Doctors, need advice on a situation, adenoids from my three year old?

[lendaddy]

I'll start at the beginning.

My youngest needed tubes in his ears when he was one, but when they fell out the holes did not heal. They tried the paper patches and that did not work. They now want to wait until he's 8 or so to do a graft patch. The doc is highly regarded among the nurses we know and he seems highly competent to me.

Moving ahead my son has had a persistent (a week a month maybe) cough and mild fevers for over a year maybe two. His PED would always give us the "it's going around" and send us off with antibiotics or a nebulizer or whatever. I got tired of this and wanted to try a new doc.

New doc says something is causing this and it's not normal at all and we're going to get to the bottom of it. He orders a blood test and visit to the ENT (one he works with, not our guy that did the tubes) for adenoid inspection. The blood test reveals that 12 of the 14 antibodies?(I think that's what it said but I don't have it in front of me) were not doing their thing and he needed some type of booster shot to jump start them(which he just got).

Then we went to the new ENT yesterday and he says his adenoids are quite large (he said 8-9 on a scale of 10) and scheduled a surgery to remove. He also said the ear drum holes should/could be cleaned up at the same time since he's under as they are looking a little jagged and he doesn't want cysts to form and it's a good idea to stimulate the edges to promote blood flow and healing (how I understood what he said). He seems like a good guy and also competent. He said he can't say that the adenoid removal will fix the infections he's getting but it might and should be done regardless to help nasal breathing, etc...

Another point of interest is that my son seems to be a slow healer. Not a bleeder, just actual healing. Not sure how that applies but it might.

I think we'll get a second opinion from ENT one but I wonder how he'll feel that we didn't request him for the adenoid inspection. I guess I don't care but a good relationship with a doc is important and the graft surgery is coming up in a few years (son is three BTW)

Any thought all all this jumble? Is adenoid removal disputed science or clear cut? Can I expect ENT number one to be miffed? I really hate the idea of putting him under again. Thanks.....

[livi]

Right. There are several parts and aspects of this situation. The specific ear drum issue is not my area so I won´t comment on that.

First, the longer periods of cough and fever is probably attributed to the compact impact of virus and bacteria that children are facing daily. Each individual immune system will react more or less vigilant to any given amount and type of bug. The cough may be an asthmatic reaction to all these bugs, as well as the fever. I suspect thats why you got the nebulizer. What drugs where you prescribed? I would go for a daily dose of inhaled steroid, like for example Budesonide 200-400ug daily for about a month to see if it make any difference in the coughing. If that did not help (and perhaps simultaneously) I would give him a prolonged period of macrolide (for ex. Erythromycin) antibiotics - maybe 2-4 weeks.

Next, the adenoid tissue. Its rather common for preschool children to have an unnecessarily large adenoid tissue behind the nose. This will often lead to various problems related to breathing, congestion and such. As it is immunologically very active tissue, much like the tonsils, it may also contribute to the immune systems response to all these, previously mentioned, bugs. Hence it may also contribute to fever reactions and cough.

This was the short version, but in summary, I would recommend removing the adenoid. It is a routine procedure, low risk, with good chances of improvement on several levels.

Best of luck and please PM me if you have any other or related questions!

[lendaddy]

Thanks Livi!

He has done steroids and antibiotics. They do seem to help but only short term.

I feel better about the adenoid removal but I still hate the anesthesia issue on a little guy.

FWIW the doc said his tonsils looked great which is a relief.