tonsilloadenoiditis = Is there any medication for this in order to avoid surgery?

Dear Dr.Kondekar,

I came across your replies to a parent with tonsilloadenoiditis.
======= as i see many cases of TA in children, i dont recall which case are you discussing about. well the management remains tricky and if not properly tackled, parents end up with multiple docs.

I have a 3.5 year old daughter who has the same problem.
=========== more likely if she coughs alot(day time) and has poor weight gain, anfd also has bad mouth smell and refuses to take solids and prefers milk. you may have worsening symptoms in winter or with icecreams.


We are staying in mumbai from the last 1.5 years, before that we were in bangalore. As early as i can remember, she has recurrent throat and chest infections, with bad cough, cold , runny nose, fever....
======== recurrent throat and related infections are common in India upto 8 times aday. we need to worry if it causes some persistant problem and/or is allergic. if its always with runny nose, its more like recurrent common (viral) cold. Allergic cold will usually come without fever or bad cough, but surely with sneezing.


She seems to catch throat / chest infection very easily.
========= sick , low weight and unimmunised chidlen catch infection very often, especially after visiting a crowded place. a simple way to avoid problems in children is to keep adult contact away by insisting them to wash hands use hankie during sneeze and cough and not to touch kids often.


The worst / the peak of this problem was in march 07 when she got pneumonia, which thankfully got ok with just antibiotics.
======= pneumonia is usually diagnosed after an x ray examination and x ray chest shows some white shadows apart from normal heart and bone shadows. usually such chidren below 5 years of age will be admitted and observed under antibiotic cover. pneumonias can be viral (more often) and / or bacterial. bacterial pneumonias tend to be more serious. read danger signs at my blog.


Her pediatrician Dr.********** has told us that we might have to give some time
======== yes time may be good cure in most conditions, but not always.

to see if her tonsilloadenoiditis might resolve itself with age.
========= tonsisl grow smaller with age as the body also rises and immunity develops, and adult may no longer need any tonsils for any reason. most cases do resolve except those that cause persistant and repetitive problems resulting in decreased intake and growth failure.

She has OSA due to 'kissing tonsils' and her adenoids are bad too...
========= keeping child in prone (tummy to ground) position usually is comforting in OSA. adenoids children usually bretah with open mouth taht can further worsen problems. surgery may be a solution if symptoms are too distressing and if it doesnt respond to antibiotics and decongestants.


Is there any medication for this in order to avoid surgery?
============ doctors usually treat with antibiotics like amoxicillin . its important to treat for at least 10 days of antibiotics. smaller courses cause frequent probelms. symptoms can be comforted by giving plain saline inhalations with a nebuliser as and when required. maintaining a oral hygeine , habit of brushing teeth 2 times a day and if possibel drinking enough water and gargling will surely help avoiding or delaying surgery, with comfort. Surgery needs to be weighed against its risks and the benefit the child may get. it can be judged upon number of episodes , size of tonsils or adenoids and growth failure. Many ENT surgeons are reluctant to operate younger ones as the risks may be involved and/or skills may be inadequate. it requires greta precision to operate in children and at times surgery may go incomplete.

If surgery is inevitable, till when should we wait, becaue she is very lean,
=========== if her weight is less than 8 kg for 3.5 years and if she is getting problems 3 times in 6 months, and has persistant cough vomiting and / or large tonsils it may be prudent to visit an ENT surgeon to plan surgery after basic evaluations to confirm diagnosis.


is very irritable and has issues with behaviour, which i guess is due to her sleep-lessness. As parents its difficult to see her suffering...
========= well, i feel all replated to the rpesnet problem. you are lucky that wheezing doesnts eem to be added on to this problem.

Parent history:Mother : Have undergone tonsil operation. Had been suffering from allergic rhinitis my entire teenage years.
========= allergic rhinitis and tonsilloadenoidtis usually have no correlation. parent history of TA doesnt affect chidlren. but parent history of allergy may incresae chanes of Allergies in child. as your kid has kissing tonsils current problem is not allergic even though she may develop it later.


Father : Has childhood asthama, still persists.
========== wll it depends on many conditions. most of my patients who are receiving AR or asthma tretament elsewhere; its common that they did miss some findings that may make them curable with therapy.

Have attached her latest picture , as u had suggested in your reply to the other patient...
=== i didnt receive any pic. but adding a pic will help me suggets confidently.

Pls do advice... Thanks in advance.












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child health expert pediatrician online from India.
Dr kondekar santosh is a pediatrician, lecturer at G S Medical college from KEM hospital Mumbai, India. He is clinical expert in various childhood illnesses including asthma , cold, allergy and respiratory diseases. he is also a pediatric intensivist at KEM hospital Mumbai. The KEM hospital caters to a vast number of patients from various category and speciality. Dr is exposed to various children suffering from infectious diseases including tuberculosis, pneumonias, malaria , leptospirosis, dengue fever etc and congenital hearts and metabolic diseases.
The PICU at KEM hospital also caters to difficult respiratory cases including ARDS and also to serious infections like tetanus. ACademicians are always welcome to discuss various cases with dr kondekar at paediatric yahoogroup.


Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA, online pediatrician mumbai India