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Does my child require adenoid surgery for recurrent cough and cold?

Q: I have a 3 years old son who is suffering from recurrent and prolonged episodes of cough and cold since the past 6 months. He has taken antibiotics almost every month or even more than that because each episode is associated with high grade fever and lasts longer than usual. During the last episode, we got all investigations done and found adenoid enlargement for which we consulted an ENT who then advised tympanometry. Tympanogram shows flat lines for both ears. According to the ENT specialist, he has fluid in both the ears and hence surgery that includes B/L adenoidectomy and myringotomy with grommet insertion is a must. He has otherwise never complained of earache and never has any discharge from his ears. Apparently, he has a normal hearing and speaks everything. He has received - amoxycillin, augmentin, cephalexin, azithromycin, clarithromycin in the past 6 months in adequate doses and duration. Could adenoids be the only focus of recurrent episodes of cough and cold? Is his age appropriate for removal of adenoids or is it too early? Can we wait for the fluid to resolve on its own or surgery is must? Can adenoidectomy alone can take care of middle ear fluid or we will have to go for myringotomy? Are there other hearing tests we can go for, at this age to correctly know about his hearing loss if any. Are there any drugs (intranasal sprays etc.), which can provide temporary relief in his nasal stuffiness till he outgrows the problem?

A:Intranasal steroid sprays like metaspray would help in reducing the size of the adenoids to some extent. You need to be more concerned about adenoids, rather than grommets, since inserting grommets is a very minor surgery with almost no complications. Adenoidectomy is a major surgery. I normally do only grommets at the first instance, unless the x-ray shows adenoids to be really large (more than 50% of the airway being blocked). Further adenoids do tend to go down with age. However, if definitely indicated, then adenoidectomy can be done especially if the child is snoring and mouth breathing, or waking up at night There is no way of knowing if this is the only cause of infection. What about the tonsils? Indication for grommets: A repeat tympanogram, done during the period when the child does not have a cold or fever would indicate the status in the normal phase. If the curve is still flat (type B) even after 2-3 months, then YES, a myringotomy and grommet is definitely indicated. There would be improvement in hearing, and prevent further hindrance in speech development.


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