Tonsils and Adenoids Children

What are Tonsils and Adenoids?

The tonsils and adenoids are normal glands in the throat that form part of a ring of defenses in the throat to help fight infection. There are 2 tonsils, 1 on each sides of the throat behind the tongue and the adenoid is a single gland deep behind the nose. These glands are composed of lymphoid tissue, which help produce antibodies to fight infections. They are however not the only defense mechanism available and the body's immunity will not be affected if they were removed. These tissues enlarge commonly in childhood in response to infections and allergy. In adulthood they usually decrease in size.

Figure 1: A model showing a section through the head

What are the common problems with these glands?

1. Chronic or recurrent infections.

Infections of the tonsils and adenoids are commonly due to bacteria. Several types of bacteria can reside in the tonsils and adenoids to cause recurrent infections. Symptoms include fever, sorethroat and pain on swallowing. The adenoids may also cause ascending recurrent middle ear infections or effusions as they sit next to the Eustachian tube opening behind the nose. This will require treatment with a course of antibiotics. Other types of medications like lozenges, gargles and analgesics are also usually prescribed. If the tonsils and adenoids persistently get infected, they can be removed. This surgery is called tonsillectomy and adenoidectomy and is the most common childhood ENT surgery done. Recurrent infections occurring 3 times or more a year or abscess formation unresponsive to medical treatment are indications for removal.

2. Airway Obstruction.

Enlarged adenoids and tonsils can narrow the air passage. This can result in snoring or a condition called Obstructive Sleep Apnea (OSA), which causes choking during sleep. OSA has far reaching consequences because if it is left untreated it can lead to poor sleep quality, daytime sleepiness, cardiovascular diseases and other medical problems. In a child the symptoms may also include failure to thrive, poor concentration, underdevelopment of the facial skeleton, poor dentition and bed wetting.

What are other reasons for removal of tonsils or adenoids?

The most common cause of tooth decay in children is from well-meaning caregivers giving sweetened drinks in feeding bottles. Sugar is changed by bacteria in the mouth into an acid, which eats away at the teeth, causing tooth decay. Another common cause is having the milk bottle in the mouth whilst baby is asleep – the pool of milk left in the mouth is a good-enough source of sugar to cause rampant decay.

1. Suspicion of tumour growth.

An enlargement of one tonsil or swelling on the tonsil may be due to a cancerous growth. When this happens, it needs to be biopsied or the whole tonsil removed for histology to exclude this.

2. Halitosis (bad breath)

Tonsil stones which are white concretions in the tonsils, may cause bad breath and occasionally recurrent infections. Tonsillectomy may be helpful if the cause of bad breath can be attributed to tonsil stones.

The child should be introduced to the dentist's clinic at the age of 2 or 2 ? years. This will familiarise them with the different sounds and instruments, and is usually a good habit to form whilst young. Parents should be careful not to ‘transfer' their fears and phobia to the child – dental visits nowadays are very pleasant, comfortable affairs.

How is the operation done?

Tonsillectomy and adenoidectomy is performed under general anesthesia. It can be done as a day surgery procedure in older children but young children and those with medical problems may require admission overnight for further observation. The tonsils are removed through the open mouth using instruments that cut tissues to remove the tonsils off the side of the throat while stopping any bleeding. The most common instrument used is a diathermy that cuts by burning tissue. The adenoids can be removed through a combined approach through the nose and mouth using a special curved blade. There are no incisions needed on the skin of the neck or the face for this surgery.

What are the latest advances in tonsillectomy and adenoidectomy?

The latest techniques use specialized instruments like Coblation radiofrequency or microdebrider blades. These techniques improve surgical results and minimize side effects compared to traditional methods as they are more gentle on the surrounding tissues and allow faster healing with less pain.

What can be expected after surgery?

A soft diet or oral fluids can usually be started on the day of surgery. Spicy, hot or sour food should be avoided. There will be some throat pain after tonsillectomy which usually lasts about 2 weeks. The pain from an adenoidectomy is much less. Pain killers, gargles and lozenges are usually prescribed to relieve pain. Antibiotics are given to reduce the chance of infection. If infection occurs the risk of bleeding from the wound increases. This risk is about 3%. Other possible risks and side effects include numbness at the back of the tongue and a change in voice quality (only when large tonsils or adenoids are removed). Recovery time is usually 2 to 3 weeks.

Can the adenoids or tonsils grow back?

The tonsils will not grow back after they are removed. The adenoids may grow back if the cause of the enlargement is still present. This is because the adenoids are not covered by a capsule unlike the tonsils. Therefore removal of adenoid tissue is usually not as complete as the removal of tonsils. Nasal allergy which is commonly associated with adenoid and tonsillar enlargement needs to be comtrolled on the long term to prevent adenoid re-growth.