When Elana’s parents first brought her to the office, she had a several-year history of loud snoring, mouth breathing and a nasal voice. Her symptoms were year-round but worse during the cold season. Elana also had difficulty swallowing and was a poor eater.
Elana’s Enlarged Tonsils
During her physical exam, Elana appeared to be a thin girl with an open-mouth breathing pattern and hyponasal-sounding speech. A throat exam revealed enlarged tonsils that were touching each other in what is known as a “kissing pattern.” Elana’s parents described her as a restless sleeper. Although she frequently slept for eleven hours, she appeared to be tired. She had previously been diagnosed as “allergic” but found no relief from antihistamines or nasal steroid sprays. At the conclusion of her exam, Elana was diagnosed with adenotonsillar obstruction with related sleep disordered breathing. A tonsillectomy and adenoidectomy were both recommended. Elana’s parents elected to schedule outpatient surgery the following month.
Snoring Stopped the Night of the Surgery
Ten days following her adenotonsillectomy, Elana’s mother brought her to the office for a follow-up visit and reported that she had stopped snoring the night of the surgery. Although she had a painful sore throat for three days following the surgery, she was now eating normally and had returned to school.
A physical exam revealed Elana was breathing through her nose with her mouth closed. Her voice was no longer nasal but was somewhat high-pitched. Her parents were informed that a squeaky voice was common after a tonsillectomy and that her voice would return to normal in a few weeks. A throat exam revealed an open space with white patches, indicated that healing was taking place. Two months later, Elana’s mother called to report that Elana had gained four pounds and seemed “more energetic.”