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81
This year each child referred to us for operation has had a
thorough examination of nose, throat and nasopharynx, and the
general health, and home conditions as well have all been gone
into.
Infection of the upper respiratory tract in children is
extremely common, and the burden of this invasion by microbes is
borne by the lymphoid or adenoid tissue, which becomes swollen
temporarily. The swelling is a sign that the lymphoid tissue is
needed and that it is dealing with the infection. When the infection
is removed, the swelling of the adenoids will abate.
The condition usually occurs in children living under bad
hygienic conditions, generally associated with overcrowding. An
operation for removal of tonsils and adenoids in this type of child
is obviously not going to do any good, because the enlargement
is nature's attempt to deal with massive infection. It is wiser to
attempt to deal with the environmental conditions of the child.
Broadly speaking, operative interference with the lymphoid
tissue of the nose and throat will do good in cases where:—
(1) It is causing difficulty in breathing through the nose,
(2) It is definitely causing deafness,
(3) The tonsils are diseased.
Difficulty in breathing through the nose, or mouth breathing,
is one of the commonest symptoms for which children are brought
along to the throat clinic.
In a large number of these children there is no sign of nasal
Obstruction and the condition is found to be associated with a
general lack of tone. Here again operation is useless and it is our
custom to suggest measures for improving the general condition
together with regular breathing exercises.
Difficulty in breathing through the nose is very commonly
associated with swelling of the mucous membrane lining the nasal
fossae with puddling of muco pus due to defective nasal hygiene,
in older school children. It is surprising how many of these
children have never learnt to blow the nose properly, and what a
hemendous improvement results when regular and effective nose
blowing, followed by breathing exercises, is established as a daily
routine. Children who are put on this treatment are asked to return
at the end of a month for further examination.