Last week, I had the privilege of speaking at a local orthodontic office, where I had the opportunity to educate the staff about myofunctional therapy and its benefits. During my presentation, the orthodontist was surprised to learn that I don't immediately refer all my younger patients to an ENT for tonsil and adenoid concerns. This comment sparked further discussion, and led me to the conclusion that this is a topic worth reviewing.
Your palatine tonsils and adenoids are glandular tissues that play a key role in supporting the immune system. While you can usually see your palatine tonsils by sticking out your tongue, your adenoids are not visible—they are located high in the nasal cavity. As children grow, their adenoids increase in size, reaching their peak around the age of six. After that, they gradually decrease in size and eventually merge with the sinus cavity wall.(Nosetti et al., 2023)
Research suggests that mouth breathing may play a significant role in the continued growth of tonsils and adenoids. Adenoidal tonsillar hypertrophy can be seen as a cycle of cause and effect. When the tonsils and/or adenoids become inflamed or infected, they enlarge, leading to upper airway obstruction. This obstruction can trigger mouth breathing, which in turn contributes to the development of obstructive sleep apnea (Ma et al.,2024)
As a myofunctional therapist, I focus on improving proper function, which includes encouraging the habit of keeping the mouth closed. By doing so, you can reduce the exposure of your tonsils and adenoids to irritants, lowering the risk of inflammation and infection. This conservative approach to tonsil and adenoid removal is not be suitable for everyone, as many factors need to be considered.
One factor is anatomical concerns, such as the size of the tonsils, and their impact on the child’s ability to breathe. These tissues can grow quickly and cause significant breathing obstructions. Symptoms can also provide valuable insight into potential anatomical issues, such as chronic strep throat, frequent coughing, or severe snoring. While addressing function and encouraging mouth closure can help reduce the size of these tissues, if anatomical issues are preventing proper function, they must be addressed to ensure optimal health and breathing.
Another factor is the age of the patient. As mentioned earlier, tonsils and adenoids should naturally shrink over time when irritants are minimized and the mouth is kept closed. If we can address mouth breathing before the age of 7, there is a chance to monitor and observe positive changes.
Prevention is always key, but every patient is unique and presents with different anatomical considerations. In an ideal world, a myofunctional therapist could reduce the need for tonsil and adenoid removal, but this approach isn't feasible for everyone. It is crucial to have a comprehensive evaluation with a medical professional to fully understand the available options and determine the best course of action.
Early intervention can make a significant difference in addressing both functional and anatomical concerns. Don’t wait—take the first step today by scheduling a consultation with a healthcare provider or myofunctional therapist to discuss your or your child's options. Begin the journey toward better breathing and overall health today.
Ma Y, Xie L, Wu W. The effects of adenoid hypertrophy and oral breathing on maxillofacial development: a review of the literature. J Clin Pediatr Dent. 2024 Jan;48(1):1-6. doi: 10.22514/jocpd.2024.001. Epub 2024 Jan 3. PMID: 38239150. https://pubmed.ncbi.nlm.nih.gov/38239150/
Nosetti, L., Zaffanello, M., De Bernardi di Valserra, F., Simoncini, D., Beretta, G., Guacci, P., Piacentini, G., & Agosti, M. (2023). Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. Children (Basel, Switzerland), 10(8), 1426. https://doi.org/10.3390/children10081426
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