Of tonsils and adenoids

To break all of these myths, it is best we know what tonsils and adenoid glands are, their functions and what happens when they get infected. Both glands are lymphoid tissues located around the opening of our pharynx that is the inner part of the nose and mouth. Other lymphoid tissues are also present there, like on the base of the tongue and opening of the ear tube. They are placed there in a ring like manner to protect the upper airway. All the lymphoid tissues in the body have a function to protect different systems of our body from bacterial, viral allergic and even carcinogenic reactions, but sometime these fail and we end up becoming sick.

The tonsils, also known as palatine tonsils, are located on the sides of our oral cavity looking like small eggs. Everybody can see their own tonsils by sticking their tongue out. Tonsils react in different ways when infected according to age. They tend to enlarge at a younger age and usually get smaller with age. The same happens with the adenoid gland, which is also known as nasopharyngeal tonsil, as it is located behind the nasal opening in the upper end. The adenoid gland almost disappears by the age of 12 in normal cases. The tonsils just become smaller but does not disappear, and you can develop tonsillitis all your life.  But in the case of enlarged adenoids after the age of 12-13 years does not suffer from adenoiditis any more but may get other disease in that area.

So, an enlarged adenoid is a disease of childhood only, whereas tonsillitis can happen at any age.

Now let's see what the signs, symptoms and treatment for the conditions are.

First let us discuss enlarged adenoids, as I get too many queries on this. As I mentioned earlier, the adenoids are located behind the opening of the nasal cavity and tend to grow and atrophy as the child grows older. When a child gets a cold due to a bacterial, viral or allergic reaction, the glands reactively enlarge. This causes a partial blockage of the opening of the nose and so the child gets a blocked nose. As the opening of the ear tube is also located here, it may get blocked and the child will complain of an earache too. The mucosa lining the ear, nose and throat are continuous, so one area easily affects the other areas. After getting proper treatment, the child will get better, but in some cases, we see that the condition repeats itself. This may be due to malnutrition, low immunity, unhygienic conditions, etc. The parent will also complain that the child breathes with an open mouth, and snores at night. These children are repeatedly treated for upper respiratory infection, with no result.

After coming to us, we do an X-ray of the adenoids to see if they are enlarged or not. If they are enlarged and blocking half or more of the airway, the child will be given medication for at least 1-2 months. Then an X-ray will be repeated. If the swelling has reduced, the child will be treated on/off and kept under observation. But if the same symptoms are present and the child does not improve, we recommend an adenoid surgery. This is the most stressful part of the treatment for both parents and doctors.

Parents are afraid because the child is very young and want to avoid the surgery, this is very natural. I explain to my patients that this is a disease of childhood and will not happen in older children and so the child needs this treatment.

All safety measures are taken before the surgical procedure. The surgery is done under general anesthesia with a one-night hospital stay; the child recovers within 5-7 days.

What happens if the surgery is avoided? The child will suffer from chronic colds, nasal blockage and ear ache. Due to the nasal blockage, the child becomes a mouth breather, his oral hygiene will diminish and development of mouth, teeth and nose will change. As there is less oxygen going into his chest and due to the extra effort, some children develop pigeon chest. Due to the ear tube blocks, the child may have repeated ear aches and infection, leading to hearing loss, which leads to a poorer performance in school.

Besides of all these the child will lead a difficult time breathing through his mouth all the time, which is very unpleasant. I ask the parents how they will feel if they block their nose with a clip and move about like that all day long? If your child needs adenoid surgery, explore all options.

Don't be afraid and go ahead with it. It is usually seen that the child's health and growth improve drastically after the surgery.

Now let's look at the palatine tonsils. This affects people of all ages. Changes in the weather, common colds or any bacterial infection can lead to tonsillitis. Usually, there is sore throat, fever, difficulty in swallowing and malaise. This, when treated properly, will get better, but in some people, they keep getting infected repeatedly, due to low immunity and other underlying causes. If a person suffers from tonsillitis every 2-3 months, or have mild pain during swallowing all the time with low grade fever, then they have chronic tonsillitis. After being treated by antibiotics repeatedly, if the condition does not improve, surgery is advised. Again this is a safe surgery and the patient recovers well after surgery.

The patients' wellbeing should be the most important factor while treating these cases. All pros and cons should be considered and options looked into prior to treatment.