Case 1: Sounds like trouble

Abstract

A two-year-old boy was brought to his paediatrician for noisy respiration and difficulty breathing during sleep. He had a history of loud snoring and difficulty breathing, which had worsened over the past six to eight months. His sleep was described as restless, and the parents indicated they had observed obstructive apneas in which breathing efforts continued but the snoring stopped for a few seconds. Trials of oral antibiotics and nasal steroids had not resolved the problem. The child was born at 29 weeks’ gestation as the second of triplets. He had had bilateral inguinal herniorrhaphies, but no long-term sequelae of preterm birth had become apparent. Physical examination performed during wakefulness revealed a child in no distress but was remarkable for tonsillar hypertrophy and mouth breathing. There was nasal congestion, and breath sounds were equal and clear. The cardiac examination was normal, with weight just above the 5th percentile for corrected age. A lateral neck radiograph documented adenoidal enlargement. A test was performed that confirmed the child’s diagnosis.