Tonsil and Adenoid Disease

The Tonsils and Adenoids

Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils are the two masses in the back of the throat. Adenoids are high in the throat behind the nose and above the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.

Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They "sample" bacteria and viruses and 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, and that they help to develop antibodies to germs.

This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

What affects the tonsils and adenoids?

The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and 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. Tumors are rare in children.

When should I see my doctor?

You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.

Tonsillitis, Tonsil Enlargement, and Associated Symptoms

Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are:

Redder than normal tonsils
A white or yellow coating on the tonsils
A slight voice change due to swelling
Sore throat
Uncomfortable or painful swallowing
Swollen lymph nodes (glands) in the neck
Fever
Bad breath

Enlarged adenoids and their symptoms

If you or your child's adenoids are enlarged, it may be hard to breathe through the nose.

Other signs of constant enlargement are:

Breathing through the mouth instead of the nose most of the time
Nose sounds "blocked" when the person speaks
Noisy breathing during the day
Recurrent ear infectionsSnoring at night
Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)
Decreased sense of smell or taste

How are tonsil and adenoid diseases treated?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids.

Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.

Chronic infection can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss.

Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, and rarely in children, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In children, a clue may be asymmetrical enlargement of the tonsils.

In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful.

About Tonsillectomy and Adenoidectomy

Source: the American Academy of Otolaryngology - Head and Neck Surgery, Inc. 2001.