1. What exactly are tonsils and adenoids?
The tonsils and adenoids are lymphoid tissue at the sides of our throat and at the back of our nose respectively. Functioning like other lymph nodes throughout our body, they trap bacteria and viruses. Everyone has them from birth.
2. When do tonsils and adenoids cause problems?
Usually, tonsils and adenoids can grow to their largest size between the age of 2 to 8 years old. Some people have larger tonsils and adenoids than others, even if they are well. They may also increase in size after repeated infections. In young babies and toddlers, severe gastroesophageal reflux of stomach contents up to the back of the nose may also worsen the adenoid swelling. Having said this, even small tonsils and adenoids can give problems, when they are recurrently infected and become a source or nidus of infection. We can liken this to a tooth or gum disease that flares up with infection repeatedly if not a definitive treatment is sought.
3. What happens when adenoids are very large?
Large adenoids can cause chronic runny nose, bad breath and recurrent sinusitis, easily mistaken for allergy. It may also block the Eustachian tubes, resulting in recurrent middle ear infections and hearing loss with unclear speech or speech delay. Recurrent infections of the adenoid and tonsils give pain and fever, bad breath and nose bleed, and may require repeated medications and antibiotics.
4. What are the complications associated with large tonsils?
Large adenoids and tonsils can block the nose and mouth breathing airway. They can also affect swallowing. Some patients will have also have a very potato-in-the-mouth nasal type of speech. Others prefer to take softer or pureed food and gag easily. Often, they are wrongly labelled as picky eaters.
The airway obstruction can cause snoring and obstructive sleep apnea. Obstructive sleep apnea reduces blood oxygenation during sleep. Obstructive sleep apnea can result in poor concentration, irritability, bed-wetting even at 4-5 years of age, and very frequent coughs and colds. There can be poor weight gain, obesity, hormonal issues and even heart failure.
Long term block of the airway in a growing child can result in poor lower jaw growth with giving a dental overbite and more dental caries. When they become adults, their base of the tongue is more easily prolapsed backwards to block the airway too.
5. What are tonsil stones?
Tonsil stones are actually debris trapped in the tonsillar crypts of recurrently infected tonsils. This debris is made up of infected material or epithelial cells. They can sometimes be pressed out by patients themselves, but they will recur again. They cause bad breath and also recurrent discomfort in the tonsils. If it is persistent, tonsil removal may be needed.
6. How do I know it is not a tonsil cancer?
Tonsils cancers are not common though possible. If the tonsils are not symmetrical in size, if there is persistent ulceration or bleeding, or if they look unusual, the doctor may recommend a surgical removal so that it can be sent for histology examination.
7. What does the ENT doctor look for in the clinic?
When you open your mouth and say “ahh”, with or without pressing down your tongue with a spatula, the tonsils can be examined. Swabs for throat cultures can be taken to identify infections, and blood tests are sometimes done to identify infectious mononucleosis.
The adenoid can be seen only with a noodle-thin flexible pediatric or adult nose scope, or via an X-ray. In cases of significant sleep apnea or when there are other systems problems, a sleep study may be ordered.
8. What are the treatment options for adenoid and tonsil disease?
Conservative management includes treating allergies, reflux and recurrent infections with lifestyle changes and environmental control. Medications like antibiotics and antihistamines may be needed.
Surgical management is considered in certain cases like obstructive sleep apnea, impaired speech or feeding and recurrent infections. Some patients with fits during the infections, with monthly fevers of childhood, if there are associated hearing loss, poor growth, kidney disease or heart failure may require earlier surgery.
9. Will tonsil surgery reduce immunity?
Patients and parents often worry about impairing their immunity with adenoid and tonsil removal. They can be reassured as long-term research has shown adenoid and tonsil surgery does not decrease one’s immunity nor does it increase the risk of infections or cancers.
10. How are tonsil and adenoid surgery done?
Surgeries are usually done as day surgery unless the child is very young, or there are other systems concerns.
Removal of tonsils and adenoids is done under general anaesthesia. The approach is through the mouth, thus not needing any external incisions. Adenoids can be removed via curettage, coblator or suction diathermy. Tonsils can be removed via needlepoint or spade diathermy, coblator; and can be via an intracapsular or extracapsular approach.
11. How is postoperative recovery like?
The patient is discharged 3-5 hours after surgery when they have taken a soft diet. Postoperatively, pain medications and sometimes antibiotics are given. Discomfort is usually felt most between days 3 to 5, but the patient is able to still eat and drink.
