Mouth breathing and snoring in children is not healthy. Snoring in children is caused because of enlarged adenoids, tonsils, with or without co-existing allergies. If medical treatment is unsuccessful and the problems are recurrent, surgical removal should be planned.
Adenoids and snoring
Adenoids is a lymphoid tissue sac situated in the roof of the throat behind the soft palate, where the nose opens into the throat.
It is a vestigial organ whose absence will not have any adverse effects on the human body. It is seen in children up to 7 years of age, after which they atrophy and disappear entirely.
Adenoids enlarge in size due to recurring nose and sinus infections, which do not give an opportunity for adenoids to subside in size. Adenoids also act as a reservoir for bacteria during infections and protect them from the antibiotic action, slowly releasing them later leading to recurring nose and sinus infections.
Adenoids block the eustachian tube openings present just behind the nose. Proper functioning of eustachian tube is essential for ventilation of the ear, the absence of which leads to ear pain, ear blockage, fluid formation in the middle ear. Children with fluid in the middle ear may complain of intolerance to loud sounds.
Tonsils and snoring
Tonsils, another vestigial organ, when enlarged also lead to snoring by compromising the space available behind the mouth, through which air has to pass once it reaches the back of nose while breathing.
Allergic rhinitis and snoring
Allergic rhinitis causes enlargement of tissues of the nose, especially turbinates compromising the nasal space available for the air to flow through.
Snoring is harmful
Breathing through the nose is essential as nose acts as an air conditioner and filter protecting the lungs from harm and stress. Enlarged adenoids and tonsils cause mouth breathing which causes bypassing of critical functions in the nose.
Snoring is associated with sleep apnea in most of the children which cause disturbed sleep. Children with sleep apnea struggle for breath while asleep, and keep moving all around the bed in the process of finding a sleeping position where they can breathe well. Sleep apnea causes the child to be cranky, hyperactive. The child will lack concentration and stability. Most of these children tend to overeat causing obesity.
Management of snoring in children
Medical management with nasal decongestants, oral decongestants, nasal washes, nasal steroid sprays can be tried for snoring and mouth breathing.
Despite long-term medication, if the resolution of symptoms is incomplete or symptoms are recurring on a regular basis, we have to plan for surgical removal of adenoids, tonsils with or without turbinate reduction for allergic patients. If the fluid is present in the middle ear, grommetplacement in eardrum can be clubbed with adenotonsillectomy.
Allergic children will have to use anti-allergic medication and nasal sprays even after surgery to mellow down the hyper-reactivity of the nose in response to exposed allergens.