Tonsil removal for improvement in behaviour of children,Dr Deo Kumar Jha,MD.Pediatrician and Pulmonologist,Delhi-NCR

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Tonsil removal for improvement in behaviour of children,Dr Deo Kumar Jha,MD.Pediatrician and Pulmonologist,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 08 Dec, 2023 - Child Health Guides,Common Childhood Disease,Parents’ Guide,Professionals Guide, - 0 Comment

Sleep disordered breathing(SDB) is a common problem in children.

It has been ignored for years till there has been a facility to diagnose it.

Now,there is a facility for early detection of this common problem by a test called polysomnography.

Enlargement of tonsils and adenoid are the main cause of this disorder in children

The main cause of enlargement of tonsil and adenoids for a prolonged period of time is ALLERGY.

Parents are usually not aware of this problem in their children.

The common symptom is snoring in child with frequent disturbances of sleep.

It is graded by hypoapnea/apnea index(HPI) on polysomnography.

The child gradually develops behavioral changes,attention deficit,cognitive problems,day time sleepiness and later on hypertension.

There are two modes of treatment ,one is watchful observation and second is removal of tonsil.

Study  was done on 458 children of the mean age of 6 years.

At the end of 12 months of follow up 394(86%),children were available.

It was observed that there was no significant difference between the two groups for the cognitive function.

There was a significant improvement in day time sleepiness and behavioral problems in the group who underwent adenotonsillectomy(surgical removal of adenoid and tonsil) ,moreover,the quality of life were better in the group who opted for the surgical removal of adenoid and tonsil.

CONCLUSION: In case of mild sleep disorderd breathing ,adenotonsillectomy is not advisable for improvement in attention deficit or cognitive problem.

REFERENCES:

Tonsil, adenoid removal improved sleep quality, some behavioral problems in children with mild sleep apnea. https://www.newswise.com/articles/tonsil-adenoid-removal-improved-sleep-quality-some-behavioral-problems-in-children-with-mild-sleep-apnea. Published Dec. 5, 2023. Accessed Dec. 5, 2023.

NASAL POLYP,WORKING KNOWLEDGE,Dr.DEV,M.D,Pediatrician and Pediatric Pulmonologist,Mohan Nagar,Sahibabad,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 01 Jan, 2021 - Professionals Guide, - 0 Comment

Nasal polyp is not uncommon in children and parents often get afraid of it when it is visible.

It is rare below the age of 10 yeras.

It is an abnormal growth which is semitransparent and may arise from any portion of nasal mucosa or epithelium of paranasal sinuses usually at its outflow.

Contrary to the common belief,it is associated more commonly with non allergic than allergic conditions.

It is seen more commonly in children with non allergic asthma than allergic asthma

It may be single or multiple depending on etiology.

CLINICAL FEATURES:

Small polyps are asymptomatic which are usually discovered during nasal examination for other causes,when they are located anterior to the anterior edge of middle turbinate

Symptoms depend on size and location of the polyp.

Small polyp arising from middle meatus may produce symptoms by blocking the outflow tract,causing chronic and recurrent sinusitis.

common symptoms are

Rhinorrhoea,

post nasal drip

facial pain

headache

toothache

hyposmia,

anosmia,

loss of taste,

blocked nose,

snoring.

When the size becomes large,it may  cause obstructive sleep apnea

DIAGNOSIS;

Clinical examination is sufficient for the idendification of this lesion.Anterior rhinoscopy wll defines it.

Non contrast CT scan of nasal and paranasal sinuses are required to see the extent of lesions as in rare circumstances there may be malignant lesions.SO the imaging investigation of choice is non contrst CT scan.

CAUSES:

It arises due to chronic inflammation of nasal or paranasal mucosa,so it is commonly seen in children with allargic or non allergic rhinitis or sinusitis.

Multiple polyps are seen in children with cystic fibrosis,primary ciliary dyskinesia ,asthma and  allergic fungal sinusitis.

TRATMENT:

Treatment is medical in most of the cases.Surgery is required only rarely when medical treatment fails.

In most of the cases ,short term oral corticosteroid and or intranasal steroid is needed.

REFERENCES:

 

Bernstein JM, Gorfien J, Noble B. Role of allergy in nasal polyposis: a review. Otolaryngol Head Neck Surg. 1995 Dec. 113 (6):724-32. [Medline].

Tos M, Sasaki Y, Ohnishi M, Larsen P, Drake-Lee AB. Fireside conference 2. Pathogenesis of nasal polyps. Rhinol Suppl. 1992. 14:181-5. [Medline

Rudmik L, Schlosser RJ, Smith TL, Soler ZM. Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis. Laryngoscope. 2012 Jul. 122 (7):1431-7. [Medline].

Lund VJ, Flood J, Sykes AP, Richards DH. Effect of fluticasone in severe polyposis. Arch Otolaryngol Head Neck Surg. 1998 May. 124 (5):513-8. [Medline

Rudmik L, Schlosser RJ, Smith TL, Soler ZM. Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis. Laryngoscope. 2012 Jul. 122 (7):1431-7. [Medline].

 

 

 

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