Q: I am writing to you regarding my 5 year 8 months old son who is suffering from adenoids and tonsils. During a bout of cough we had an X-ray taken when he was 4 years old and the report said - Radiogram of Naso Pharynx lateral - the posterior naso-pharyngeal wall shows soft tissue swelling obliterating the air space almost completely. The features are of large adenoid hypertrophy. No bony abnormality is seen. Based on this report the child specialist asked us to give him Septilin and Manol for about 2 months and asked us not to go to an ENT specialist as they would immediately request for surgery. He seemed better after this although he used to have bouts of cough/cold which at times was severe. Of late, say for the last 2/3 months he has been snoring while asleep making a lot of noise and keeping his mouth open. The volume is higher when he is sleeping face up and left side but lower when he is sleeping in the right position. We went to another paediatrician who asked us to get an X-ray done, the report of which says: a prominent soft tissue bulge is seen along the posterior aspect of the nasopharynx causing airway compromise. Remaining pre-vertebral space is maintained. The paediatrician saw this report and advised that we take the opinion of an ENT specialist. After conducting a hearing test the ENT specialist said that we should get surgery done for adenoids. Further the ENT specialist wants to keep the Tonsillitis intact as he is of the opinion that the swelling may subside after adenoid surgery is done. As a concerned parent I would like to seek your advise on the following:

1. Is it necessary to go for surgery for adenoids?
2. What if we decide not to go for it; will it harm my child now or in the future?
3. Is there any way that this will get cured with time and medicines and hence we should wait for some more time?
4. Why and how did this happen?

A:To answer your queries:

1. Yes, it does sound that the obstruction of the airway is already leading to snoring and off and on cough and colds. If on top of it he also has some complaint of mouth breathing and pain in either ears, then surgery is mandatory.
2. No, it does not harm that much as it is said but if it is definitely an enlarged adenoid, then there can be after effects.
3. Well, adenoids are lymphoid tissues that do get wasted with time and by 14 to 15 years they start regressing in size. What is important to know is that it is not worth waiting for complications to develop, if the ENT specialist diagnoses the adenoids for you, and he is convinced that it is the culprit, then go for it.
4. Adenoids come up due to allergy, low immunological status, infection and many other factors. They regress with age. Adenoid surgery is simple and you can take your child back the same day. So pease consult your ENT person with an open mind.