The tonsils are lymph tissue located on either side of the throat. The adenoid lies on the base of the nose above the palate or roof of the mouth. Tonsils and adenoids are part of the immune system and aid in fighting disease. However, if the tonsils and adenoids become infected or overly enlarged, the removal does not affect the body’s ability to fight infection. In fact, removing such tissue can make a patient healthier. Most reasons for recommending tonsil and adenoid surgery are in two categories of problems affecting the upper respiratory tract: infection that is chronic or recurrent and obstruction to breathing or swallowing.
Tonsillitis most often occurs in children ranging from age 5 to 15; however, our physicians have treated patients of all ages with this condition. The tonsils and especially the adenoid tend to shrink in size and have less function as a child matures to adolescence. Also, children tend to have more upper respiratory tract infections that involve the tonsils and adenoids than adults. This makes them susceptible to developing recurrent or chronic infections of the tonsils and adenoid. A child’s throat cavity is much smaller than ad adult’s. Therefore, there is less room behind a child’s nose and in his throat for the normal functions of breathing and swallowing.
Symptoms & Causes
Tonsillitis may be a viral infection. The most common cause of tonsillitis is streptococcus – the same germ that causes strep throat. Some of the symptoms of tonsillitis include a sore and swollen throat, a fever, and difficulty breathing and swallowing. The tonsils may also have a gray, yellow or white coating on them. Highly contagious, tonsillitis can be spread by coughing, sneezing or touch.
If the tonsils and/or adenoid become overly enlarged, obstruction behind the nose and in the throat may occur. This may make normal breathing, eating, and even talking difficult. The obstruction may be great enough to cause blockage of breathing, especially at night when the muscles of the throat are relaxed. This is known as sleep apnea. A child and even adults with large tonsils and/or adenoid may have actual pauses in breathing during sleep, almost always snore, may perspire, be restless, or change positions frequently. Inability to breathe through the nose with chronic mouth breathing can cause abnormalities in the dental and facial growth, and affect normal swallowing function.
Are you a candidate for a Tonsillectomy and/or Adenoidectomy? The American Academy of Otolaryngology has developed preferred practice patterns for determining who is most likely to benefit from surgery. Here is a listing of some of the indications based upon national standards of care for quality.
- 1. Enlarged tonsils and/or adenoid causing oro-facial growth abnormalities in a narrowed upper airway.
- 2. Infections of the tonsils and/or adenoid with a history of
- 3 infections per year for three consecutive years
- 4-6 infections per year for two consecutive years
- 6-8 infections within a one year period
- 3. Persistent strep carrier state that has not responded to medical therapy.
- 4. Bad breath (halitosis) and/or chronic local tonsillar inflammation due to debris lodging in the crypts of the tonsil, allowing less pain than that of an acute episode.
- 5. Chronic snoring.
Diagnosis & Treatment
During your visit, the doctor will examine the ears, nose and throat. The tonsils are assessed, but the adenoid is more difficult to examine because it is not directly visible. IN adults and older children, a small mirror used in the mouth allows the doctor to visualize the adenoid. An alternative is to obtain a lateral neck x-ray which demonstrates the size of the tonsils and adenoid in relation to the size of the air passageway behind the nose and in the throat. Once your ENT doctor (Otolaryngologist) has performed the exam and tests, treatment recommendations will be made.
Many cases of tonsillitis can be treated with a strong regimen of antibiotics. For recurrent or chronic tonsillitis, a tonsillectomy may be recommended. A tonsillectomy is recommended only after thorough evaluation and consideration of alternative treatments. Tonsillectomy and or adenoidectomy involves the surgical removal of the tonsils and/or adenoid. The procedure does require that a general anesthetic be administered for the length of the procedure, which is typically 30-60 minutes. Both the tonsils and adenoid are removed through the mouth leaving no visible scars. The procedure is most commonly performed on an outpatient basis, unless the child is very young, symptoms are unusually severe, or there are other medical concerns.
Steps to prevent a common cold are helpful in preventing tonsillitis.