Surgery may alleviate problems with hyperactivity and sleep apn

February 27, 2004|by LISA TEDRICK PREJEAN

"What are adenoids?"

It was a question my 8-year-old asked after a friend's daughter had her tonsils and adenoids removed.

I had a general idea where the adenoids are located, but wasn't sure what they did, so we looked in a book about the human body.

We found the tonsils, but the diagram we examined didn't show adenoids and didn't explain their role in the body.

Since tonsils and adenoids often are the focus of a fairly common childhood surgery, I called an ENT - that's short for an Ear, Nose and Throat doctor - for some information.

If you've seen cartoons where the character is yelling and the little flap in his throat is moving back and forth, you're familiar with the area where the tonsils and the adenoids are found, explains Dr. Michael Abidin, an ENT who founded Metropolitan ENT in Northern Virginia.


That little flap, the uvula, hangs down from the soft palate. The tonsils are on each side of the flap, and the adenoids are up behind, at the back of the nose, says Abidin, who has offices in Alexandria and McLean, Va.

This area is referred to as Waldeyer's ring, an area of tissue that works with the immune system to screen the outside world.

"It helps determine what's you and what's not you," Abidin says.

When tonsils and adenoids are removed, there are other tissues in the ring - the ones at the back of the tongue, for example - that take over this policing role.

Doctors like to leave the tonsils and adenoids alone, especially until a child reaches the age of 2, but sometimes surgery is necessary as a child grows, Abidin says.

"They should be just like your elbow. You shouldn't have to do anything to them," Abidin says.

Antibiotics often can clear up infections and help a patient avoid surgery, but when tonsil or strep throat infections recur, doctors may opt for a tonsillectomy or an adenoidectomy.

The American Academy of Otolaryngology - Head and Neck Surgery - recommends that children who have three or more tonsillar infections a year undergo a tonsillectomy.

But factors other than infection sometimes are involved, Abidin says.

If the tonsils or adenoids are enlarged, that can affect a child's ability to hear, breathe, sleep, eat and talk. Enlarged adenoids and tonsils also can change the formation of a child's mouth. Because of this, many children are referred to ENTs by dentists, Abidin says.

Doctors are linking enlarged tonsils and adenoids to hyperactivity and sleep apnea, so surgery may alleviate or reduce those problems as well, Abidin says.

According to Abidin, a child may have enlarged tonsils or adenoids if:

  • He can't hear out of one ear.

  • He sleeps with his mouth open.

  • His breathing ceases momentarily during sleep.

  • He eats with his mouth open and has difficulty eating with it closed.

  • He has "tonsil speech" - it sounds like he has marbles in his mouth when he talks.

For more information, talk to your child's doctor, or go to The American Academy of Otolaryngology's Web site,

Lisa Tedrick Prejean writes a weekly column for The Herald-Mail's Family page. Send e-mail to her at

The Herald-Mail Articles