Why Is My Child Still Snoring After Having Their Tonsils and Adenoids Removed?

Approximately 500,000 children in the US each year get their tonsils and adenoids removed for recurrent strep throats as well as snoring problems and obstructive sleep apnea.

Obstructive sleep apnea, a condition affecting 3-4% of children, is commonly found in those who snore and have physical airway collapse within the back of the nose and throat. It is associated with restless sleep and frequent awakenings at night and can present as tiredness during the day and attention and focus problems at school. The diagnosis of obstructive sleep apnea is made following an overnight sleep study within a hospital setting for children. Children with this condition are often recommended to get their enlarged tonsils and adenoids removed.

Tonsil and adenoid removal often improves restless sleep, difficulty breathing through the nose, and obstructive sleep apnea in the majority of patients. The effectiveness of tonsil and adenoid surgery for children depends on different factors. Tonsil and adenoid surgery is most successful in resolving obstructive sleep apnea in:

• Younger children, (age ≤ 7-8 years old)
• Children of normal weight, based on standard measurements for their age
• Children without any syndromes or other complex medical problems
• Children with large tonsils and adenoids

Tonsil and adenoid surgery has been found to be effective in curing mild to moderate obstructive sleep apnea in children with the above characteristics and sometimes in children with severe obstructive sleep apnea.

After tonsil and adenoid removal, snoring often improves or resolves in most children within 2-4 weeks. However, obstructive sleep apnea can occasionally still be present but silent, even in children whose snoring has resolved after surgery. Depending on the severity of a child’s obstructive sleep apnea or if a child still snores after surgery, a sleep study about 6-8 weeks after tonsil and adenoid surgery may still be recommended to check for any remaining sleep apnea.

Children who continue to snore after tonsil and adenoid removal should return to see their Ear, Nose, Throat (ENT) Physician for additional evaluation. Similarly, snoring can recur for many reasons over time, even after tonsil and adenoid removal. These include:

• Gradual change or increase in a child’s weight
• Seasonal allergies or chronic runny/stuffy nose that is untreated with medicines
• Chronic or recurrent nasal congestion/stuffiness from colds during the winter months at school or daycare
• Chronic smoke exposure at home
• Regrowth of tonsil or adenoid tissue or growth of any other obstructive soft tissue in the throat
• Lack of exercise and physical activity

Children who continue to snore after tonsil and adenoid removal can be evaluated by an ENT physician to talk about the timing of symptoms since the procedure. The examination will look for:

• Runny or stuffy nose with swollen or inflamed nasal lining
• Enlarged soft tissues within the nose
• Recurrent enlarged tonsil or adenoid tissue that regrows
• Enlargement of any additional tonsillar tissue on the back of the tongue
• Airway appearance and dimensions of the nasal and throat airway

Based on the history and exam findings, your ENT may recommend:

• medical therapy for nasal stuffiness or congestion, or even allergy testing
• a nutrition and/or weight loss referral if a child’s weight is thought to be significantly contributing to their snoring
• a repeat sleep study to check for persistent obstructive sleep apnea
• additional sleep surgery if a new site(s) of airway obstruction is discovered, if that surgery can be safely used to improve your child’s snoring and airway
• referral to a medical sleep doctor for non-surgical therapy options if your child has persistent obstructive sleep apnea that is not ideally treated with additional surgery