My 3 1/2 year old daughter has had fluid in both ears for over a year. She seldom gets ear infections but an audiologist confirms that she has some degree of hearing loss in both ears (this is only apparent to me when she has a cold). I was referred to an ENT doctor to have grommets put in the ears. But when I mentioned that she also has sleep apnea he recommended removing her tonsils and adenoids as well as putting the tubes in her ears. I read that chronic inflamation of the tonsils and adenoids generally settles down by the age of 7 and was hoping to wait until then. Is all this surgery really necessary as the child shows none of the classic complications of apnea or having fluid in her ears and has no symptoms from her chronically enlarged tonsils?? Also how dangerous is general anaesthetic for a person with sleep apnea??
Reply: ------------------------------
One does not wait for complications of sleep apnea to develop before treating the condition. If sleep apnea is indeed present, it should be treated, period. If there is a question as to whether your child actually has sleep apnea or merely snores heroically, then a formal sleep study should be done. However, loud heroic snoring in children combined with irregular breathing patterns accompanied by frank cessation in breathing for short periods is highly suggestive of sleep apnea. In the majority of children with sleep apnea, the condition is caused by adenotonsillar hypertrophy and can therefore be cured by adenotonsillectomy. While there are risks associated with adenotonsillectomy, there are also very serious, even potentially lethal risks associated with sleep apnea. If sleep apnea is indeed present, the potential risks of serious complications from untreated sleep apnea would be considered much more significant than the potential risks of adenotonsillectomy. There are certain anesthetic risks associated with patients who have sleep apnea which can be minimized by careful preparation by the anesthesiologist.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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