Pediatric Tonsils And Adenoids
Tonsils and adenoids are really just terms for a type of tissue called lymphoid tissue that surrounds the throat. There are three sets of tonsils: the adenoids, the left and right palatine tonsils (often referred to as “tonsils”), and the lingual tonsils, which make up much of the surface of the very back of the tongue. Only the palatine tonsils and adenoid tissue are routinely removed during a tonsillectomy or tonsillectomy and adenoidectomy. The lingual tonsil is more commonly removed in adults due to airway obstruction or to rule out tumors.
What do tonsils and adenoids do?
The short answer is that the tonsils and adenoids, as well as all the lymphoid tissue in the human body, help the immune system to make antibodies. However, removal of the tonsils and adenoids will not impair the body’s immune system. In actuality, by removing a potential source of chronic infection in selected patients, tonsillectomy and adenoidectomy can actually significantly improve the general health of the patient over time. An excellent rule of thumb when making this decision is that the tonsils and adenoids are only removed when there is a clear clinical benefit to the patient. This is a judgment that is best made after discussion with your otolaryngologist. If the tonsils and adenoids are more likely to cause harm, than the benefit they may serve, they should be considered for removal.
The adenoids are located the very back of the nose, above the soft palate. Therefore, they cannot be seen well through the mouth without the use of a mirror, which is often difficult in children. For this reason, physicians will often order a lateral x-ray to try to determine the size of the adenoid pad. While adenoids are referred to in the pleural, the reality is that they are a single pad of lymphoid tissue at the back of the nose. When adenoid tissue becomes inflamed or enlarged, symptoms include:
- Sore throat
- Nasal obstruction
- Hearing loss due to fluid back up into the middle ears.
The adenoids sit at the same level as the openings of the eustachian tubes into the throat. That’s why it’s common for children who require myringotomy and tube placement in the ear to undergo an adenoidectomy, especially when a second set of tubes is placed. Removal of adenoid tissue is usually very straightforward with minimal bleeding and extremely low risk in children. The most common benefits are:
- Improved breathing through the nose
- Decreased nasal congestion and snoring
- Long-term improvement in eustachian tube function and reduced ear infections
Tonsils are very similar to adenoid tissue, but they are located on the sides of the throat. A careful examination of the throat through the mouth generally reveals some lumpy tissue with small pockets called “crypts” on the side of the throat. These are the palatine tonsils. Typically, tonsils are removed due to:
- Chronic or recurring infection (often called strep throat if the bacteria infecting the tonsils is, in fact, strep)
- Enlargement of the tonsils which can cause difficulty breathing while sleeping, snoring, witnessed episodes of apnea, and even choking on solid foods.
Removal of tonsils is significantly more uncomfortable than removal of adenoids due to the increased sensation at the back of the throat. For this reason, techniques such as coblation tonsillectomy have been developed to decrease the severity of the discomfort and improve the healing process and speed of recovery while decreasing the frequency of the most common complications of surgery. These complications include primarily the risk of bleeding during the healing process (generally around 7-10 days after surgery) and dehydration (most common in children under age 3). With the use of coblation, recovery from tonsillectomy with or without adenoidectomy in young children is generally 7-10 days of moderate to severe sore throat. This is a marked improvement from the 2-3 weeks of severe sore throat and the third degree burn of the throat that most patients experienced with more traditional electrocautery excision of tonsils and adenoids.
Is A Tonsillectomy And Adenoidectomy, Or Adenoidectomy Appropriate For Your Child?
You should factor in not only the risks of the procedure(s), but also the risks of not undergoing the procedure. This is where a conversation with your otolaryngologist can be critical. Each child has their own set of circumstances and medical concerns that should be fully explored with your otolaryngologist prior to agreeing to schedule your child for tonsillectomy and adenoidectomy. Our surgeons at CornerStone Ear, Nose & Throat will discuss the reasonable expectations of surgery, our reasons for recommending the surgery, and our concerns if the surgery is not performed. If you are continuing to struggle with this difficult decision, please do not hesitate to contact our office to schedule a consultation with one of our surgeons for your child to be evaluated.