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|  Tonsils and Adenoids- Learn More!
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Contributed by Dr.Mandar V. Bichu |
Medical problems related to tonsils are familiar to all. Throat pain, high grade fever, difficulty in eating – all these symptoms have been experienced by almost every child -and for that matter everybody- some time or other. Most of you must also be aware of operations to remove enlarged tonsils. Abnormally enlarged ‘Adenoids’ – a tonsillar ‘cousin’ in the body- is another closely related and equally, perhaps even more important health issue that is unfamiliar to most parents.
What are Tonsils and Adenoids?
What we call ‘Tonsils’ are ‘Pharyngeal tonsils’ in medical terms or simply – ‘tonsils in throat’. Just opening the mouth wide open we can usually see enlarged tonsils, but sometimes their lower portion is not visible unless tongue is depressed and that may be the largest portion. Enlarged tonsils are not synonymous with infected tonsils.
Adenoids are ‘Nasopharyngeal tonsils’ or tonsils situated behind the nose and above throat. They are covered by soft palate and are not seen easily. To see them a procedure called nasopharyngoscopy is performed by specialists or an X-ray or CT scan of the region is obtained.
Both these structures – tonsils and adenoids- are made up of lymphoid tissue that produces antibodies. Both of them act like guards protecting the respiratory tract. They filter the inhaled air by trapping foreign particles- including bacteria and eliminate them through action of antibodies.
What are effects of hypertrophy of tonsils and adenoids?
Hypertrophy or abnormal enlargement of tonsils and adenoids occurs when the lymphoid tissue making up these structures starts working overtime because of continuous antigenic stimulation. This happens as a result of a chronic infection or an allergy. Once hypertrophied both these structures lose their benefit as protectors and instead become easy targets for infections.
Another problem arising out of their enlargement is obstruction of respiratory tract. Because of their increased bulk, air-flow from nose to lungs is compromised, particularly in the lying down position at night leading to snoring and mouth-breathing. If this compromise is more severe then, sleep apnea develops. In this condition, there is intermittent stoppage of breathing during sleep leading to slowing of heart rate and decreased oxygenation of blood. This in the long run causes overwork for right side of heart, which could enlarge in size and suffer strain.
Enlarged adenoids also obstruct the nasal end of Eustachian tube, which joins nose and middle air and equalizes the middle ear air pressure with atmospheric air pressure. The resultant disturbance in pressure equilibrium can cause middle ear fluid collection and infection.
What happens in tonsillitis?
Acute tonsillitis causes the tonsils to become enlarged, severely congested and red. Sometimes even pus follicles are visible on them. Throat pain is severe and it causes dysphagia (difficulty to eat) and sometimes even drooling of saliva. Fever is high grade. Usually this infection is caused by Group B Streptococci – a specific group of bacteria. With appropriate antibiotics, the infection subsides and size of tonsils returns back to normal. If the tonsils were already hypertrophied prior to infection, then on recovery the size remains enlarged but the congestion subsides. What are indications for tonsillectomy?
- Significant, recurrent tonsillitis.
- ‘Kissing tonsils’ – severely enlarged tonsils touching each other in midline and blocking airway.
- Enlarged tonsils that have become chronic ‘carriers’ of Group B streptococci in spite of medical treatment with antibiotics.
- Tonsillar abscess.
- Haemorrhagic tonsillitis.
- Continuous mouth breathing and snoring in presence of enlarged tonsils.
- Episodes of sleep apnea in presence of enlarged tonsils.
What frequency of recurrent tonsillitis is considered significant?
For practical purposes 5-7 episodes of tonsillitis per year is a good warning signal. The severity of symptoms in each attack, response to antibiotics and affection of daily and school activities due to these attacks – all these factors play role in decision to consider tonsillectomy – surgical removal of tonsils. When should we suspect hypertrophied adenoids?
Repeated upper respiratory tract infections (involving nose, throat, sinuses and ears), persistent thick pus-like nasal discharge, halitosis (bad breath), mouth breathing, snoring and sleep apnea are indicators that enlarged (and sometimes infected) adenoids might be present, especially if these symptoms are occurring in absence of enlarged tonsils. Even if tonsils are enlarged, then in presence of all these symptoms, simultaneous adenoid enlargement should also be ruled out. How do we manage adenoid problems?
Steam inhalation, nasal drops, decongestants, anti-allergic medicines and antibiotics are used with varying degree of success in adenoid problems. The failure of medical treatment and significant symptoms in presence of X-ray proved enlargement of adenoids necessitates adenoidectomy – surgical removal of adenoids. Does removal of adenoids and tonsils hamper immunity or growth?
The answer is ‘No.’ There is no negative effect on immunity or growth of the individual whose tonsils and/or adenoids are removed. Many a time, there is a growth spurt observed after these operations as the recurrent infections interfering with growth and nutrition are eliminated. Is there a minimum age for these operations?
If symptoms are significant and severe, then these operations can be performed at any age according to surgeon’s decision. These operations are fairly common, not too time-consuming and usually without major complications. As after around six years of age, the activity level of lymphatic tissues in body starts slowing down, there is a theoretical possibility that the size of enlarged tonsils and adenoids might reduce to normal so in case of mild to moderate cases, a ‘wait and watch’ policy can be adopted till that age.
What are the preventive measures to avoid tonsil and adenoid problems?
Whenever it becomes clear that tonsils and adenoids are enlarged and causing problems related to infection and obstruction, then it is always better to try and prevent these problems from escalating. Regular steam inhalation, warm water gargles, avoidance of cold drinks and cold items taken directly from the fridge, saline nasal drops/ spray and up-to-date vaccinations (especially Influenza and H.influenza vaccines) are good preventive measures in these problems.
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