Video

Voice Over:
Mum Jennifer brought three year old Hemmie to see Dr Dawn because she was concerned about her persistent dribbling.

Jennifer:
On a bad day she’ll have a sort of v-shape on her top, absolutely soaked through. We’ll go through two, three, four tops even.

Voice Over:
Hemmie also suffers from frequent bouts of tonsillitis and terrible snoring. Dr Dawn thought these symptoms could be linked so she’s referred Hemmie to ears, nose and throat surgeon Dr Nimesh Patel for a specialist’s opinion.

Dr Patel:
Do you think you could open your mouth big and wide? Oh, that’s wonderful. Can we just have a little ‘ah’? Wow, big tonsils eh? Pop your tongue out for me, stick out. She’s got a bit of a tongue tie hasn’t she?

Jennifer:
Has she?

Dr Patel:
Yeah. Can you just lick your lips for me? Good girl. And can you lick the other lip, at the top? The tongue’s tied down to the bottom of the mouth, that’s what we call a tongue tie. Ok sweetie, that’s fantastic.

Voice Over:
A tongue tie is a birth defect where the string of tissues that secure the tongue to the mouth are too short. 1 in 20 babies are tongue tied and it can affect breast feeding, however, symptoms are generally minor and require no treatment.

For Hemmie, it seems that her tongue tie and large tonsils could be the cause of the constant dribbling.

Dr Patel:
I think if she is suffering lots of episodes of tonsillitis, on that basis alone, one would talk about performing a tonsillectomy, which is an operation to remove those balls at the back of the throat. That might give her a lot more space in her mouth and throat and one would hope then that she much more able to control the saliva that is there and more importantly that she’s not so sore or the time as that can make her reluctant to swallow. At the same time, it wouldn’t be unreasonable just to remove that tethering of the tongue, it’s a very little procedure, we literally just snip that. That will increase her ability to move her tongue around. The snoring; that’s very common and it tends to be that the tonsils and the gland in the back of the nose, which is a bit like the tonsils, called the adenoid, is large and when you fall asleep you lose a lot of muscle control and the airways can get vibration of the tissues in the throat causing the snoring sound. So what we often do is check the back of the nose to make sure that the adenoid isn’t enlarged, and if the adenoid is enlarged one would remove the adenoid.

Voice over:
Adenoids are small lumps of tissue at the back of the throat that are part of the child’s immune system. They generally disappear during the teenage years. If they become infected they can swell and cause other problems such as hearing, sleeping and breathing issues. Having them removed doesn’t affect the development of their immune system.

Dr Patel:
She’s interestingly enough entering this peak age for sore throats and tonsillitis etcetera anyway. Generally speaking, between four to seven or eight you find that children suffer from these conditions. So yes, she’s entering the bad times, and winter’s coming up as well. But equally it’s not something that I would necessarily rush into, certainly something we could talk about, discuss with your husband and decide where we want to go from there.

Voice over:
After some careful thought, mum Jennifer, decides that Hemmie should brave the procedure to get her mouth sorted out. So they’ve come to Spire Hospital in Southampton.

Jennifer:
We’re feeling great about today, Hemmie’s been really excited actually, she’s surprised me how mature she’s actually been. I keep reminding her that yes it’s going to hurt afterwards, and she’s been saying, well it will be really good in the long run. So she’s shown quite a lot of maturity for a four year old.

Dr Patel:
What we are planning to do today is release the tethering at the front of the tongue, that’s a tongue tie, and perform a tonsillectomy and an adenoidectomy.

So that’s the uvula, the dangly bit in the back of your throat. That’s left tonsil, right tonsil. So, just felt behind and she has a very large adenoid. So I think this is the right thing to do.

Voice Over:
First, Mr Patel removes Hemmie’s adenoids; the small lumps of tissue at the back of the throat that help fight infection.

Dr Patel:
So that’s a fairly substantial adenoid. I’m going to perform a tonsillectomy now. In a little child I tend to do a tonsillectomy using electricity, called diathermy.

Voice Over:
A tonsillectomy is one of the most common major operations performed on children in the UK. Mr Patel uses and electrical probe with a current that destroys the tissue around the tonsils and seal the blood vessels to prevent bleeding. The hope is that with more space in her throat and mouth, Hemmie will find it easier to swallow the saliva.

Dr Patel:
Just do the tongue tie now. I’ll buzz it and then I’ll snip. This tongue tie is pretty impressive, she’s really tethered.

Voice Over:
The procedure to remove a tied tongue is called a frenectomy.

Dr Patel:
There we go, you can see that the tongue can come out now.

Jennifer:
Hemmie is sleeping off the anaesthetic now. Hopefully she’ll wake up in a couple of hours feeling a lot better, she’ll have something to eat and something to drink, and hopefully we’ll be home tomorrow.

Voice over:
Two months later Mum Jennifer and Hemmie return to update Dr Dawn.

Dr Dawn:
It’s lovely to see you again.

Jennifer:
You too.

Dr Dawn:
Now how have you been getting on?

Jennifer:
Well, it was eventful, there was a lot of things that came out that we weren’t expecting but the end result has been excellent.

Dr Dawn:
But the big problem was the dribbling, has that got better?

Jennifer:
It has, the first few weeks after the surgery the dribbling was worse, which was expected really because she was sore in her mouth. but over the last month I’ve only seen a couple of episodes of dribbling. At the moment, she has a cold which would normally mean absolutely sopping wet, so there’s been a few little dribbles but nothing major at all.

Dr Dawn:
So presumably she’s got large adenoids and large tonsils away now so the snoring’s completely stopped now.

Jennifer:
She’s not snoring at all, and she’s sleeping better than she’s ever slept before.

Dr Dawn:
You must be thrilled.

Jennifer:
Absolutely, it’s been amazing for her and it’s just been a huge difference in her confidence.

Dr Dawn:
Oh well that’s great isn’t it. Thank you so much for coming back. Good to see you both. Bye bye Hemmie. Well done you.

Read the video transcript

4 year old Heather-Mae has a problem with excessive dribbling and loud snoring. It is normal to produce a lot of saliva, however most people simply swallow it, Dr Dawn wonders whether Heather-Mae has a problem with swallowing and refers her to ear, nose and throat specialist Dr Nimesh Patel. Heather-Mae has a tongue tie and very large tonsils and is sent for an operation to loosen her tongue so that she can have more control over her swallowing, and to also remove her tonsils. During the operation, Heather-Mae is found to have a substantial adenoid, which is removed as well to open up the back of the throat. Back to see Dr Dawn, mum Jennifer remarks on the excellent results. There is now very little dribbling and no snoring, so a good night sleep to be had by all.

The EB team would like to thank:

Mr Nimesh Patel, Consultant ENT Surgeon
Spire Southampton Hospital

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hello my daughter is 10 and she has just had tonsil stones she went to the school nurse they said nothing but just go to the doctors then when she came home her neck started hearting she finds it very hard to swallow and eat she says it hearts at the back she was playing and found a tonsil stone near her teeth she is very scared but i told her not to worry from Jane





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Hi. My daughter is only 5 yrs old and has a smelly discharge cumin frm her virgina and she is quite smelly dwn der i have to wash her dwn there 2times a day ive taken her to my gp she gave sum cream which hasnt helped. I am very worried plz help .





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I am 70 years old and I cant keep saliver in my mouth and my mouth is very sore. The Doctor said my muscles have weekend so I can't stop dribbling. Are there any exercises I can do? Or have a operation.Alice





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Hi my little kid Hannah dribbles and gets sore eyes and gets dead skin on her nose and round her mouth





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My son is 2yrs 6 months and had his tonsils and adenoids removed 10 days ago. From the age of 8 months he has been a heavy mouth breather, had loud snoring and constant dribbling. After numerous trips to the doctors and an ENT specialist at 12 months who told us he was fine I took matters into my own hands. I recorded him on my mobile sleeping, when he was on his back he had long pauses in his breathing up to 10 seconds. I took this to the doctors and this time they referred him straight away to the ENT. Before the ENT appointment I videoed him on my phone whilst he was asleep on his back which showed him intercosal breathing, his chest caved in and his rib cage raised, in fact I took this to A&E as I was worried and they nurse was really shook up with video! As my appointment was only a few days later they let us come home. The ENT consultant took one look at both videos and checked his tonsils and confirmed they were some of the biggest he has seen. It has took a good 10 days for him to be back on track following the op, the dribbling is a bit better but should improve, no snoring although his voice seems higher? and just seems a lot happier. He was always a really good talker but I'm interested to see how things impove. Tough 10 days but worth it. The doctor confirmed if he had carried on breathing at night like that it would put too much pressure on his heart.





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Ok my 4 year old dribbles and has sores on his chin, mouth breaths and has delayed speach and struggles even to say his own name, gags on food and takes him self off to be sick before finishing his food . About 18 ago he was waking up on the night chocking and being sick which thankfully the night time sickness has stopped . Had visits to a peadiactrics last year who said he as enlarged adenoids and that was prob causing a form of sleep apnia that was causing the nighttime troubles but didn't meet nhs criteria to have them removed and to go bk to the doctors this April if things ate no better. We have done that and seen at ENT today who said that he didn't know what to do as the nhs would not let him remove them as he still didn't meet the criteria. He starts school in September and still falls asleep during the day sometimes is dribbling etc . I don't know where to go from here and advice would be great





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Hi I am going through exactly the same thing with my son, now 12 but he has been like this since he was a toddler. We have just been refered to a Gastroentirologist recently. He was on meds for reflux but that didn't seem to make it go completely.There is a condition called eosonophilic oesophogitis where certain trigger foods cause a delayed reaction in kids sometimes days after.They tend to have issues with eating, trouble swallowing, vomiting, coughing while eating, having to drink between mouthfuls are some of the issues. My son described it as it is like he has a door in his throat and sometimes it is open and the food goes down ok, and sometimes it shuts and the food gets stuck.He then has to induce vomitng to get the food out.He has also been running off to the loo like this since he was 4. He gets a ' look' on his face and stops eating and you can tell what is coming next. The Dts thought it might be a hiatus hernia but 2 bariums showed nothing untoward wrong.The only way to diagnose eosonophilic oesophogitis is with an endoscopy and biopsies which look for more than 50 white blood cells present in the osophogus which normally should not be there.These are caused by consuming food/ foods which the child is allergic to, but because the reaction is a delayed one it is harder to detect.The cells inflame the throat causing scarring and this causes the dysphagia ( trouble swallowing) This is what I am trying to get the Drs to check for woth my son as he is typically atopic ( allergic ) . My son has year round rhinitis, mouth breathes and many allergies including pets, dust, tree and grass pollens, foods and asthma since he was 1. Also in young children failure to thrive or being small for age, sleep difficulties, tummy aches and lots of ear/ throat infections are very common as well as what you mentioned. I hope you get some answers and us too ! It's been a long road !

Hi my 3 yrold daughter ticks all the boxes snoring enlarged tonsills delayed speech gagging with certain food and sometimes she even puts her fingers in her mouth and removes food that's stuck she only sleeps a few hours at night she wakes most nights we've got an appointment for ent but I'm constantly worried about her I hope they can help





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so has my daughter who is 5 it can get really bad you know.

hello, my daughter harriet is 2 and 6 months and still drools excessively, her tops are always wet and im costnatly wiping he mouth, and it literally runs and hands out of her mouth, she eats fine and doesnt snore, and has a dummy, she is fine in herself, but just wonderign now if this could be the issue? Marnie





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My 5 year old has also dribbled all his life. It doesn't bother him as much as it does me. He also refuses to eat certain foods and I now wonder if this is why.





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Hi, Hemmie's Mum here! On the food thing Hemmie had issues with some foods, mainly potato, she couldn't swallow that texture, she was the only child I knew who didn't like chips! A year on from surgery she can now manage to swallow these foods, it has taken time as she had to get used to it and lose the fear of gagging when she ate these foods. A proud moment was a little under a month post surgery when the school dinner lady told me she had eaten a roast potato at the school Christmas dinner. I would recommend a trip to the GP for a look in the mouth to see if there is anything going on.

my son is 5 1/2 ears old,he has always suffered with enlarged tonsils.he still dribbles alot,he used to do this when he had a sore throat but now it is constant and has a sore patch on his chin and now he is at school it goes on his work.he also snores and sleeps with his mouth open.we have been to an ent consultant who said he would grow out of it.we have seen a speech therapist who said there is no problems.he does have problems with gagging on food occasionally and will not eat anything chewy.





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