Cases in Tonsil Disease: From the Routine to the Serious

Gordon H. Sun, MD, MS


May 23, 2017

Snoring the Night Away

James, a 12-year-old boy, was brought by his mother to his pediatrician with a 2-year history of loud snoring and mouth breathing. He denied nasal congestion, rhinorrhea, dysphagia, or dyspnea. He did note that he sometimes dozed off in class but became defensive when he was asked whether he was having other problems in school. His mother stated that at a recent parent-teacher conference, several instructors had commented on the patient's hyperactivity and occasionally disruptive behavior. However, he has not missed school due to illness or behavioral problems. He is otherwise healthy, with no known medical problems. He is not taking medications and has no known drug allergies.

Physical examination demonstrated a short, thin adolescent male in no distress. His vital signs were all within normal limits. He exhibited no stridor or dysphonia. The patient had no notable ocular findings other than faintly discolored lower eyelids. Otoscopic exam was normal. Nasal passages were grossly patent. Oral cavity and oropharyngeal exam demonstrated a modified Mallampati class II view and symmetrically enlarged, cryptic tonsils. Dentition appeared normal. There was no macroglossia. The neck was supple and nontender with no visible or palpable masses. Lungs were clear to auscultation bilaterally.


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