Adenoid and Tonsil Disease in Children

The tonsils are lymph tissue on each side of the throat, held inside a capsule. Bacteria settle in the small pits they contain, so the tonsils become a source of long-standing infection, and acute tonsillitis returns whenever the body’s resistance drops. Repeated infection also makes the lymph tissue grow, and large tonsils cause snoring, blocked breathing in sleep and pauses in breathing.

The adenoid sits behind the nose, in the roof of the nasopharynx. It has no capsule and no pits. When it grows and closes the openings from the nose into the back of the throat, it causes a blocked nose, snoring and pauses in breathing during sleep.

What they are for

The tonsils and the adenoid sit close to the entrance of the airway, placed strategically to catch infectious agents from outside. Harmful agents such as bacteria and viruses make these tissues inflame themselves. In this way the tonsils and the adenoid help produce antibodies, which are the weapon of the body against germs, and so they take part in its defence system.

How they are assessed

The methods are questioning, examination, cultures for bacteria, X-ray, endoscopy and blood tests.

Your doctor asks about the patient’s problems with the ear, the nose and the throat, and then examines. For the nose and the throat the doctor may use a small lighted flexible tube, which is a flexible endoscope. The examination also shows whether anything is swollen in the neck.

When the adenoid is removed

An enlarged adenoid that blocks the nasopharynx is removed surgically when

• breathing through the nose is disturbed, and the child breathes through the mouth, snores or has pauses in breathing during sleep
• the nose, the nasopharynx and the sinuses become infected repeatedly, or the infection becomes long-standing
• middle ear infection and fluid in the middle ear occur together with reduced hearing

There is no age limit for adenoid surgery. An adenoid large enough to harm the child’s health, to cause pauses in breathing, and to make fluid collect in the ear, is removed without delay.

When the tonsils are removed

• Tonsillitis returns often: more than 3 to 5 times a year in children, more than twice a year in adults
• A malignant tumour of the tonsil is suspected
• The tonsils are so large that they make breathing and swallowing difficult
• Long-standing tonsillitis causes bad breath and swollen lymph nodes
• Rheumatic heart disease is present

Tonsil disease is known as a childhood condition, though adults get it too. Apart from cases where surgery cannot wait, the lower limits are set at 3 years of age and 10 kg of weight. Adults with frequent throat infections and signs of a blocked airway should have the operation as well. There is no upper age limit, though the condition becomes less common in later life and anaesthesia there needs more care.

The technique

The operation is done under general anaesthesia in children.

After the patient is asleep, the surgeon opens the mouth with a special instrument and removes the enlarged adenoid from above the soft palate and the uvula, using a specially angled instrument. The tonsils are freed from the surrounding muscle and separated at their attachments. Bleeding is then controlled and the operation ends.

The tonsils can be removed with classic instruments such as scissors and a scalpel, and also with newer technologies: bipolar electrocautery, radiofrequency, thermal welding and coblation plasma. Each of these has its own advantages and disadvantages.

After the operation

While waking from the anaesthetic the child can be both restless and sleepy. Three to four hours after the operation, once the anaesthetic has worn off, the child can be checked and sent home. Patients are usually kept in hospital overnight, so that they can be watched and treated at once if anything happens.

Take the prescribed medicines regularly.

Sore throat and difficulty swallowing continue for about 7 to 10 days, and medicines ease them. A slight change in the voice and speaking through the nose, a slight change in taste, a feeling of pressure in the jaw joint and mild bad breath can occur. The patient is also given a diet list for 10 to 14 days.