My 3 year old son had a T and A about 4 months ago. He has been having nasal congestion from allergies and his ent decided to scope him. There is a pocket of asymmetric adenoid tissue that was left located inferiorly. He said it was about 25 % of the initial adenoid. Can this cause problems with his voice such as hypernasality from the soft palate not closing correctly around it? And if so, should it be removed now or wait and see if it involutes. My son has not submucosal cleft palate, I just did not know if asymmetric tissue left over or that regrows from small amount left over could cause hypernasality. thanks for your help. If your answer is yes, how would you test for hypernasality?
Adenoidectomy is a procedure to either remove the entire adenoid tissue or a part of it. The indications for its removal are nasal obstruction, poor feeding, ear problems, etc. Adenoidectomy can be done using various methods such as a blind procedure through the nasopharynx, endoscopic removal combined with the former technique, or with the use of a microdebrider.
If the adenoids are removed through a blind approach, there is always a chance of leaving behind a remnant of the adenoid tissue. Secondly, in cases associated with nasal allergy, there can occasionally be a recurrent growth of the adenoids even after complete removal.
The 25% of the remnant tissue that you mention should not cause any problem, particularly nasal obstruction. Yes, there will be hypernasality because of increased space in the post nasal region (behind the nose). This will become normal after a period of time, probably within a year. I do not see the need for a second surgery as removal of the remnant tissue will increase the post nasal space even further leading to increased hypernasality.
I also feel that your son may require medicines such as a steroid nasal spray and an antihistaminic as there is a possibility of recurrence of the adenoid tissue over a period of time because of the nasal allergy.
Hope that this information helps and hope that you will get better soon.
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Could the hypernasality be secondary to the asymmetric tissue inferiorly positioned toward the right side, and if so, wouldn't removal help the hypernasality go away because then the soft palate would be able to close on a flat surface rather than asymmetric one? I read an article that said incomplete removal of adenoids could actually cause vpi without palatal defect. thanks for your help.
Hypernasality or excessive nasal speech resonance is the result of velopharyngeal insufficiency with emission of too much air through the nose.
Velopharyngeal insufficiency can happen because of cleft palate, damage to the posterior tonsillar pillar, resection of the uvula or post adenoidectomy. In most cases, the more the space created in the post nasal area (the space where the adenoids are present) the more is the hypernasality. Hence, in my opinion, if the remnant of the adenoids is also removed, the hypernasality will worsen.
So to specifically answer your query:
Q: Could the hypernasality be secondary to the asymmetric tissue inferiorly positioned toward the right side, and if so, wouldn't removal help the hypernasality go away because then the soft palate would be able to close on a flat surface rather than asymmetric one?
A: No, I do not think the hypernasality is related to the asymmetric tissue, and its removal might increase the hypernasality.
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