8 Things to Know
- The tonsils and adenoids are lymphoid tissue that trap bacteria and viruses in the sides of our throat and the back of our nose. Usually, they are largest between 2 to 8 years old. They may also increase in size and not go down after repeated infections and untreated nasal allergies. In young babies and toddlers, severe gastroesophageal reflux of stomach contents up to the back of the nose may also aggravate the swelling. A small tonsil can also be recurrently infected.
- Large adenoid seen in a neck xray
- When tonsils and adenoids become very large, they may block the breathing or affect swallowing. Some patients will have nasal speech and prefer to take softer food. Some are mistaken as picky eaters. The obstruction can cause snoring and obstructive sleep apnea (OSA), with reduced blood oxygenation in sleep leading to poor concentration, irritability, bed-wetting, frequent coughs and colds. Long term block in a growing child can result in poor lower jaw growth, increased risk of snoring continuing into adulthood, narrow palate and upper face, and poor dentition. OSA can cause poor weight gain, obesity and even heart failure.
- A large adenoid can cause chronic runny nose, bad breath and recurrent sinusitis. This is often mistaken for allergy. It may cause recurrent middle ear infections and hearing loss and speech delay. Recurrent infections of the adenoid and tonsils give pain and fever, bad breath and nose bleed. Children may then require repeated medications and antibiotics.
- Rarer problems are stone-like debri trapped in the tonsil, causing discomfort, infection and bad breath. The risk of a tonsil cancer is increased if the tonsils are asymmetrically enlarged, and there is a chronic ulcer or bleeding of the tonsil.
- The adenoid can be seen only with a flexible pediatric or adult nose scope, or on an xray. In cases of significant sleep apnea or in a patient with more complex other systems problems, your doctor may order a sleep study. Swabs for throat cultures can be taken to identify infections, and blood tests are sometimes done to identify infectious mononucleosis.
- Chronically infected and enlarged tonsils removed via surgery
- After managing conservatively for allergies, reflux and recurrent infections with medications like antibiotics, antihistamines and lifestyle changes, surgery may be needed for certain cases like: Obstructive sleep apnea, Impaired speech and eating, and recurrent infections, fits during fever, hearing loss and poor growth.
- Patients usually ask if their immunity will be impaired after adenoid and tonsil removal. Long term follow up of patients who have undergone those surgeries do not show any increased risk of immune problems, lymphoma, infections nor cancers.
- Removal of tonsils and adenoids is under general anaesthesia through the mouth, with no external incisions. Adenoids can be removed via curettage, coblator or suction diathermy. Tonsils can be removed via diathermy, or coblator ( intra or extracapsular). Surgeries are usually done as day surgery, unless the child is very young.
