Q: I have a patient with a crossbite. Also some speech impediments. She has had two sets of tubes for her ears. She has not had any tonsil infections. Snores at night. No oral habits. I referred her to ENT and he graded her tonsils a +1 out of +4 and noted that she could breath comfortably through her nose during the apt with him. He does not think that the risks of tonsil and adenoid removal are worth the benefits.

Snoring and crossbite. Seems like an airway problem to me. Should I just recommend the patients mother find another ENT to go to? Can crossbite/snoring be caused by something else?

Dr. Smith: In Jankleson’s publication on posture and airway, he quotes a study saying only 1% of upper airway obstruction is due to tonsilar hypertrophy.

39% adenoid hypertrophy
34% allergic rhinitis
21% turbinate hypertrophy
21% habitual mouth breathing
19% deviated septum
8 % vasomotor rhinitis.

So don’t forget asking the ENT to check some of these if the tonsils look normal We really need to be careful and only remove the offending obstructors, and then only if nutritional therapy to remove inflammation has been considered. With tonsillar tissue specifically (which includes the adenoids), we should be careful not to remove these unless we know they are obstructing, as they play a big part in our immune system.

That being said, the newest research is showing obesity and neck size larger than the norm are playing a bigger role in adolescent snoring and OSA, so I do not want to lessen the importance of these two.