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Doctor, explain tonsils and adenoids
Tonsils
and adenoids are masses of tissue that are similar to the lymph nodes or
"glands" found in the neck, groin, and armpits. Tonsils are the two masses
on the back of the throat. Adenoids are high in the throat behind the nose
and the roof of the mouth (soft palate) and are not visible through the
mouth without special instruments.
Tonsils and adenoids are near the entrance to the breathing passages
where they can catch incoming germs, which cause infections. They "sample"
bacteria and viruses and can become infected themselves. Scientists believe
they work as part of the body's immune system by filtering germs that attempt
to invade the body, and that they help to develop antibodies to germs.
This happens primarily during the first few years of life, becoming
less important as we get older. Children who must have their tonsils and
adenoids removed suffer no loss in their resistance.
What affects tonsils and adenoids?
The most common problems affecting the tonsils and adenoids are recurrent
infections (throat or ear) and significant enlargement or obstruction that
causes breathing and swallowing problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of
small pockets within the tonsils that produce foul-smelling, cheese-like
formations can also affect the tonsils and adenoids, making them sore and
swollen. Tumors are rare, but can grow on the tonsils.
When should I see my doctor?
You should see your doctor when you or your child suffer the common symptoms
of infected or enlarged tonsils or adenoids.
The Exam
The primary methods used to check tonsils and adenoids are:
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Medical history
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Physical examination
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Throat cultures/Strep tests
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X-rays
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Blood tests
What should I expect at the exam?
Your physician will ask about problems of the ear, nose, and throat and
examine the head and neck. He or she will use a small mirror or a flexible
lighted instrument to see these areas.
Cultures/strep tests are important in diagnosing certain infections
in the throat, especially "strep" throat.
X-rays are sometimes helpful in determining the size and shape of the
adenoids. Blood tests can determine problems such as mononucleosis.
How are tonsil and adenoid diseases treated?
Bacterial
infections of the tonsils, especially those caused by streptococcus, are
first treated with antibiotics. Sometimes, removal of the tonsils and/or
adenoids may be recommended. The two primary reasons for tonsil and/or
adenoid removal are (1) recurrent infection despite antibiotic therapy
and (2) difficulty breathing due to enlarged tonsils and/or adenoids.
Such obstruction to breathing causes snoring and disturbed sleep that
leads to daytime sleepiness in adults and behavioral problems in children.
Some orthodontists believe chronic mouth breathing from large tonsils and
adenoids causes malformations of the face and improper alignment of the
teeth.
Chronic infection can affect other areas such as the eustachian tube
– the passage between the back of the nose and the inside of the ear. This
can lead to frequent ear infections and potential hearing loss.
Recent studies indicate adenoidectomy may be a beneficial treatment
for some children with chronic earaches accompanied by fluid in the middle
ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason
for removing the tonsils and adenoids.
In some patients, especially those with infectious mononucleosis, severe
enlargement may obstruct the airway. For those patients, treatment with
steroids (e.g., cortisone) is sometimes helpful.
Tonsillitis and its symptoms
Tonsillitis is an infection in one or both tonsils. One sign is swelling
of the tonsils. Other signs or symptoms are:
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Redder than normal tonsils
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A white or yellow coating on the tonsils
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A slight voice change due to swelling
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Sore throat
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Uncomfortable or painful swallowing
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Swollen lymph nodes (glands) in the neck
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Fever
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Bad breath
Enlarged adenoids and their symptoms
If you or your child's adenoids are enlarged, it may be hard to breathe
through the nose.
Other signs of constant enlargement are:
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Breathing through the mouth instead of the nose most of the time
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Nose sounds "blocked" when the person speaks
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Noisy breathing during the day
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Recurrent ear infections
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Snoring at night
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Breathing stops for a few seconds at night during snoring or loud breathing
(sleep apnea)
Surgery
Talk to your child about his/her feelings and provide strong reassurance
and support throughout the process. Encourage the idea that the procedure
will make him/her healthier. Be with your child as much as possible before
and after the surgery. Tell him/her to expect a sore throat after surgery.
Reassure your child that the operation does not remove any important parts
of the body, and that he/she will not look any different afterward. If
your child has a friend who has had this surgery, it may be helpful to
talk about it with that friend.
For at least two weeks before any surgery, the patient should refrain
from taking aspirin or other medications containing aspirin. (WARNING:
Children should never be given aspirin because of the risk of developing
Reye's syndrome).
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If the patient or patient's family has had any problems with anesthesia,
the surgeon should be informed. If the patient is taking any other medications,
has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns
about the transfusion of blood, or has used steroids in the past year,
the surgeon should be informed.
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A blood test and possibly a urine test may be required prior to surgery.
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Generally, after midnight prior to the operation, nothing (chewing gum,
mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth.
Anything in the stomach may be vomited when anesthesia is induced, and
this is dangerous.
When the patient arrives at the hospital or surgery center, the anesthesiologist
or nursing staff may meet with the patient and family to review the patient's
history. The patient will then be taken to the operating room and given
an anesthetic. Intravenous fluids are usually given during and after surgery.
After the operation, the patient will be taken to the recovery area.
Recovery room staff will observe the patient until discharged. Every patient
is special, and recovery times vary for each individual. Many patients
are released after 2–10 hours. Others are kept overnight. Intensive care
may be needed for select cases.
Your ENT specialist will provide you with the details of pre-operative
and postoperative care and answer any questions you may have.
After surgery
There are several postoperative symptoms that may arise. These include
(but are not limited to) swallowing problems, vomiting, fever, throat pain,
and ear pain. Occasionally, bleeding may occur after surgery. If the patient
has any bleeding, your surgeon should be notified immediately.
Any questions or concerns you have should be discussed openly with your
surgeon, who is there to assist you.
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