What are effective non-surgical treatment options for a snoring child?Ear, Nose & Throat
My 5 year old son has a stuffy nose and snoring issues and we brought him for a scope recently. He was diagnosed with enlarged turbinates, adenoids and tonsils. The doctor recommended surgery. Are there alternatives to surgery, and how effective are these options?
Thank you for your question. Snoring occurs due to some narrowing of the upper airway (the breathing passage from the nose, mouth and throat region up the level of the voice box). As a result, the air that goes through the upper airway airway becomes turbulent. The turbulent air can cause vibrations along the walls of the upper airway, resulting in snoring.
The concern about anyone who snores is that it is often a sign of a potentially more serious health condition known as obstructive sleep apnoea (OSA). This is a condition in which the sufferer momentarily "stops breathing" or "chokes" repetitively during sleep. As a result, the lack of oxygen can result in growth disturbances, poor concentration/attention span and behavioural problems in children. In adults, OSA can have an increased risk of heart (e.g. high blood pressure, heart attacks, heart failulre etc) and brain (e.g. stroke) complications.
Common reasons for a narrowed upper airway in children include enlarged turbinates, adenoids and tonsils. If your child's ENT Specialist has recommended surgery, these structures are likely significantly causing his upper airway narrowing. Surgery to widen the airway for these conditions (e.g. reducing the size of turbinates and removal of tonsils and adenoids) are very effective in reducing snoring and even potentially curing obstructive sleep apnoea and its associated complications. Other risk factors for snoring and OSA include being overweight/obese and having a receded/small chin and bulky base of tongue.
The adenoids are tissues located at the back of the nose and are similar to the tonsils. They tend to be big in most children aged 3-5 years old. They do start to shrink by about age 7-8 years old. If you would like to take a more conservative approach and your child's snoring is not significant or does not cause behavioural issues (e.g. hyperactive, inability to focus or pay attention in class etc) or excessive daytime sleepiness, you can consider using a nasal steroid spray to reduce nasal congestion from enlarged turbinates and adenoids while waiting for his adenoid to shrink when he is older. If your son is overweight, losing weight will help reduce snoring and the risk of OSA. Sleeping on his side (perhaps get him to use a bolster) may also help.
The gold standard in the treatment of snoring and OSA in an adult is the use of Continuous Positive Airway Pressure (CPAP) therapy. This involves wearing a mask that is attached to a machine every night to sleep. The machine pumps air through a tube attached to the mask to keep the upper airway "splinted" open during sleep. This will eliminate snoring and OSA if used properly. However, the use of CPAP in your son will likely not be the first line recommendation as it will be difficult to make a child comply with CPAP therapy. Dental devices are other options to widen the upper airway during sleep. It is best to visit a Dentist with a special interest in managing patients with OSA if you would like to consider these options.
Hope this helps and all the best!
Dr Gan Eng Cern
MBBS, MRCS, MMed, FAMS
38 Irrawaddy Road #08-45
Mount Elizabeth Novena Specialist Centre
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