Tonsillitis
Tonsillitis is an inflammation of the tonsils caused by a viral or bacterial infection. Tonsillectomy was commonly done in preschool and school-age children, since they are most often affected with tonsillitis; fortunately this isn't a case anymore.
In some cases, children's behavior and sleep had improved after a tonsillectomy. A study has shown that half of the children with attention-deficit/hyperactivity disorder (ADHD) did not have the disorder a year after their tonsils were removed as their sleeping habits improved significantly. [1] However, for many parents the choice between a tonsillectomy procedure and alternative treatment still stands strong.
After the children in the study group had their tonsils out, tests showed little difference between them and the children in the comparison group. The results appear to support previous research, suggesting a link between children's sleep-related breathing problems and daytime behavior problems. However, these findings do not prove cause and effect, nor the claim that tonsillectomy is a cure for ADHD.[1]
Tonsils and Adenoids
Tonsils and adenoids are masses of tissue similar to the other lymph nodes in our organism. These lymph nodes or glands are found in the neck, groin, and armpits. Tonsils are the two masses in the back of the throat, while adenoids are high in the throat behind the nose and the roof of the mouth, known as soft palate. Adenoids are not visible through the mouth without special instruments.
Tonsils and adenoids are placed near the entrance to the breathing passages where they can catch incoming germs that cause infections. Since they sample bacteria and viruses, they can become infected themselves. Scientists believe they work as part of the body's immune system by filtering germs that attempt to invade the body. Their role is to develop antibodies to germs that invade a human organism, primarily during the first few years of life, becoming less important as we get older. Therefore, children who must have their tonsils and adenoids removed suffer no loss in their resistance.[2]
What Affects Tonsils and Adenoids?
The most common problems affecting the tonsils and adenoids are recurrent throat or ear infections. Also, problems often arise involving a significant enlargement or obstruction that causes breathing and swallowing problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. While tumors are rare, they can grow on the tonsils as well.
When is a doctor’s exam needed?
You should see your doctor when you (or your child) experience the common symptoms of infected or enlarged tonsils or adenoids, so the doctor could examine them promptly. The primary methods used to check tonsils and adenoids are medical history, physical examination, throat cultures or strep tests, X-rays, and blood tests.
During the exam, your doctor will ask about problems of the ear, nose, and throat, and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas to get you right diagnosis. Cultures or strep tests are important in diagnosing certain infections in the throat, especially streptococcus throat. X-rays are sometimes helpful in determining the size and shape of the adenoids, while blood tests can determine problems such as mononucleosis.
How are tonsil and adenoid diseases treated?
The two primary reasons for tonsil and/or adenoid removal are recurrent infection despite antibiotic therapy and difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep, which leads to daytime sleepiness in adults and behavioral problems in children. [3]
Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth, which is interesting to hear. A study proved a significant increase in IMPA (angle between long axis of lower incisor and mandibular plane angle), interlabial gap, and facial convexity in both groups with breathing problems — mouth breathing children with enlarged adenoids and 60% of nasopharynx obstruction and a group of children without nasal obstruction — when compared to children who were nasal breathers. The study concluded that all children who had a mouth-breathing habit showed a significant increase in lower incisor proclination, lip incompetency, and convex facial profile.[4]
Other studies claim that chronic infections can also affect other areas such as the eustachian tube, which can lead to frequent ear infections and potential hearing loss. Some recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear.[5] In adults, the possibility of cancer or a tumor may be another reason for tonsillectomy or adenoidectomy.
Symptoms of tonsillitis
Tonsillitis is an infection in one or both tonsils, so one of the signs is swelling of the tonsils. Other symptoms are a reddening of the tonsils, white or yellow coating on the tonsils, slight voice change due to swelling, and, most commonly, a sore throat. When you experience uncomfortable or painful swallowing, swollen lymph nodes or glands in the neck, fever, or bad breath, you should pay a visit to the doctor.
Causes of tonsillitis
As previously explained, tonsils are a pair of specialized lymph nodes located on either side of the throat, just behind and above your tongue and they're part of your body's immune system, protecting our organism from microorganisms that can cause infection. Tonsils store white blood cells to engulf bacteria and viruses as they enter through your nose and mouth, so when bacteria and viruses are engulfed by white blood cells, this may result in a low-grade infection in your tonsils. This minor infection then stimulates your body's immune system to form antibodies. However, your tonsils may be overwhelmed by a bacterial or viral infection, and they swell and become inflamed, so the final result is tonsillitis.
A number of respiratory viruses can cause tonsillitis, including the Epstein-Barr virus (EBV), the same virus that causes mononucleosis. Some strains of bacteria can also cause tonsillitis, but the most common culprit is the same bacterium that causes an infection of the throat commonly known as strep throat - Streptococcus pyogenes, or group A beta-hemolytic streptococcus.
Symptoms of enlarged adenoids
If your or your child's adenoids are enlarged, it may be hard to breathe through the nose, but there are more symptoms as well. Common symptoms of constant enlargement are breathing through the mouth instead of the nose. These patients also have nose sounds blocked in speech, noisy breathing during the day, recurrent ear infections, and snoring at night. Breathing could also be stopped for a few seconds at night during snoring, which is known as sleep apnea.
Surgery on tonsils and adenoids
A surgical removal of tonsils and adenoids is called tonsillectomy and adenoidectomy, respectively. The first report of a tonsillectomy was made by the Roman surgeon Celsus in 30 AD, and he described scraping the tonsils and tearing them out, or picking them up with a hook and excising them with a scalpel. Today, the scalpel is still the preferred surgical instrument of many ear, nose, and throat specialists, but there are other procedures available. The choice may be between a complete tonsil removal versus a partial tonsillectomy, but other considerations such as pain and post-operative bleeding should also be taken into account.
When the doctor decides your child should have a tonsillectomy or adenoidectomy, you should talk to your child about his/her feelings. You should also provide strong reassurance and support throughout the process. It is important to encourage the idea that the procedure will make him/her healthier, and you should be with your child as much as possible before and after the surgery.
The patient can expect a sore throat after the surgery, so you should reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. It is important to know that for at least two weeks before any surgery, the patient should refrain from taking Aspirin or other medications containing Aspirin. (Children should never be given Aspirin because of the risk of developing Reye's syndrome.) If the patient or the patient's family has had any problems with anesthesia, the surgeon should be informed before surgery starts. If the patient is taking any other medications, has any therapy or any disease, the surgeon should be informed. Besides this, a blood test and possibly a urine test may be required prior to surgery. It is important to know that nothing should be eaten at least a few hours before the surgery, because anything in the stomach may be vomited when anesthesia is induced, and this could be very dangerous, even life-threatening. Anyhow, detailed instructions before the surgery should be given by your doctor!
Post-op
After the tonsillectomy or adenoidectomy is done, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged, because every patient is special, and recovery times vary from one individual to the next. Many patients are released after 2-10 hours, while others are kept overnight. In some cases, intensive care may be needed. There are several postoperative symptoms that may arise, which include but are not limited to swallowing problems, vomiting, fever, throat pain, and ear pain as well as changes in patients' voice. Occasionally, bleeding may occur after the surgery, so if the patient has any bleeding, the surgeon should be notified immediately. It is also recommended to drink plenty of fluids after the operation, even if it hurts a bit at first.