Large tonsils and snoring.

Large tonsils, or hypertrophic tonsils, can frequently cause severe snoring, breathing holding, difficulty eating, choaking, and sleep apnea. This can occur as an isolated event or in conjunction with recurrent tonsillitis. If the problem becomes severe, tonsillectomy with adenoidectomy is often recommended.

Obstructive sleep apnea tonsils.

Obstructive sleep apnea in normal children is almost always caused by  enlarged (hypertrophic) tonsils and adenoids). These children will display the  typical sleeping patterns of sleep apnea. They have loud snoring, frequent  pauses with breathing at night, frequent awakening from sleep, restless sleep,  nightmares, and bedwetting (enuresis). During the daytime, these children are  mouth breathers, may have excessive daytime sleepiness, and poor school  performance.

Other more rare causes of sleep apnea include any congenital (present from  birth) or acquired cause of upper airway obstruction.

The treatment of obstructive sleep apnea is directed to the cause of the  obstruction.

As noted above, most cases of obstructive sleep apnea in children is caused  by enlarged tonsils and adenoids. Surgical interventions are therefore directed  to what is causing the obstruction. In the case of enlarged tonsils and  adenoids, tonsillectomy and adenoidectomy is usually successful in relieving the  problem. If the problem is not the tonsils and adenoids, the cause of the  obstruction must be determined. For example, surgery of the jaw may be required.  In some cases, even a tracheostomy is necessary. Non-surgical therapies include  oral prostheses (difficult in children), medications (steroids, stimulants), and  weight reduction.

In almost every case of obstructive sleep apnea in children who do not have  unusual anatomic problems, tonsillectomy and adenoidectomy is a safe and  effective treatment, and is highly recommended.

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