Tonsil and Adenoid Enlargement
Tonsils are collections of lymphoid tissue located on each side of the back of the throat. Though the exact function of tonsils is still being studied, it is thought that they play a role in fighting disease and the development of immunity early in life. Tonsils trap bacteria and viruses and help produce antibodies and "killer cells" to fight infection. This action diminishes rapidly with age. Studies have shown that children without their tonsils do not suffer more frequent infections than children with tonsils.
Tonsillitis occurs when the tonsils become infected. This may be caused by bacteria or viruses. Generally under preschool age children develop viral tonsillitis while older children and adults are affected by bacterial infections. Viruses can also lead to bacterial infections secondarily.
Adenoids are collections of lymph tissue very similar to tonsils, found in back of the nose. As they are located near the entrance to the breathing passages, it is thought that their function is to sample or catch inhaled bacteria or viruses. In early childhood this process is important in the formation of the body's immune system to fight infection. This function diminishes with age and is probably of minimal importance after 2 or 3 years of age. Adenoids shrink or atrophy as children enter adolescence or young adulthood. Long-term investigations have shown no loss of ability to fight infection or disease in children who have had their adenoids removed.
Symptoms of enlarged adenoids include mouth breathing, snoring, pauses in breathingduring sleep, and distorted speech.
How are Enlarged Tonsils and Adenoids Treated?
Antibiotics have been highly successful in treating tonsillitis and are the standard of care at this time. Penicillin is still an effective agent which treats most bacteria causing tonsillitis. Viral infections, however, do not respond to antibiotics and are treated by supportive measures alone.
Tonsillectomy is the surgical removal of the tonsils. A tonsillectomy is done when medical and supportive measures are not effective. This may be done both for recurrent infections or for chronically enlarged tonsils. Studies have shown that those with a history of bacterial infections which occur more than five to six times per year, or at least two to three times per year for several years, benefit from tonsillectomy. If your child has had persistent or recurrent sore throats, they should be checked by a physician to determine whether or not the episode was a case of tonsillitis.
Enlarged or swollen tonsils can be normal for many children. If left alone, tonsils may shrink on their own over time, or the child may outgrow them. However, they can become so large that they block a child's breathing. This shows up most prominently at night as a child struggles to breathe as he relaxes with sleep. The child may develop respiratory pauses in breathing called sleep apnea. Sleep apnea is now one of the more common indications for tonsillectomy.
In cases where enlarged adenoids are chronically infected, significantly obstruct nasal breathing, or contribute to ear infections, removal of the adenoids has been found to be beneficial. This may be done in conjunction with a tonsillectomy for severe breathing difficulty during sleep (sleep apnea) or, along with ventilation tube placement in cases of chronic ear infections. Adenoid surgery is always done under general anesthesia in an operating room. This is a brief procedure that usually takes 20 minutes.