What Are Tonsils and Adenoids?
Tonsils are the two round lumps in the back of your throat. Adenoids are high in the throat behind the nose and above the roof of the mouth. The adenoids are not visible through the mouth or nose without special instruments.
Tonsils and adenoids are part of the immune system, similar to lymph nodes. They are the body’s first line of defense and help protect the body from disease. They “sample” bacteria and viruses that enter through the mouth or nose. Unfortunately, sometimes they can get infected or cause problems by being too large.
What problems affect the Tonsils and Adenoids?
The two most common problems affecting the tonsils and adenoids are recurrent infections, and significant enlargement that can cause nasal obstruction and/or breathing, swallowing, and sleep problems.
Abscesses around the tonsils, chronic tonsillitis, and buildup in the small pockets within the tonsils that produce foul-smelling white deposits (tonsil stones) can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.
What is Tonsillitis?
Tonsillitis is an infection of the tonsils often caused by virus or bacteria. Tonsillitis is common in children; most children in the United States experience at least one episode. Up to 70 percent of cases of acute tonsillitis are caused by viruses. Children and young adults infected with the Epstein-Barr virus (EBV), which causes mono, may develop tonsillitis.
Bacteria cause 15 to 30 percent of tonsillitis cases. Group A beta-hemolytic streptococcus (GABHS) is the most common bacteria associated with tonsillitis. Bacterial tonsillitis is often referred to as strep throat. It is believed that GABHS is spread through airborne droplets when someone who is infected coughs or sneezes, or through shared food or drinks. Individuals are most infectious early in the course of the disease.
Symptoms of tonsillitis can include:
- Sore throat
- Bad breath
- Difficulty swallowing
- Painful swallowing
- Tender lymph nodes in the neck
- Mouth breathing, snoring, or sleep apnea
- Tiredness, lethargy, and malaise
- White patches, pus, and/or redness of the tonsils
- A fine red rash over the body suggests that scarlet fever may be complicating a case of tonsillitis. These symptoms usually clear up in three to four days, but may last up to two weeks, even with therapy. Some patients experience recurrent acute tonsillitis in which symptoms return shortly after completing antibiotic therapy.
What problems do Enlarged Tonsils and Adenoids cause?
Enlarged adenoids may make it hard to breathe through the nose, cause mouth breathing, a nasal voice, chronic runny nose, and recurrent ear infections. Enlarged tonsils can cause snoring at night, restless sleep, pauses in breathing for a few seconds while sleeping, and difficulty swallowing.
How are Tonsils and Adenoids evaluated?
Your physician will ask about problems of the ear, nose, and throat, and examine your ears, nose, throat, and neck. They may use a small mirror or a flexible scope to see these adenoids.
To determine whether a patient has a viral or bacterial infection, a doctor will typically perform a throat swab. Rapid strep testing can have false negatives, so it is recommended that doctors obtain a throat culture in patients with negative rapid strep testing but who also show symptoms.
Sometimes and Xray may be recommended to assess the size of the adenoids. Blood tests such a Mono tests may be ordered.
A sleep study (called a polysomnogram) may be recommended to help decide whether sleep apnea is present and if sleep disturbance may be due to enlarged tonsils and adenoids
How is Tonsillitis treated?
Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Viral tonsillitis usually gets better without additional treatment. Hydration and pain control are important, and hospitalization may be required in severe cases, particularly when a patient becomes dehydrated or has an airway obstruction.
What is a Peritonsillar abscess?
A peritonsillar abscess is a severe case of tonsillitis in which an abscess (pocket of pus) develops behind the tonsil. It is usually found in adolescents and adults but can occur occasionally in children. Symptoms of peritonsillar tonsillitis include:
- Severe throat pain
- Difficulty opening the mouth (called trismus)
- Muffled voice quality
- One tonsil may appear larger than the other
Do I need surgery for my tonsils or adenoids?
In certain situations, determined by your ENT specialist, surgery may be recommended to remove the tonsils and/or adenoids. Typically, children who have seven episodes of tonsillitis in one year, or five episodes per year for two consecutive years, or three episodes per year for three consecutive years, are considered candidates for tonsillectomy. If a patient has had multiple peritonsillar abscess, surgery may be needed to drain the abscess around the tonsil.
If the tonsils or adenoids are significant enlarged and cause sleep apnea they may be removed as well.
Frequent infections of the adenoids can affect the ear’s as well. Enlargement of the adenoids can block the eustachian tube. This can lead to frequent ear infections and collection of fluid in the middle ear that may cause temporary hearing loss. Removal of the adenoids may help some children with chronic ear infections accompanied by fluid in the middle ear (called otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids.
There are several postoperative problems that may arise. These include pain, difficulty swallowing, vomiting, fever, dehydration, and ear pain. Rarely, bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately. It is also important to drink plenty of liquids after surgery to avoid dehydration. Dehydration is the most common problem after surgery.
Any questions or concerns you have should be discussed openly with your surgeon.