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Advice for ENT visit


faith
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There's actually a lot of links to read about t and a surgery and adhd. . I googled "apnea+tonsils+adhd"

 

http://www.webmd.com/add-adhd/news/2006040...helps-kids-adhd

 

Of the 22 children in the adenotonsillectomy group who had been diagnosed with ADHD, 11 no longer met the conditions for the behavioral disorder a year after surgery.
http://www.drgreene.com/21_930.html

 

Evidence continues to mount about a strong connection between chronic sleep deprivation and ADHD. A fascinating study published in the March 2002 issue of Pediatrics found that among the 866 children studied, those who snored were almost twice as likely as their peers to have ADHD. The common denominator seems to be obstructive sleep apnea. Large tonsils and adenoids can partially block the airway at night, causing snoring, poor sleep quality, and perhaps ADHD. For children with true obstructive sleep apnea and ADHD, taking out the tonsils and adenoids might result in both better sleep and better behavior, without the need for medications.
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faith,

 

I think the sleep issues would be the #1 reason to have it done. I have been told taking them out as an adult with sleep apnea does not work, so get it done while he is small.

 

Vickie, I think you said something about talking funny. My son always sounded like he had a cold.

 

CP

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Vickie, I think you said something about talking funny. My son always sounded like he had a cold.

 

CP

 

 

My dd does too.. I am taking her in to the ent (she's supposdedly my non pandas dd) because she gets strep with sore throat all the time... 2 speech therapists told me her nasaly voice sounds like it's enlarged adenoids.... I think I yell at her for whining when it's just her voice :unsure:

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When I took my oldest to the ENT for possible speech related issues because he had large tonsils (per the slp), the ENT said that tonsils would only affect speech if they were so large the speech sounded like he was talking with a mouth full of marbles. All garbled.

 

My middle PANDAS son also has speech problems.He had t and a for PANDAS but I asked if it would help his speech at all with the t and a. He said it probably won't change speech at all. There is a slight chnace with t and a that something could go wrong and it changes speech for the worse, but that's rare.

 

If your child sounds like they have a cold, I would rule out a sinus infection. Even if he always sounded like that. That was the only symtpom my son really had of his current sinus infection. He sounded like he was stuffy or like there was swelling.

 

If out of no where they sound very high pitch, that could be croup. Again, my son's only symptom of croup was a very high pitch voice lasting for a week.

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you all give good points and things to think about....

 

I just spoke to a freind over the phone whose son recently had the tonsils out (14 yrs old), and she said that he always had big tonsils, but only started getting strep when older, so interesting. don't want that to suddenly be a problem when it wasn't before. even sleep problems could get worse as they get older.....

 

I think I am not going to give myself a chance to flounder,...that's it...I'm DOIN it!!.... :unsure:

 

 

Faith

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You inspired me to make the appt and I now have one for her tomorrow... called the ped to get her strep history..

 

Feb 2008

August 2008

December 2008

September 2009

November 1 2009

January 2009

 

So it doesn't quite fit my pediatricians guideline of 6 times in a season but it sure seems like a lot to me...

 

 

Interesting vickie on the speech stuff.. my dd got speech for articulation... now she doesn't qualify but she always sounds mumbly and whiny... of course that could just be because she is a girl ^_^

 

 

you all give good points and things to think about....

 

I just spoke to a freind over the phone whose son recently had the tonsils out (14 yrs old), and she said that he always had big tonsils, but only started getting strep when older, so interesting. don't want that to suddenly be a problem when it wasn't before. even sleep problems could get worse as they get older.....

 

I think I am not going to give myself a chance to flounder,...that's it...I'm DOIN it!!.... :unsure:

 

 

Faith

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I think the ENT said something like 6 strep infections or more within a year qualifies kids for a t and a, except for PANDAS. He'll take them out after one strep infection for a PANDAS kid.

 

As for the slp suggesting seeing the ENT. The slp doesn't usually look at kids tonsils, but we asked her if it could make a difference in his speech, so she looked at them. Then told us to get a consult since they were big.

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I just wanted to put this out there...

 

Of all who have had their child's T&A out, did you notice they did better in school? I mentioned this to faith in a PM, but thought maybe some of you had noticed this with you child.

 

My son school history:

K-5 I would say all A's

 

age 12 start of the explosion of vocal tics (grades 6-9) C & B student with his best subject math taking a tumble.

 

Today (grade 10) first quarter 2 C's, 3 B's, 2 A's. T&A done in Nov. The 2 C's were in history and science both are now A's, Spanish 3 was a B now an A. English was a B- and is now a B+

 

So I was wondering if he was getting better sleep after the T&A and so getting better grades.

 

He does have to keep a C in all subjects and give his report card to the fire dept. or he would be kicked out. so I'm a little confused on why he is jumping from C's to A's. Not like him to push for A's he would be fine with just getting by.

 

Comments anyone?

 

CP

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It would be hard for me to correlate how he does in school now vs his t and a since he had another strep triggered excaerbation a month after t and a. His surgery was Feb 2009. he is doing well in school now but he is also recovered from his exacerbation.

 

If your child had t and a for apnea. I can see how school performance would improve post surgery.

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We have seen ability to concentrate in school increase dramtically since surgery in my ds8. We just did the surgery a few weeks ago, but the difference was immediately noticeable. The teacher has a sticker system where if you are focusing and have the correct place, you can earn up to 6 stickers a day. Prior to the surgery, my son was getting two or three stickers a day. As soon as he returned to school, he earned six stickers every day.

 

He still has some residual OCD that has not yet improved since the surgery.

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  • 4 weeks later...

I just wanted to update here.

 

my son had the T&A done today......he did pretty well and is home resting now. THe doc did say his adenoids seemed kind of big as well. Even tho we do not really seem to get strep here an this wans't the reason we were doing it, this doctor was aware of my concerns re PANDAS and so I asked if he could look more at the tonsils when they were removed and possibly culture to see if anything was found. He said he would, and did tell me when he came of OR that they were big and he said "when I sliced them open", and then made kind of a face, I didn't exactly know what he meant. i asked if they were all crypty and infected looking and he said no, it didn't have any pus or anything, but he I think took some tissue from the middle and sent it to culture. I think that's what I understood. really this is just out of curiousity, and I know many here are interested in a finding like that, so I'll let you know. He gave us 2 weeks of amoxycillin. he said he didn't want to give augmentin because it causes stomach issues. (I had planned on giving a week of augmentin prior to the surgery and gave him about 3 days worht, and the fourth morning he woke up nauseated and vomiting several times. I am not sure if it was a virus, but I went back and forth wondering if it was the augmentin. he didn't want to eat that day at all and anything he drank, he threw up. so I didn't give him any more of the augmentin. he was better after a day and a half and was okay for surgery today. So I'm fine with the amoxy.

 

Hopefully, this will help his sleeping and eating issues somewhat, and we talked a little about attention here as well. One thing I can say is that it definitely so far did not do anything for his attitude, as he heard me speaking to my brother on the phone telling him he didn't want to eat anything, and my son screamed at the top of his lungs ^_^ "I AM EATING!!".............. :)

 

I think he was upset because he heard me tell the doctor five minutes before that, that he was fine, and that he didn't want to eat, and that I was starting to hearing some vocals already. he really doesn't like me mentioning that......so, so far as of right now, he is well enough and his vocal tic is still there.

 

Thanks so much to everyone for the help and advice on this issue.

 

Faith

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One thing I can say is that it definitely so far did not do anything for his attitude,

Faith

 

 

 

Ah thanks Faith, this is a good reminder to me to remember to tell the doctor to remove my dd's attitude at the same time as the tonsils and adenoids... would hate to forget :lol:

 

Glad to hear it is done and over with! What a relief I am sure... keep us posted on any changes you see once he is healed.

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Faith, thank you for updating and glad to hear the surgery went well. I am really looking forward to hearing updates on whether this helps.

 

Oh, my daughter has the laugh too. She just started it a couple of months ago. It is a very exaggerated laugh. I really didn't think anything of it except that it was annoying until I read your post. Again, I just wrote it off as an age thing. Interesting.

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  • 3 weeks later...

Further update on tonsil culture:

 

I mentioned here that I was going to ask our ENT to culture the tonsils and that I would update the finding.

 

To remind those not familar, my son has strep in the past, but not in recent years, and all swabs, cultures and titer testing that we've had have been negative. Altho the reason for the tonsilectomy was because of enlarged tonsils, breathing/apnea, possible failure to thrive (underweight), and not necessarily for PANDAS issues, our ENT did agree to culture the tonsils in the hopes of laying rest the idea of strep hiding in the tonsils.

 

Strep was not found. What was found in both tonsils was a bacterial called Haemophilus Influenzae (non type) the worst is type B, as in the HIB vaccine given to babies, but it is not the type B here). At present, we are not sure what exactly this means. ENT is not sure as he has not cultured tonsils before. I've consulted with Dr. T. on this. Since he's not seen this before, we are just looking at it as another peice of the puzzle.

 

What could it mean? To me, I wonder if, since it is a bacteria (gram negative), could it be the culprit for us, in that my son is a carrier, similar to if someone had strep in thier tonsils? My son shows no sign of any active infection or symptoms now or in the past of h.influenzae (this is a bacteria, not the virus that causes flu, it is not flu.) Could this be natural flora in a majority of population? maybe. Even so, could it be acting similar to strep in the way of keeping my son's antibodies active? again, we don't really know. Dr. T. has prescribed a course of antiboitics to treat it as an active infection in the hopes of eradicating anything that might be circulating inside him. The treatment was 4 days of Rifampin along with a 10 day course of Augmentin. my son was not on abx right prior to this, altho we did give him a few days of Augmentin before the surgery, but had to stop midway due to vomiting, which I think was viral.

 

Since, Dr. T. has posted on the board about this finding and apparently, a couple other patients are reporting this as well. I don't know what it means. I am just wondering if this is a bacteria, and it was in fact harbored inside my son's tonsils, could this be our smoking gun? :lol:

 

any thoughts? does anybody have any info about h. influenzae with respect to how it may play into PANDAS or autoimmune?

 

thanks,

Faith

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