Treatment of Snoring and sleep apnea in children
Tonsillectomy
Tonsillectomy is surgery to remove the tonsils.
The tonsils help protect against infections. However, children with large tonsils may have frequent sore throats and ear infections or have nightly breathing problems-snoring and sleep apnea. In these cases, surgery to remove the tonsils will be helpful.
Tonsillectomy is usually done under general anesthesia, which means that the person is put to sleep for the procedure. A device holds the mouth open, and a clamp is applied to the tonsil. An incision is then made in the lining over the tonsil. This incision can be made with scissors, knife, laser, or electrocautery. The incision exposes a loose tissue layer between the tonsil and the muscles of the palate. The tonsil is then “shelled” out.
Why the Procedure is Performed
A tonsillectomy should be considered when tonsillitis attacks are so frequent or severe that they affect a child’s general health or interfere with school, hearing, or breathing. However, some physicians believe tonsillectomies are done more often than necessary, so get a second opinion when there is any doubt.
Specifically, the guidelines for surgery are:
and 5 or more episodes of tonsillitis in 1 year
and Enlarged tonsils that interfere with breathing-sleep apnea
and An abscess in the tonsils
and Grossly asymmetric tonsils
Tonsillectomy also may be needed if the tonsils are enlarged and blocking access to the adenoids during an adenoidectomy or if the physician suspects the presence of a tonsil tumor.
Recovery
Complete recovery can take 2 weeks.
Expect some throat and ear pain in the first days following surgery. Ice packs can help relieve pain, and sucking on an ice cube or eating ice cream may provide some comfort. In addition, pain-relief medication may be prescribed. During recovery, it is recommended to eat soft, easy-to-swallow food and to drink a lot of cold fluids.
Tonsils and Adenoid
Tonsils and adenoids are collections of lymphoid tissue that help the body fight infection. The tonsils are located on both sides of the back of the throat. The adenoids are located higher and further back, where the nasal passages connect with the throat, and are not visible through the mouth. However, tonsils and adenoids can become enlarged-for example, when they become infected with bacteria that cause pharyngitis. When this happens, the tonsils become more prominent and the adenoids may block the nose. Usually, the tonsils and adenoids return to normal size once the infection is over. Sometimes they remain enlarged, particularly in children who have had frequent or chronic infections.
Symptoms
Most enlarged tonsils and adenoids cause no symptoms; some degree of tonsillar enlargement is even considered normal in preschool and adolescent children. However, children with enlarged tonsils or adenoids can experience sore throat and discomfort or pain with swallowing. Enlarged adenoids can give the voice a “pinched nose” quality and lead to changes in the shape of the child’s palate and the position of the teeth.
Enlarged tonsils and adenoids are considered a problem when they cause more serious effects. They can cause chronic ear infections and hearing loss due to obstruction of the eustachian tube and fluid accumulation in the middle ear. They can also cause recurring sinus infections and nosebleeds. Some children have obstructive sleep apnea with snoring and brief periods without breathing; this can cause low oxygen levels in the blood, frequent waking, and daytime sleepiness. Rarely, obstructive sleep apnea caused by enlarged tonsils and adenoids can lead to serious complications, such as high blood pressure in the lungs (pulmonary hypertension) and changes in the heart that result from pulmonary hypertension (cor pulmonale)
Sleep apnea
Sleep apnea, is disruption of breathing while asleep When you stop breathing during sleep due to sleep apnea, the balance of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates the brain to restart the breathing process. The brain signals you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing .
Snoring
Snoring is not the same as sleep apnea. Snoring is simply a loud sound that you make during breathing while asleep if there is any obstruction in your airway. On the other hand, people with sleep apnea are deprived of oxygen due to a complete blockage of airways, which can have a major impact on health.
Snoring does often accompany sleep apnea, but just because you snore does not mean that you have sleep apnea.
Types of sleep apnea
Obstructive Sleep Apnea (OSA)
OSA is the most common type of sleep apnea. It is caused by a breathing obstruction, due to enlarged tonsil and adenoid which stops the air flow in the nose and mouth.
Central Sleep Apnea (CSA)
Central sleep apnea (CSA), less common than OSA, is a central nervous system disorder that occurs when the brain signal telling the body to breathe is delayed. CSA can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease. People with CSA seldom snore. However, while the causes of apnea are different in CSA and OSA, the symptoms and results are much the same – a deprivation of oxygen and poor sleep. The treatments for CSA include medications that stimulate the need to breathe and administration of oxygen.
Primary causes of obstructive sleep apnea
and Being overweight or obese (although 50% of people with sleep apnea are not obese)
and Large tonsils or adenoids
and Other distinctive physical attributes (deviated septum, shape of head and neck, receding chin, enlarged tongue)
and Nasal congestion or blockage (from cold, sinusitis, allergies, smoking, etc.)
and Throat muscles and tongue relax more than normal during sleep (possibly due to alchohol or sedatives or age)
Obstructive sleep apnea does seem to run in families which may be a result of anatomic abnormalities or medical conditions that are genetic.
Sleep apnea has serious health consequences and can even be life-threatening. The main effects of sleep apnea are sleep deprivation and oxygen deprivation.
