Can hypertrophic adenoids cause morning cough in a child?

Hypertrophic Adenoids as a Cause of Morning Cough in Children

Yes, hypertrophic adenoids can cause morning cough in children due to postnasal drainage and airway obstruction during sleep. 1

Pathophysiology of Adenoid-Related Morning Cough

Adenoid hypertrophy contributes to morning cough through several mechanisms:

1. Postnasal drainage: Enlarged adenoids can cause accumulation of secretions in the nasopharynx that drain posteriorly during sleep, triggering cough upon waking 1

2. Upper airway obstruction: Adenoidal hypertrophy can play a significant role in causing sinus disease in children, leading to increased secretions 1

3. Relationship with allergic conditions: Adenoid hypertrophy often coexists with allergic rhinitis, creating overlapping symptoms including cough 1

Clinical Presentation

Children with adenoid-related morning cough typically present with:

• Morning cough that improves throughout the day
• Mouth breathing, especially during sleep
• Nasal speech quality
• Snoring
• Possible sleep disturbances 1, 2

Diagnostic Approach

When evaluating a child with morning cough potentially related to adenoid hypertrophy:

1. Nasal endoscopy: The gold standard for evaluating adenoid size and percentage of airway obstruction 1

2. Lateral nasopharyngeal X-ray: Can be used to assess the adenoid/choana (A/C) ratio 3

3. Sleep assessment: Important to evaluate for sleep-disordered breathing, especially in children with significant adenoid hypertrophy 1

Treatment Options

Treatment should be directed at the underlying adenoid hypertrophy:

Medical Management:

• Intranasal corticosteroids: Fluticasone propionate nasal drops (400 μg/day) have shown significant improvement in adenoid-related symptoms including night cough after 8 weeks of treatment 3
• Antihistamines: May be beneficial if allergic components are present 4

Surgical Management:

• Adenoidectomy: Consider when medical management fails and symptoms significantly impact quality of life 1
• Important caveat: In children with allergic rhinitis, adenoidectomy alone may not provide satisfactory benefits for respiratory symptoms, as the underlying allergic inflammation may persist 4

Special Considerations

• Age factors: Adenoid tissue naturally grows until age 6 and then gradually atrophies, typically disappearing by age 16 5

• Comorbidities: Children with craniofacial abnormalities, Down syndrome, or neuromuscular disorders may have more severe symptoms and require more aggressive management 1

• Environmental factors: Exposure to environmental tobacco smoke and other pollutants can worsen adenoid hypertrophy and associated symptoms 1, 5

When to Consider Alternative Diagnoses

Morning cough in children can have multiple etiologies beyond adenoid hypertrophy:

• Asthma: Though often considered, most children with isolated cough do not have asthma 1
• Gastroesophageal reflux: Can cause cough but is infrequently the sole cause of isolated cough in children 1
• Postinfectious cough: Following respiratory infections 1

Follow-up Recommendations

Children treated for adenoid-related morning cough should be monitored for:

• Resolution of cough symptoms
• Improvement in sleep quality
• Need for additional interventions if symptoms persist despite appropriate treatment

Early intervention is important as chronic adenoid hypertrophy can affect craniofacial development and respiratory function in children 2.