Thursday, September 20, 2012


This child is referred to you for a routine tonsillectomy and adenoidectomy. His cleft lip and palate have not been repaired. His pediatrician, however, feels that the tonsils and adenoids are more of a problem because the child has severe OSA and recurrent tonsillitis. When you examine the child, he is able to repeat nasal consonants ("m" "n"). However, with plosives ("Bobby" "puppy"), you hear air escape. You also note air escape with sibilant fricatives ("s" "z" "sh").

Challenge: Would you do the tonsillectomy, adenoidectomy, both, or neither?

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1 comment:

Craig Chen said...


Adenoidectomy is contraindicated here because the trouble with pronunciation may be worsened. This child demonstrates hypernasality from inability to seal the soft palate against the posterior pharyngeal wall. The adenoids may be serving to help fill the relative velopharyngeal void and facilitate normal speech production. There is no contraindication for tonsillectomy.

Sources: UpToDate; Wikipedia.