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.

Dr. Smith: No experience at all with childhood epilepsy and OSA. However, yes, I treat children with OSA…had one in today with great parents who both come with him at appointments. Mom was going in to hold his jaw forward for at least an hour every night to get him at least SOME restful sleep. Sleep centers are very comfortable with studies on children. Sleep walking shows no neurological effects or predispositions, so no worries there.

Children do not have to snore at all to have OSA, and when they do, the palatine tonsils are rarely (about 2% of the time) the cause. MUCH more common to have adenoidal obstruction (about 38% of the time, if memory serves), so his nasal obstruction is likely the source. I would get him in to see about the adenoids, then get a sleep study if this does not appear to be the problem. They put CPAPs on small children, but I doubt he will need that.

Dr. Smith: Excellent questions! I’ll address each numerically.
1. Most sleep centers are well equipped to handle children’s sleep studies, so if you suspect sleep apnea in your child, a study would be a good idea.

pediatric sleep room at Comprehensive Sleep Medicine

If they prefer no sleep study, I would suggest an allergist first, to rule out any allergens that could be disrupting the immune system, creating an inflammatory process that swells the pharyngeal tissues. It’s also a good idea to find an ENT with good knowledge of the child’s airway and the negative developmental changes that can occur when the airway is restricted during growth.

2. Tonsils (palatine – the ones you can see, out of 4 sets) should only be removed if the cost-benefits are weighed appropriately. Studies show that tonsillar tissue helps in creation of T-Cells, which are important for cancer prevention. However, if they are impeding the airway, and if inflammatory processes have been addressed, I would have them removed. Remember, the child does have 3 other sets. Oh, and one more thing. The adenoids are FAR more likely to be obstructing the child’s airway, so THIS set of tonsils should be studied by the ENT, if anything! The ENT’s organization has a set of guidelines for when they will remove tonsils. They can be found here. Finally, yes, most will “outgrow” large palatine tonsils and adenoids. Actually, the tonsillar tissues usually shrink, unless there are inflammatory processes present. The usual suspect is a mouth breather, who has to use the tonsils to trap pathogens as they enter the oral cavity. Without the valuable nose filters, which are set up to do this job with regularity and expertise, the tonsils take on this arduous responsibility, and become enlarged to house the many bad guys. This can be seen in the “pocked” tonsils with “crypts”. Does that conger up a lovely thought?

3. Can snoring in children cause ADHD? You bet. Email me or comment here if you would like to read some studies. Additionally, a Johns Hopkins study showed that children with OSA average a 16 point drop in I.Q. What parent wants this?

Dr. Smith: Protocol is to get a good view of her palatine tonsils. I am assuming they are very swollen, but the adenoids, which you can’t see, are far more likely to be a problem. What you really need to do is watch her while she sleeps and see if she ever gasps for air or stops breathing for more than 5 seconds or so. The peak size for tonsillar tissue is between 3 and 5 years of age, so she will probably get worse. Girls are also ahead of boys at this age for pediatric OSA (peaks at age 4), then the numbers go down, and peak again in the mid to late twenties, with boys from then on taking over the lead.

If she DOES stop breathing, this can affect her growth and development in MANY ways, so it is not something to be taken lightly. please get her in for a sleep study soon. 2 years old is not too young.

Prior to having kids, I was a pretty deep sleeper. My mom used to say that I could sleep through World War III and never even know it. Once kids came along, though, I started waking up at the drop of a hat. Now, I’m lucky to sleep throughout an entire night without someone or something disturbing my slumber.

It started out with my husband being the sole snorer in the family. It used to be just when he slept on his back. Now, it’s whether he’s on his back, his side, or standing on his head — it makes no difference. To give him credit, he has tried to rectify the situation by testing out the Breathe Right strips, the mouth sprays, etc., but, unfortunately, nothing seems to work. I, too, have tried to better the situation by nudging him, yelling at him, and even kicking him in the night, of course to absolutely no avail. I have finally resorted to wearing those stupid foam ear plugs each and every night to block out the noise.

And, wouldn’t you know, my other little man in the house has now followed in the footsteps of his father. Over the past couple of years, my son has become a mouth breather. Translation: the kid saws logs like nobody’s business at night. I can often hear him all the way down the hall even though his bedroom door is closed. My mom made me ask the pediatrician about it to see if he might have a problem with his adenoids. The doctor said that he really doesn’t recommend removing them unless sleep apnea is involved. He definitely doesn’t seem to stop breathing in his sleep — I’ve listened intently on many occasions. He’s got a steady and very excruciating rhythm going on with his snoring.

So, why is it that men are typically the ones who snore? My daughter doesn’t snore, and I certainly don’t either. Am I really doomed to stuff foam in my ears for the remainder of my nights? I don’t want to become like Lucy and Ricky and sleep in two different beds! I guess I just answered my own question — foam forever it is….

Dr. Smith: Don’t know where you live, but you should not take either your husband’s, nor your little man’s snoring lying down, and get some help. If your husband is now snoring regardless of sleep position, this has almost certainly elevated to obstructive sleep apnea, and if you don’t know the complications related to this, feel free to read all about them on my web site.

As far as your son, mouth breathing is not healthy, and can mean his adenoids are swollen. When this happens, he is forced to breathe through his mouth, which swells the tonsils even more. It also causes some structural changes in his mouth over time, as his upper arch begins to narrow, the roof of his mouth rises up, and before you realize it, there is even MORE constriction of the nasopharynx, and he becomes a permanent obligate mouth breather.

So, for your husband’s health, energy level, weight complications, etc.., get him some help. For your son’s future, get HIM some help. Let me know if I can help guide you somewhere.