Coincidentally, I saw three patients a few days ago that were told by another physician that they will outgrow their large tonsils or adenoids. One was a 9 year old girl with golf-ball sized kissing tonsils who kept getting recurrent throat infections. Since none of her throat cultures came back positive, surgery wasn’t recommended. The second patient was a 29 year old man with life-long history heavy snoring. When he was 6 years old, his ENT surgeon told his parents that he would eventually outgrow his large tonsils. The last patient was a 17 year old girl with repeated ear infections as a young child and chronic nasal congestion. Similarly, she was told that she would grow out of her large adenoids.
By the time I saw all three of these patients, their doctors were all correct: They all grew out of their large tonsils and adenoids. In fact, all of their tonsils were markedly smaller than what was described many years prior.
However, all three patients had one thing in common: severe dental crowding, a high arched hard palate, and chronic nasal congestion due to a deviated nasal septum, bilateral turbinate hypertrophy, and nasal valve (nostril) collapse. All three were found not to have any significant apneas on a sleep study.
Over the years, a number of studies revealed that for some conditions related to obstructive sleep apnea, a watchful waiting method may be an option. One such finding was reported in the recent Childhood Adenotonsillectomy (CHAT) Study, a multi-institutional, prospective, randomized study of 464 children undergoing surgery vs. watchful waiting. They looked at various outcomes after seven months, including sleep study and neurocognitive information. Not surprisingly, children with more severe cases of obstructive sleep apnea had more improved outcomes. However, about 30 to 50% of children who underwent observation only had normal sleep studies after 7 months. There were also no significant differences in cognition between the two groups. Adenotonsillectomy, however, was found to have more significant improvements in sleep duration and quality.
The CHAT study didn’t look at nasal breathing measures or any changes to craniofacial or dental measurements. Additionally, 7 months is is very short period of time to follow-up children after a surgical procedure. It would be interesting if they measured all these variables 5 or even 10 years later.
Despite the results of the CHAT study, I don’t hesitate to offer adenotonsillectomy in a child with obviously large tonsils, who snore and choke at night.
Have you or your child ever been told by a physician that you can outgrow your large tonsils or adenoids? If so please tell us your story below.