-bed academic medical center located in Boston’s historic South End, providing medical care for infants, children, teens and adults.
One Boston Medical Center Place Boston, MA 02118
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What Is Obstructive Sleep Apnea In Children
Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It happens because of a blockage in the upper airway. This is the passages through the nose and mouth to the windpipe and lungs. The pause in breathing may occur many times in a night, disrupting the childs sleep. Most children will snore, but other symptoms such as wetting the bed or sleep walking may also occur.
The condition is most commonly found in children ages 3 to 6.
Symptoms Of Enlarged Adenoids
Most of the time, enlarged adenoids affect children. Infants and younger children may not be able to express that they are in pain or are experiencing other symptoms of enlarged adenoids. Some signs to look out for in babies and children include:
- breathing through the mouth frequently
- the nose being stuffy or runny without illness
- frequent or persistent ear infections
- poor-quality sleep or pauses in breathing during sleep
These signs do not always mean that a childs adenoids are swollen, but it is important to see a doctor to determine the cause.
The doctor will take a childs medical history into account before recommending adenoid removal. This procedure may be beneficial if one or more of the following problems are occurring:
- snoring or sleep apnea due to enlarged adenoids
- recurring ear infections that do not respond to antibiotics
- a buildup of fluid in the ear and earaches from adenoid swelling
- repeated infection of the adenoids that does not clear up with antibiotics
- excessive daytime sleepiness due to adenoids interfering with sleep
- behavior or learning issues as a result of poor-quality sleep
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What Are The Possible Side Effects
Surgery on the palatine tonsils is a more major procedure than surgery to remove the adenoids. The wound can hurt, and swallowing can be painful in the first few days after the operation too. People sometimes feel sick or vomit. As with any type of surgery, the wound can become infected and there are other general risks .
Bleeding after surgery occurs in less than 1% of children whose tonsils are partially removed. This type of bleeding can happen shortly after the procedure, but delayed bleeding is also possible often after about one week. If severe bleeding isnt discovered in time, it can become life-threatening.
Because tonsils play a role in the immune system, some parents are concerned that tonsil surgery could weaken their childs immune system in the long term and, for instance, increase the risk of allergies or respiratory tract infections. There hasnt been enough research in this area to say whether these concerns are well founded. But it is known that tonsils play a more important role in the immune system during the first few years of life than later on in life.
Tonsillectomy For Sleep Apnea As First
For adults with obstructive sleep apnea, the standard treatment is positive airway pressure therapy . Surgery is reserved for patients who are unable to tolerate or benefit from positive airway pressure therapy. For children, adenoidectomy and/or tonsillectomy for sleep apnea is the standard treatment. Positive airway pressure therapy is not an ideal treatment for most children. This is due to concerns over effects on facial growth and difficulty that children may have with tolerating it through the night. It is reassuring that surgical outcomes in childrenwhile by no means perfectare relatively good, especially when the tonsils or adenoids are enlarged and when the child is not considered substantially overweight.
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What To Think About
Surgery is rarely used to treat snoring. It may not completely cure snoring, and the risks of surgery may not be worth the small benefit you gain.
If you develop sleep apnea after having UPPP, diagnosis may be delayed because you do not snore. Snoring is the major symptom of sleep apnea.
Snoring is not always considered a medical problem, so provincial health plans or private insurance may not cover treatment.
Before considering surgery, all people who snore should try non-surgical treatment.
Laser-assisted uvulopalatoplasty also may be used to treat snoring.
What Causes Obstructive Sleep Apnea In A Child
The muscles in the head and neck help keep the upper airway open. When a child falls asleep, these muscles tend to relax. That allows tissues to fold closer together. If the airway is partially closed while awake, falling asleep may cause the passage to close completely.
In children, the most common cause for such a blockage is enlarged tonsils and adenoids. These glands are located at the back and to the sides of the throat. They may grow too large. Or an infection may cause them to swell. They may then briefly block the airway during sleep.
Obstructive sleep apnea may also be caused by:
A tumor or growth in the airway
Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome
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Tonsil Removal For Sleep Apnea
Sleep apnea can be caused by a lot of things, which means that the treatment methods may also be different. A lot of sleep apnea is dependent on each specific person, so its important that the dentist or doctor carefully evaluates each person. Tonsil removal to treat sleep apnea is only recommended and performed in certain situations.
What Is A Tonsillectomy
A tonsillectomy is surgery to have your tonsils removed. Children who have sore throats often or who snore might have their tonsils taken out. But tonsillectomies aren’t just for kids. Adults can need them, too. It’s done the same way in children and adults, but an adult’s risks and recovery can be different.
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How Are Adenoid Problems Diagnosed
If your doctor thinks your child may have a problem with their adenoids, they will talk to you and your child and examine them. They may also arrange for:
- x-rays or other scans
- a scope, where a thin, flexible tube with a lighted camera on the end is inserted into the nose or throat to look at the nasal passages and adenoids
- a sleep study if your child’s sleep is affected
Recovery From Tonsil And Adenoid Removal
It will usually take around two weeks to recover from a tonsillectomy and a week to recover from an adenoidectomy. But this can vary, so ask your surgeon what to expect. You may feel tired for the first few days, so get plenty of rest. For the first couple of weeks, keep away from crowded, smoky places and from people with coughs and colds.
Your throat may feel sore for around 10 days after your tonsils are removed. The pain may get worse for a few days after the operation, before it gradually gets better. Youll need to take painkillers to help but dont take aspirin because it may cause problems with bleeding. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.
Try to drink and eat something as soon as you can. You could start with something soft like ice cream and jelly and then start to eat normal food as soon as possible. Eating normally will help your throat to heal. If it’s uncomfortable to eat, you may find it helps to take a painkiller half an hour before a meal. Chewing gum may also help to ease the pain. For more information, see our FAQ: What can I eat after a tonsillectomy?
Your throat may look white as your skin heals and you might see some small threads in your throat these will fall out by themselves. If you notice any bleeding from your throat, have a fever or a bad smell from your throat, contact your hospital immediately.
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What Are The Symptoms Of Obstructive Sleep Apnea In A Child
Symptoms can occur a bit differently in each child. They can include:
Loud snoring or noisy breathing during sleep
Pauses in breathing, lasting usually a few seconds up to a minute
Need for a nap past the age of napping
The symptoms of obstructive sleep apnea can be like other health conditions. Have your child see his or her healthcare provider for a diagnosis.
Tips For Sleeping With Someone Who Snores
Snoring can affect sleep quality for a bed partner, as well. Those who sleep with someone who snores are more likely to have trouble sleeping , wake up feeling unrefreshed, and feel tired during the day. It may help to use ear plugs or a white noise machine to muffle the sound of your partners snoring.
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Take Bleeding After Surgery Seriously
The wound usually takes two to three weeks to heal. Before it has healed properly, it might start bleeding again. If that happens, blood typically comes out of the nose or mouth. Although this kind of bleeding is rare, it can lead to the loss of a lot of blood because the tonsils have a very good blood supply. But after-surgery bleeding sometimes goes unnoticed because children tend to swallow the blood. So its important to look out for less obvious signs of bleeding, such as the child swallowing more often than usual. After some time the child might start vomiting blood, or blood might get into their windpipe.
If you notice signs of this kind of bleeding, its important to immediately go to a hospital or call the emergency services even if the bleeding seems to have stopped on its own. The doctors in the hospital will decide whether a further operation is needed.
Tonsillectomy Or Adenoidectomy For Snoring
When snoring is linked to enlarged tonsils or adenoids, surgery may be recommended to remove them. Removing the tonsils or adenoids is a relatively straightforward procedure and it can be very effective at treating snoring. Surgery can be particularly beneficial when the problem goes beyond snoring and is associated with breathing problems. Sleep apnoea in children can reduce the quality of sleep, leading to behavioural and educational problems during the day. Interrupted breathing can also have serious consequences if it isnt treated. However, if your childs breathing is not affected then it can be better to wait and see if they grow out of snoring as they get older. As the throat grows larger, the tonsils or adenoids may not cause blockages any more.
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Why Does My Child Need A Tonsillectomy/adenoidectomy
If your child snores and has obstructive sleep apnea or sleep-disordered breathing , he or she may be recommended to have a tonsillectomy and adenoidectomy. Children with untreated SDB or OSA tend to be tired and irritable, and can have problems with their behavior, attention and learning in school. Chronic, untreated SDB or OSA also can be associated with many serious heart and lung problems that can develop in your child over many years.
Why Do Some Children Need To Have Their Adenoid Removed
There are actually quite a number of reasons that your doctor may recommend removal of your childs adenoid.
Today, the most common reason that children have their adenoid removed is to help them breathe and sleep better. In some children, the adenoid becomes too big. This may happen for a variety of reasons, but we usually dont know why it happens to a particular child. If the adenoid becomes too large it can partially block a childs breathing during sleep. In severe cases, the adenoid can completely block the back of the nose! This will usually result in loud snoring and sometimes causes a childs sleep to be very restless or fragmented resulting in poor concentration during the daytime, behavior changes, and sometime persistent bedwetting. This is known as sleep apnea. Removing the adenoid makes this breathing much better. Sometimes just the adenoid needs to be removed and sometimes both the tonsils and adenoids need to come out to solve this problem.
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Will My Childs Snoring Improve After Surgery
Frequently, snoring is improved or resolved in children within one month after a tonsillectomy and adenoidectomy. If your child still snores after surgery, your childs ENT physician may wish to further evaluate to check for other reasons for this persistent snoring. Your childs tonsillectomy and adenoidectomy surgery may also be combined with our ENT procedures during this same surgery to help with snoring. Your physician will discuss follow up plans with you at the time of surgery.
What Else Do I Need To Know
Upset stomach and vomiting are common during the first 24 to 48 hours after surgery. If vomiting continues for more than 1 or 2 days after surgery, call our office.
Signs of dehydration include sunken eyes, dry and sticky lips, no urine for over 8 hours, and no tears. If your child has these signs you should call our office.
Streaks of blood seen if your child sneezes or blows the nose are common during the first few hours and should be no cause for alarm.
Severe bleeding is rare after adenoidectomy. If your child coughs up, throws up, or spits out bright red blood or blood clots you should bring him or her to the emergency room at Childrens Hospital immediately. Although rare, this type of bleeding can occur up to 2 weeks after surgery.
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