Tonsils and Adenoid Disease
What are Tonsils and Adenoids?
The tonsils and adenoids are lymphatic tissue similar to the lymph nodes found in the neck and other parts of the body. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat.
The tonsils are the two masses of tissue on either side of the back of the throat. Small depressions are often found on the surface of the tonsils, called crypts. These crypts may appear deep and contain stones called tonsilliths (tonsilliths may create a foreign object sensation in the back of the throat and may also result in bad breath). The adenoids are located high in the throat behind the nose and soft palate (the roof of the mouth). Unlike tonsils, the adenoids are not easily visible through the mouth.
The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in long-term immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss in their future immunity and their ability to fight infections.
Why are Tonsils and Adenoids removed by surgery? (Tonsillectomy and Adenoidectomy)
Tonsillectomy and adenoidectomy are common surgical procedures. The reasons for surgery include:
- Recurrent tonsil and/or adenoid infections despite treatment with medications
- Tonsil and/or adenoid enlargement causing upper airway obstruction (sleep apnea or difficulty breathing), nasal obstruction, or difficulty swallowing.
- Recurrent peritonsillar abscess (a collection of pus in the area around the tonsils). Sometimes a peritonsillar abscess in a child will require a tonsillectomy as children may not be able tolerate needle aspiration of the abscess.
- Persistent foul taste or bad breath due to chronic tonsillitis and/or tonsilliths (stones in the depressions of the tonsils) not responsive to medical therapy.
- Large Tonsils could be a concern for possible malignancy (cancer).
- Tonsil and/or adenoid enlargement in children can causes dental misalignment or adverse affects on facial growth due to chronic mouth breathing.
- Chronic otitis media (ear infections) – For children requiring ear tubes for chronic otitis media, adenoidectomy has been shown to reduce the likelihood of recurrent ear infections once the tubes come out.
- Chronic rhinitis(nose infection)/chronic sinusitis (sinus infections) – Studies have shown that adenoidectomy can reduce the number of sinus/nasal infections in children who have persistent nasal disease despite appropriate medical treatment.
Surgical Treatment and Care
Tonsillectomy and adenoidectomy are commonly performed surgeries, generally performed in an outpatient setting. Surgery is performed under a general anesthetic. A typical procedure may take approximately 30 minutes.
The tonsils and adenoids are both accessed through the mouth. A variety of instruments can be used to remove the tonsils and adenoids. Popular methods include electrocautery, laser, and radiofrequency ablation (RFA, or Coblation). This technology is continually evolving, with the goal of reducing tissue injury and improving postoperative healing. The adenoids are visualized through the mouth by retracting the soft palate forward and upward. Blood vessels are cauterized with the surgical instruments and sutures are rarely used. Most patients will recover for about 1½ hours in outpatient recovery before being discharged home, although this process varies from individual to individual.
There is always throat pain following tonsillectomy. This begins to improve significantly after the first postoperative week. Ear pain is also common due to a nerve in the back of the throat that sends a branch to the ears resulting in "referred pain" to the ears.
There is a 1-5% risk of bleeding following tonsillectomy. This bleeding most commonly occurs between the 5th and 10th postoperative day when scabs in the tonsillar bed come off. Occasionally, this bleeding may require treatment in the operating room. Mild bleeding may rarely occur following adenoidectomy, which almost always resolves on its own.
Any surgery involving the mouth carries the risk of injury to the lips, teeth and gums.
The adenoids help the soft palate close the nose off from the throat during speech and swallowing. In rare cases, patients may experience the regurgitation of liquids coming out through the nose during swallowing as well as a hypernasal speech quality. These problems are usually temporary and resolve as swelling resolves. In rare cases, further surgical management may be necessary to correct these problems.
There is significant pressure on the tongue during tonsil/adenoid surgery. In rare cases, this pressure results in tongue numbness. The numbness almost always resolves spontaneously in a few days to weeks.
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