Tonsils And Adenoids
Although tonsils and adenoids are all part of the immune system, they can become infected (tonsillitis) or enlarged (tonsil and adenoid hypertrophy). These infections can cause:
- Sore throat
- Nasal obstruction
- Difficulty breathing and swallowing
Infected or enlarged tonsils and adenoids can also cause sleep disturbance due to airway blockage, snoring, or sleep apnea. Removal of the tonsils and/or adenoids, if necessary, does not create problems with immunity or the body’s ability to fight infection.
At some point, almost every child in the United States will have at least one episode of tonsillitis. This is the most common form of bacterial pharyngitis (throat infection), especially in school-aged children. This bothersome and often painful condition occurs when the tonsils, which are lymphoid (antibody-producing) organs on the side of the throat, become inflamed due to a viral or bacterial infection.
Acute tonsillitis – Symptoms include fever, sore throat, bad breath, and difficult or painful swallowing. In some cases, tonsillitis can cause mouth breathing, snoring, sleep apnea, a “scarlatina” rash (scarlet fever), and a feeling of lethargy. These symptoms can last from three days to two weeks. Acute tonsillitis typically responds well to oral antibiotics and hydration. An exception would be tonsillitis associated with the Epstein-Barr virus (mononucleosis), which can last many weeks and be quite severe. These viral infections do not typically respond well to antibiotics. In severe cases, hospitalization may be required due to dehydration or the need for atonsillectomy.
Recurrent tonsillitis – The diagnosis for patients with multiple episodes of acute tonsillitis in a single year. An ENT doctor should be consulted if a patient experiences five or more episodes of acute tonsillitis in a 12-month period.
Chronic tonsillitis – Symptoms of chronic tonsillitis usually include all symptoms of acute tonsillitis, including frequent sore throats, bad breath, and persistently tender cervical nodes. Chronic tonsillitis is often associated with a related condition called tonsillar cryptitis, with or without cryptic debris (persistent infection of the pockets of the tonsils, with or without a buildup of organic material, sometimes inaccurately called “tonsil stones” or tonsilloliths). Tonsil stones and chronic tonsillitis are among the most common reasons adults seek to have their tonsils removed.
Peritonsillar abscess – Severe throat pain, fever, drooling, foul breath, difficulty opening the mouth (trismus) and muffled voice are typical symptoms of a patient with a peritonsillar abscess. This condition is extremely uncomfortable and usually develops rapidly over a few days. It often occurs in patients with no prior history of recurrent tonsillitis. Patients with a peritonsillar abscess invariably have pain much worse on one side of the throat than the other, and the tonsil is pushed toward the uvula with a firm area of fullness lateral to it. Diagnosing a peritonsillar abscess can be difficult, so if this condition is suspected, the patient should immediately seek the care of an ENT or emergency department physician.
Enlarged Tonsils And Adenoids
Enlarged tonsils and adenoids usually make it difficult to breathe through the nose and cause breathing disturbances during sleep. Other symptoms of this condition can include:
- Breathing through the mouth most of the time
- Sounding “nasally” when speaking, as if you have a cold
- Chronic runny nose
- Noisy breathing during the day
- Recurring ear infections
Chronic infection or inflammation of the adenoids can lead to frequent ear infections. A buildup of fluid in the middle ear can even cause temporary hearing loss. Chronic adenoiditis is generally a diagnosis made by inference in children requiring a second set of tubes in the ears.
Treatment Of Tonsil And Adenoid Problems
Antibiotics are the standard initial treatment for most tonsil and adenoid problems. If the problem is chronic or recurrent, surgery to remove the tonsils (tonsillectomy) and adenoids (adenoidectomy) are often recommended. In the case of a peritonsillar abscess, drainage via incision or needle aspiration is almost always necessary. In severe cases, a tonsillectomy may be recommended.
Historically, electrical cautery or a cold steel knife have been the most common methods for the removal of tonsils and adenoids. The process of electrical cautery burns the tissue at very high temperatures, effectively creating a burn in the throat of the patient and subsequently thick eschar (scabs) that must heal.
The coblation procedure for removing tonsils and adenoids works at about 70 degrees Celsius and is used under a constant cool saline (saltwater) irrigation. With Coblation, the tissue is cut and cooled simultaneously, which typically results in a much lower risk of bleeding and significantly less pain for the patient. Coblation allows patients to tolerate fluids and solid food more quickly, and recover in less time, with fewer complications and less discomfort than the more traditional methods.