Q: My 3 years old daughter had undergone adenoid removal surgery last year, after facing the problem of running nose for a year. But she still has a snoring problem and her mouth also remains open while sleeping. I have noticed a sound coming from her nose when she breathes. She has also got very big tonsils too. The doctor says that it can be removed when she will be 4 years old. Could it be possible that her adenoid is not removed properly?

A:First, I will explain to you the rationale behind the tonsillectomy operation and the adenoidectomy operation. And, then, discuss your individual problem. This way, you will be able to comprehend the discussion better. The tonsils are situated in the oral cavity, on either side of the hind portion of the tongue. The adenoids are also situated inside the throat, but at a higher level (in line with the plane of the nose) and are, hence, hidden from view by the palate. Both the adenoids and the tonsils are lymphoid organs and have the functions. Because of their different positioning, the complications arising out of their diseases are different. The usual reasons for their removal (operation) are also different. Adenoids are removed if they cause any ear discharge or recurrent collection of pus. The tonsils are removed if they cause any recurrent throat infection. However, both may produce obstruction to the airway and lead to snoring. Contrary to the common perception, snoring is not an innocuous symptom. It may be the tip of the iceberg. Snoring in a child or an adult must make us sit up and take notice. A due diligence on the part of the examining doctor may unmask some serious conditions like obstructive sleep apnea (OSA). This is a condition, where consequent to continued airway obstruction leads to serious consequences like heart failure, cognitive deficits and behaviour problems. This condition is serious that it is blamed as the leading cause of highway accidents.

• You have mentioned that your three-year-old daughter had adenoidectomy one and a half months ago and still continues to have snoring. Usually the healing takes a little longer time. Hence, you can expect relief in a few weeks. While the indications for surgery for the tonsils and the adenoids are distinctly different, they may commonly co exist - hence, several surgeons prefer to remove both of them together in the same surgical sitting. Some surgeons, on some occasions, prefer to remove only what they consider diseased. The reasons could be any one of the following: a) When only one is causing the problem, there is no justification in removing the other innocent organ. Clubbing the removal of both, automatically, without giving proper thought, will only increase the risks of surgery and also, delay postoperative recovery. b) Poor weight increases the risks of surgery; hence, it will prudent to do only what is essential. You can always operate on the next organ, at a later time, when and if any need arises.
• Regarding the question whether there is any possibility of a remnant of the adenoids still remaining, the answer is yes. However, the very technique of surgery is such that a remnant may remain. However, the mere presence of a remnant portion will not give rise to any problem. Only when it enlarges to a significant extent, it may give rise to snoring again.
• In addition, the following fact must be taken note of: The outer dimensions of the airway itself i.e. the bony cavity of the throat itself, might have been smaller, right at the outset. On top of such a bony narrowing, the adenoids might have got enlarged, leading to a significant level of airway obstruction and consequent snoring. In such a situation, it will become obvious to you that mere removal of the content of the narrow nasal cavity (namely the adenoids alone) may not yield good results. Such a persistent snoring needs a little more discerning examination and investigation.
• With all the above, kindly note that expedient treatment of any cold that your child develops, will certainly relieve the problem. Hence, you need not despair at all.