Our son who is 3 years 4 months has had a chronic cough for the last 6 months. He has been tested for food and inhallent allergies and has tested positive to milk, soy, dogs and dust. We have eliminated milk and soy which we have suspected for the past 3 years, made a huge amont of environmental changes in our home. These have helped but he still coughs. He has been on and off (more on) of antibiotics over this 6 month period for "underlying sinus infections"
He has seen an allergist and an ent. Our pediatrician thinks he has cough variant asthma in addition to the sinus problems. However, he does not respond albuterol at all. He has been on 3 doses of Prelone and it supressed the cough in 2 of those cases. Our last effort to solve this problem was a visit to the ent, who diagnosed him with Adenoiditis and put him on preventative antibiotics. He has been on Intal since the middle of december and Nasalcrom since the beginning of January. He was actually cough free and healthy for approximately 4 weeks.
He then developed Croup which led to conjuntiveitis and a severe cold. 3 days later he was coughing again with a Adenoid infection. He then went back on full stength antibitiocs and is doing much better. He is currently scheduled to get his adenoids removed April 11. Before I ask the final questions let me tell you that he had quite a history of chronic ear infections from 6 months - 18 months and these were treated with antibtiotics for a while. WHen he got so sick from the antibitotics we took him to a homeopathic dr and chiroprator and he was ear infection free for 14 months.
My question is is removing his adnoids the right thing to try? If so, what are the chances that he might be a healthy child again?
Thanks.
Reply -------------------
Of course, the answer to your question is best determined by the consensus of opinion of the physicians who are treating your son. The extensive history of upper respiratory problems you have described warrants a comprehensive evaluation to address multiple possible causative factors including environmental and allergic factors. Second-hand cigarette smoke exposure and day care are also two common risk factors which can contribute to recurrent or chronic upper respiratory problems in children and such risk factors if present should be addressed. Also, with the history you have described, a radiographic assessment of the sinuses should be considered if not already done.
The rationale for an adenoidectomy at this point would be based on the premise that there has been a chronic bacterial colonization of the lymphoid tissue that comprises the adenoid. Such bacterial colonization could account for ear infections due to reflux of bacteria or contamination of the eustachian tubes which are nearby; chronic purulent nasal discharge; and post-nasal drainage which could irritate the windpipe causing cough. If an underlying asthmatic condition were present, cough due to post-nasal drainage could be a predominant symptom.
However, I would advise caution against envisioning adenoidectomy as a simple cure-all. If chronic sinus disease was also present, as evidenced by x-ray, removal of the adenoids may not eliminate the potential source of infection. Recent studies have raised doubts as to whether adenoidectomy helps eradicate sinus disease and have suggested that surgical drainage of the sinuses is occasionally necessary for children who have chronic sinusitis that fails long-term comprehensive medical therapy. Many otolaryngologists, however, will still advise adenoidectomy as an initial surgical approach in the child with chronic upper respiratory symptoms thought to be related to nasal or sinus disease when long-term non-surgical approaches fail. In some cases adenoidectomy will be combined with an irrigation of the sinuses. This initial approach is based on the argument that adenoidectomy +/- a sinus irrigation is associated with less surgical risk than sinus surgery in small children. Sinus surgery, if necessary, would then be reserved for those children who fail to improve after adenoidectomy, yet still are found to have symptoms and radiographic evidence of sinus disease despite continued measures to eliminate environmental factors.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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