American Medical Association Family Medical Guide - American Medical Association [195]
However, myringotomy is usually done only if the child has significant hearing loss that could interfere with his or her language development.
Disorders of the Respiratory System
The respiratory system delivers oxygen to the body’s cells and removes carbon dioxide from the body. The respiratory system consists of the nose, throat, larynx (voice box), trachea (windpipe), and lungs, and a system of blood vessels that carry blood to and from the lungs. In children, infections are the most common cause of respiratory system disorders.
Adenoid Disorders
The adenoids are small masses of lymph (infection-fighting) tissue that lie on either side of the back of the nasal cavity, above the tonsils, and are part of the body’s immune system. In most children, the adenoids begin to grow at about age 3, when children are especially vulnerable to infection. At about age 5, the adenoids begin to shrink, and usually disappear by the time a child reaches puberty. In some children, however, the adenoids continue to grow, eventually blocking the airway that leads from the nose to the throat. When this occurs, the flow of secretions at the back of the nose is blocked, and the adenoids become infected. If the infection is not treated promptly, it can spread from the nasal cavity through the eustachian tube to the middle ear, causing a middle ear infection (see page 417).
Symptoms
When the airway that leads from the nose to the throat is blocked, the child usually has a stuffy nose, breathes through the mouth, and snores. In some cases, the child’s voice may sound nasal. Infected secretions drip from the child’s nose during the day. When the child lies down, these secretions drip down into the throat, causing an irritating cough. The child may have difficulty breathing while asleep, which can lead to restlessness or more serious sleep disturbances such as obstructive sleep apnea (see page 636). If the eustachian tube becomes blocked, the main symptom is a persistent earache. If a chronic middle ear infection develops, hearing loss may result.
Diagnosis
To diagnose an adenoid disorder, the doctor will ask you about your child’s symptoms and perform a physical examination. He or she probably will examine your child’s adenoids using a tiny mirror with a light attached or a viewing instrument that shines a light on the back of the throat. The doctor may order a side-view X-ray of the child’s head to see if the adenoids are enlarged.
The adenoids
The adenoids—small masses of lymphoid tissue (left) that lie on either side of the back of the nasal cavity, above the tonsils—are part of the immune system. The adenoids tend to enlarge (right) when a child has an upper respiratory tract infection.
Treatment
In many cases, an adenoid infection goes away on its own without treatment and the swelling disappears. In other cases, doctors prescribe antibiotics to clear up the infection and relieve the swelling. If the swelling persists after the infection is gone, doctors may prescribe corticosteroid nasal sprays and oral decongestants or antihistamines to help open the airways. When recurring earaches affect a child’s hearing, interfere with school attendance, or persist after treatment with antibiotics, a doctor may recommend surgery to remove the adenoids (called adenoidectomy). A doctor also may recommend surgery if the enlarged adenoids cause snoring or obstructive sleep apnea.
Croup
Croup is inflammation and narrowing of the trachea (windpipe) from a respiratory infection caused by a virus called parainfluenza virus, which is prevalent in early fall and in spring. The condition affects children up to about age 5.
Symptoms
The hallmark symptom of croup is a loud, barking cough. Hoarseness also occurs. Older children may experience discomfort at the front of the throat around the larynx (voice box) or at the front of the chest. A child with croup often awakens at night with an attack of stridor (a shrill wheezing or grunting sound), which usually subsides in a few hours. If stridor develops suddenly and is accompanied